In
June 1981, the first cases of what is now known as AIDS were reported in
the United States. In the 1980's, there were rapid increases in the number
of AIDS cases and deaths of people with AIDS. Cases peaked with the 1993
expansion of the case definition and then declined. The most dramatic
declines in cases and deaths have occurred since 1996, with the widespread
use of antiretroviral therapy. Persons with AIDS are surviving longer and
are contributing to steady increases in the number of people living with
AIDS.
Historically,
many states have only reported AIDS cases, but more states are
implementing HIV cases reporting in response to the changing epidemic and
the need for information on persons with HIV infection as a result of AIDS
testing. This
identification of HIV infections and AIDS cases enables state and local
areas to estimate the size of the population living with HIV/AIDS and to
predict the services and resources needed. It is anticipated that all
states will be reporting cases to the CDC within the next two years.
Through
June 2001 there were 455,750 persons reported to the CDC as living with
HIV infection or AIDS. These reports only include persons diagnosed with
HIV infection in States with integrated HIV/AIDS surveillance systems and
persons diagnosed with AIDS in all States and Territories. In 1999, CDC
estimated that 800,000 to 900,000 persons in the U.S were living with HIV
or AIDS. The difference in these values is due to several factors,
including the fact that:
- Reporting of persons diagnosed with HIV has not yet
been implemented in all States and Territories
- Anonymous tests are excluded from case reports
- Many people are unaware of their HIV status
During
the 1990s, the epidemic shifted steadily toward a growing proportion of
AIDS cases in blacks and Hispanics and in women, and toward a decreasing
proportion in MSM, although this group remains the largest single exposure
group. Blacks and Hispanics, among whom AIDS rates have been markedly
higher than among whites, have been disproportionately affected since the
early years of the epidemic. In absolute numbers, blacks have outnumbered
whites in new AIDS diagnoses and deaths since 1996, and in the number of
people living with AIDS since 1998.
The
proportion of women with AIDS has increased steadily, and the proportion
infected heterosexually has also increased, surpassing (in 1994) the
proportion infected through injection drug use. Midway through the 1990s,
effective therapies became available, and as early as 1996 their effect on
decreases in AIDS incidence and on deaths were detected through
surveillance at the population level. As deaths have decreased, AIDS
prevalence has steadily increased, a trend that will continue as long as
the number of people with a new AIDS diagnosis exceeds the number of
people dying each year.
From
July 2000 to June 2001 194 pediatric AIDS cases were reported. Of these,
90% were acquired parentally. The number of estimated pediatric AIDS cases
diagnosed each year has declined since 1992. The decline in pediatric AIDS
incidence is associated with the implementation of Public Health Service
guidelines. The guidelines include universal counseling and voluntary HIV
testing of pregnant women and the use of zidovudine by HIV-infected
pregnant women and their newborn infants. Pediatric HIV surveillance will
play an important role, helping to gauge the extent to which intensified
prevention efforts contribute to reduce transmission.
From
July 2000 to June 2001 22,011 newly diagnosed cases of HIV infection (not
AIDS) were reported from 36 areas. Of the HIV reports received in 2000,
68% were among adult men, 31% were among adult women, and 1 % among
children under 13 years of age. Recent HIV reports represent a mixture of
people with recent infection and others who may have been infected in the
past but only now being diagnosed.
Sources:
U.S. Department of Health and Human Services
Public Health Service
Centers for Disease Control and Prevention
National Center for HIV, STD and TB Prevention
UNAIDS Joint United Nations
Program on HIV/AIDS,
"AIDS Epidemic Update
December 2001 " and " Report on the global HIV/AIDS epidemic
December 2001".
