|
Surveillance of AIDS
AIDS cases are reported to CDC by all 50 states, the District of Columbia, and
U.S. dependencies, possessions, and associated nations, by use of a uniform
surveillance case definition and case report form. In this report, cases were
reported according to the 2000 surveillance case definition [1].
Surveillance of HIV Infection (not AIDS)
This report includes case reports from 30 areas whose laws or regulations
required confidential reporting by name of adults and adolescents with confirmed
HIV infection (not AIDS), in addition to the reporting of persons with AIDS.
Over time, HIV infection may progress to AIDS and the person is again reported
to surveillance. Persons with HIV infection (not AIDS) who are later reported as
having AIDS are deleted from the HIV infection (not AIDS) tables and added to
the AIDS tables.
Tabulation of Data
The supplemental report is organized in three sections (1) diagnoses of
HIV/AIDS or AIDS, (2) persons living with HIV (not AIDS) or AIDS, and (3)
reports of cases of HIV/AIDS or AIDS. Sections 1 and 2 present point estimates
of cases that have been adjusted for reporting delays and for the redistribution
of cases initially reported without a mode of HIV exposure. CDC routinely
adjusts data for the presentation of trends in the epidemic. Data to estimating
the number of persons with diagnoses of HIV/AIDS or AIDS and the number of
persons living with HIV (not AIDS) or AIDS have been statistically adjusted to
correct for delays in the reporting of cases and deaths. For the assessment of
trends in diagnoses or prevalence, it is preferable to use adjusted data,
presented by year of diagnosis instead of year of report, to eliminate artifacts
of reporting in the surveillance system. Therefore, readers are encouraged to
use tables that present trends by year of diagnosis or year-end prevalence.
Section 3 presents reports of cases of HIV/AIDS and cases of AIDS reported
through 2002, by race/ethnicity. These data have not been adjusted for delays in
reporting and are presented by year of report to CDC. Tables of cases by year of
report represent the most up-to-date information reported to CDC; however, cases
by year of report do not reflect incident cases, the most recent diagnoses or
trends. Not all cases of HIV/AIDS or AIDS reported in 2002 were newly diagnosed;
rather, the reported cases include cases diagnosed during earlier years. The
racial/ethnic distribution of reported cases of HIV/AIDS reflects the
racial/ethnic distribution of the 30 areas and should not be considered
representative of all persons with HIV/AIDS in the United States.
The data in this report are provisional. This report includes information
received by CDC through June 30, 2003. Data for the U.S. dependencies,
possessions, and associated nations are included in the totals.
Selection of Areas with Mature HIV Reporting Systems for Analysis of Diagnoses
of HIV/AIDS and of HIV Infection (not AIDS)
The inclusion of areas with mature confidential name-based HIV reporting for
the tabulation of HIV/AIDS and HIV infection (not AIDS) data was based on the
date HIV reporting was implemented in the area and the ability to calculate 4
years of reporting delays so that trends would be reliable. For this report, 30
areas with laws or regulations requiring confidential name-based HIV infection
reporting since 1998 were eligible for inclusion. The 30 areas are Alabama,
Arizona, Arkansas, Colorado, Florida, Idaho, Indiana, Iowa, Louisiana, Michigan,
Minnesota, Mississippi, Missouri, Nebraska, New Jersey, New Mexico, Nevada,
North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota,
Tennessee, Utah, Virginia, West Virginia, Wisconsin, Wyoming, and the U.S.
Virgin Islands.
Race and Ethnicity
In the Federal Register for October 30, 1997 [2], the Office of
Management and Budget announced the Revisions to the Standards for the
Classifications of Maintaining, Collecting, and Presenting Federal Data on Race
and Ethnicity, also known as Statistical Policy Directive 15. At a minimum, data
on the following race categories should be collected: American Indian or Alaska
Native; Asian; black or African American; Native Hawaiian or Other Pacific
Islander; and white. Additionally, systems must be able to retain information
when multiple racial categories are reported. Regardless of race, two ethnicity
categories should be collected: Hispanic and not Hispanic.
Because data for this report were compiled from reports to CDC through June
2003, race and ethnicity information may have been collected under two systems.
The race and ethnicity categories in the system used through December 2002 are
maintained in this report because most data were collected under that system.
Persons who reported multiple racial categories or whose race was unknown are
included in the cumulative totals. Also, persons reported as non-Hispanic may
include persons whose ethnicity was not reported.
