New HIV data show impact on women, minorities

Numbers take on importance as AIDS cases decline

While the incidence of AIDS has dropped significantly in the past year because of improved treatment, the number of people diagnosed with HIV appears to have remained relatively stable, raising concerns that the ability to track the epidemic is being eroded. A new report, however, shows that HIV name reporting in the 28 states that are using it is complete and accurate.

The 1997 HIV case data, released by the Centers for Disease Control and Prevention in the Morbidity and Mortality Weekly Report, examines trends in HIV diagnoses reported through name-based integrated HIV and AIDS reporting systems in the 25 states that have had HIV reporting since 1994.1 The data show that between January 1994 and June 1997, a total of 72,905 adults and adolescents were diagnosed with HIV or AIDS in those states. Of that number, 72% were initially diagnosed with HIV, compared to 28% with AIDS.

In contrast to the decline in the AIDS incidence rate, the data also show that the number of new HIV cases has remained stable in these states. However, a growing percentage of HIV case diagnoses were reported in women, African-Americans, and Hispanics, the CDC reports.

The CDC notes these additional trends in the data from 1995 to 1996:

· HIV diagnoses declined slightly among men - from 10,762 to 10,393, or 3% - but increased among women, from 4,126 to 4,235, or 3%.

· HIV diagnoses declined slightly among African-Americans - from 8,569 to 8,300, or 3% - and among whites, from 5,093 to 4,966. However, they increased 10% among Hispanics, from 971 to 1,070, the CDC reports, adding that cases among Hispanics still remain relatively few in number.

When looking at new cases among people aged 13 to 24 years old, the analysis shows that 63% were African-American, 44% were female, and 5% were Hispanic. More than one-quarter (26%) of the cases were from heterosexual transmission, 31% from men having sex with men, and 6% from injection drug use.

The CDC notes that HIV diagnoses in this age group have remained constant throughout the four years, underscoring the importance of prevention efforts targeted at this population.

Many patients miss out on early therapy

By evaluating both HIV and AIDS reporting in these states, the CDC was able to show that about 25% of all new diagnoses were reported only after the person had developed AIDS. The finding indicates that many patients are not being diagnosed early in the course of infection and are missing out on the positive effects of early therapy.

The CDC analysis shows that HIV reporting in these states was nearly 90% complete (only 12% of HIV diagnoses were not first reported through the HIV reporting system) and that less than 2% of reports were duplicates. The findings are comparable with AIDS surveillance systems, the CDC adds.

One of the weaknesses of the data is the fact that the 25 states represent only about one-third of the HIV burden in the United States. Despite the need for increased HIV surveillance, many states are struggling with whether to implement HIV reporting, either with names or unique identifiers. In Georgia, for example, state health officials have an HIV reporting system ready to put into action, but a recent public debate showed there still is strong opposition to name reporting.

Reference

1. Centers for Disease Control and Prevention. Diagnosis and reporting of HIV and AIDS in states with integrated HIV and AIDS surveillance - United States, January 1994-June 1997. MMWR 1998; 47:309-314.