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Trends in HIV/AIDS Diagnoses

Trends in HIV/AIDS Diagnoses --- 33 States, 2001--2004

In 2003, more than 1 million persons in the United States were estimated to be living with human immunodeficiency virus (HIV) infection.

During 2001--2004, an estimated 157,252 persons had HIV/AIDS diagnosed in the 33 states reporting to CDC. Of these, 112,106 (71%) were male and 45,146 (29%) were female. Blacks accounted for 80,187 (51%) of persons with HIV/AIDS diagnosed (68% among females and 44% among males); 45,479 (29%) were white; 28,673 (18%) were Hispanic; 1,340 (1%) were Asian/Pacific Islander; and 766 (<1%) were American Indian/Alaska Native. The route of HIV infection for the majority (61%) of males was through male-to-male sexual contact; 17% occurred through high-risk heterosexual contact, and 16% occurred through injection-drug use. The majority (76%) of females with HIV/AIDS diagnosed were exposed through high-risk heterosexual contact; 21% were exposed through injection-drug use. The proportional distribution of HIV/AIDS diagnosed among males and females by transmission category varied by race/ethnicity. Although the main transmission category for males was male-to-male sexual contact, among blacks, one fourth of HIV infections occurred through high-risk heterosexual contact.

The total number of HIV/AIDS diagnoses decreased from 41,207 (CI = 40,961--41,453) in 2001 to 38,685 (CI = 37,924--39,445) in 2004; the average annual decrease was not statistically significant. A nonsignificant average annual increase occurred in the number of HIV/AIDS diagnoses among men who have sex with men (MSM), from 16,609 (CI = 16,260--16,957) cases in 2001 to 18,196 (CI = 17,609--18,782) cases in 2004. From 2003 to 2004, the number of HIV/AIDS diagnoses among MSM increased 8%; this increase was statistically significant (p<0.05). A significant average annual decrease of 9.1% occurred among injection-drug users (IDUs).

The overall annual rate of HIV/AIDS diagnoses per 100,000 population did not change significantly, from 22.8 per 100,000 in 2001 to 20.7 per 100,000 in 2004. However, a significant 5.0% average annual decrease in rates among blacks was observed, from 88.7 per 100,000 in 2001 to 76.3 per 100,000 in 2004. Among Asian/Pacific Islanders, a significant 9.0% average annual increase occurred, from 5.6 per 100,000 in 2001 to 7.2 per 100,000 in 2004. The highest annual rates were among blacks, followed by Hispanics, American Indian/Alaska Natives, whites, and Asian/Pacific Islanders.

Reported by: L Espinoza, DDS, HI Hall, PhD, ML Campsmith, DDS, LM Lee, PhD, Div of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, CDC.

Editorial Note:

An important event in HIV/AIDS reporting is the inclusion of data from New York in the analysis of national HIV data in 2005. Although New York implemented name-based HIV/AIDS reporting in June 2000, this is the first time these data have been included in analyses of national surveillance data. As a result, an additional 36,111 HIV/AIDS diagnoses were added to the surveillance system during 2001--2004; this substantial addition should be considered when making comparisons with previous reports. An evaluation of the impact of adding a state with high morbidity to national surveillance data is under way.

In April 2003, CDC launched the Advancing HIV Prevention (AHP) initiative to increase emphasis on HIV testing and providing prevention services for persons living with HIV. An estimated 25% of persons living with HIV do not know they are infected. AHP is aimed at getting persons with undiagnosed HIV tested and into care and prevention services. Because AHP emphasizes increased testing, an increase in HIV/AIDS diagnoses might be expected; however, a decrease in diagnoses among IDUs and blacks was observed. Subsequent analyses will examine whether these changes were a result of a differential change in testing patterns among various populations, decreased incidence of HIV infections, or the effect of additional data added to the national surveillance system. In addition, CDC is working with states to develop a new system for monitoring HIV incidence (i.e., new HIV infections) more directly through the use of a testing method that distinguishes recent from longstanding infections.