Age Groups
Age groups of persons living with HIV infection (not AIDS) or with AIDS are
based on the person’s age as of December 31, 2002. All other age groups are
based on the person’s age at the first documented positive result of an
HIV-antibody test result for persons with a diagnosis of HIV infection (not
AIDS), and age at AIDS diagnosis for persons with a diagnosis of AIDS. The age
category for adults and adolescents comprises persons ≥13 years; the age
category for children comprises children <13 years of age.
Geographic Designations
Regions of residence included in the report are defined as follows.
Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New
York, Pennsylvania, Rhode Island, and Vermont
Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri,
Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin
South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia,
Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South
Carolina, Tennessee, Texas, Virginia, and West Virginia
West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada,
New Mexico, Oregon, Utah, Washington, and Wyoming
The U.S. dependencies, possessions, and associated independent nations
comprise Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, the
Republic of Palau, the Republic of the Marshall Islands, the Commonwealth of the
Northern Mariana Islands, and the Federated States of Micronesia.
Tables of persons living with HIV infection (not AIDS) or AIDS
Estimates of persons living with HIV infection (not AIDS) or with AIDS (Tables
8 through 10) were derived by subtracting the estimated cumulative number of
deaths of persons with HIV infection (not AIDS) or AIDS from the estimated
cumulative number of persons diagnosed with HIV infection (not AIDS) or AIDS.
Estimated diagnoses and deaths have been adjusted for reporting delays, but not
for incomplete reporting. Annual estimates are given for the most recent year
for which reliable estimates are available [3].
Exposure Categories
For surveillance purposes, cases of HIV infection (not AIDS) and cases of AIDS
are counted only once in a hierarchy of exposure categories. Persons with more
than one reported mode of exposure to HIV are classified in the exposure
category listed first in the hierarchy. The exception is men who report sexual
contact with other men and injection drug use; this group makes up a separate
exposure category.
Persons whose exposure category is classified as male-to-male sexual contact
include men who report sexual contact with other men (i.e., homosexual contact)
and men who report sexual contact with both men and women (i.e., bisexual
contact). Persons whose exposure category is classified as heterosexual contact
are persons who report specific heterosexual contact with a person with, or at
increased risk for, HIV infection (e.g., an injection drug user).
Adults and adolescents born in, or who had sex with someone born in, a country
where heterosexual transmission was believed to be the predominant mode of HIV
transmission (formerly classified as Pattern II countries by the World Health
Organization) are no longer classified as having heterosexually acquired AIDS
unless they meet the criteria stated in the preceding paragraph. Similar to
other cases among persons who were reported without behavioral or transfusion
risks for HIV infection, these cases are now classified (in the absence of other
risk information that would classify them in another exposure category) as no
risk reported or identified [4].
Cases in persons with no reported exposure to HIV through any of the routes
listed in the hierarchy of exposure categories are classified as “no risk
reported or identified.” NIR (no identified risk) cases include cases that are
being followed up by local health department officials; cases in persons whose
exposure history is incomplete because they died, declined to be interviewed, or
were lost to follow-up; and cases in persons who were interviewed or for whom
other follow-up information was available and no mode of exposure was
identified.
References
- CDC. Guidelines for national human immunodeficiency virus case
surveillance, including monitoring for human immunodeficiency virus
infection and acquired immunodeficiency syndrome. MMWR
1999;48(No. RR-13):29-31. Available at:
http://www.cdc.gov/mmwr/
preview/mmwrhtml/rr4813a1.htm Accessed
March 1, 2004.
- Office of Management and Budget. Revisions to the Standards for the
Classification of Federal Data on Race and Ethnicity. Federal
Register 1997;62:58781-58790. Available at:
http://www.whitehouse.gov/omb/fedreg/ombdir15.html
Accessed
March 1, 2004.
- Karon JM, Devine OJ, Moregan WM. Predicting AIDS incidence by
extrapolating recent trends. In: Castillo-Chavez C, ed. Mathematical
and Statistical Approaches to AIDS Epidemiology (Lecture Notes in
Biomathematics). Berlin: Springer-Verlag;
1989:58-88
- CDC. Current trends: heterosexually acquired AIDS—United States,
1993. MMWR 1994; 43:155-160. Available at:
http://www.cdc.gov/mmwr/preview/mmwrhtml/
00025380.htm
Accessed March 1, 2004.
|
