Persons tested for HIV--United States, 2006

Early diagnosis of human immunodeficiency virus (HIV) infection enables infected persons to obtain medical care that can improve the quality and length of their lives and adopt behaviors to prevent further HIV transmission. However, at the end of 2003, approximately one fourth of the estimated 1 million persons living with HIV remained unaware of their infection. Among all persons with HIV infection diagnosed in 2005, 38% received a diagnosis of acquired immunodeficiency syndrome (AIDS) within 1 year of their first positive HIV test. To reduce the number of persons with undiagnosed HIV infection, CDC issued recommendations in September 2006 to implement HIV screening as part of routine medical care for all persons aged 13-64 years. To establish a baseline for evaluating the effects of these recommendations and other strategies to increase HIV testing, CDC analyzed data from the National Health Interview Survey (NHIS). This report summarizes the results of that analysis, which indicated that testing rates remained nearly flat during 2001-2006. In 2006, 40.4% (an estimated 71.5 million persons) of U.S. adults aged 18-64 years reported ever being tested for HIV infection. In addition, 10.4% (an estimated 17.8 million persons) reported being tested in the preceding 12 months, and 23% of persons who acknowledged having HIV risk factors reported being tested in the preceding 12 months. These findings indicate that many persons in the United States have never been tested for HIV infection. Health-care providers should routinely screen all patients aged 13-64 years for HIV in accordance with CDC recommendations. New strategies are warranted to increase HIV testing, particularly among persons who are disproportionately affected by HIV infection.     

Rapid HIV test distribution--United States, 2003-2005

At the end of 2003, an estimated 1 million persons in the United States were living with human immunodeficiency virus (HIV) infection, including those with acquired immunodeficiency syndrome (AIDS); approximately one fourth of these persons had not had their infections diagnosed. In 2003, CDC implemented a new initiative, Advancing HIV Prevention (AHP), focused, in part, on reducing the prevalence of undiagnosed HIV infection by expanding HIV testing and taking advantage of rapid HIV tests that enable persons to receive results within 30 minutes, instead of the 2 weeks typically associated with conventional tests. In support of AHP strategies, during September 2003-December 2005, CDC purchased and distributed rapid HIV tests to expand testing and assess the feasibility of using rapid tests in new environments (e.g., outreach settings or emergency departments). This report summarizes the results of this rapid HIV-test distribution program (RTDP), in which CDC distributed tests to 230 organizations in the United States and identified 4,650 (1.2%) HIV infections among 372,960 rapid tests administered. The results suggest that RTDP helped scale up rapid HIV-testing programs in the United States and enabled diagnosis of HIV in persons who might not have had their infections diagnosed otherwise.     

Rapid HIV testing in outreach and other community settings--United States, 2004-2006

In 2003, an estimated 1 million persons in the United States were living with human immunodeficiency virus (HIV) infection. Approximately 25% were unaware of their infection; however, that percentage might have been greater among persons at high risk for HIV infection, including racial/ethnic minority populations. To increase the proportion of persons aware of their HIV serostatus, CDC launched the Advancing HIV Prevention initiative in 2003. One strategy of the initiative is to implement new models for diagnosing HIV infections outside medical settings. During 2004-2006, CDC funded a demonstration project to provide rapid HIV testing and referral to medical care, targeted to racial/ethnic minority populations and others at high risk in outreach and other community settings. This report summarizes the results of that project, which indicated that, of 23,900 clients who received a rapid HIV test, 39% were non-Hispanic blacks, 31% were Hispanics, 17% reported male-male sex, and 6% were injection-drug users. A total of 267 (1%) persons had confirmed HIV-positive test results; of these, 195 (74%) were either non-Hispanic blacks or Hispanics. The project results demonstrate that rapid HIV testing in outreach and other community settings can identify large numbers of persons in racial/ethnic minority populations and others at high risk who are unaware they are infected with HIV.     

Results of the Expanded HIV Testing Initiative--25 jurisdictions, United States, 2007-2010

Approximately 20% of the estimated 1.2 million persons living with human immunodeficiency virus (HIV) infection in the United States at the end of 2008 were not aware of their infection. Testing, diagnosis, medical care, treatment with highly active antiretroviral therapy (HAART), and access to prevention services soon after HIV infection can prevent morbidity and mortality and reduce a person's risk for transmitting HIV. In 2006, CDC recommended screening patients aged 13--64 years for HIV infection in health-care settings that have a prevalence of undiagnosed HIV infection of ≥0.1%. In October 2007, CDC initiated the Expanded HIV Testing Initiative (ETI), through which it funded 25 health departments to facilitate HIV screening and increase diagnoses of HIV infections and linkage to care among populations disproportionately affected by HIV, especially non-Hispanic blacks. This report describes the results of that effort. Annual progress reports designed to provide data specific to ETI indicated that 2,786,739 HIV tests were conducted, of which 29,503 (1.1%) were positive and 18,432 (0.7%) resulted in new HIV diagnoses. Blacks accounted for 1,411,780 (60%) of tests and 11,638 (70%) of new HIV diagnoses. Clinical settings comprised at least 75% of the 1,331 testing venues and accounted for 90% of all tests and 81% of all new HIV diagnoses. Based on follow-up data available for 16,885 persons with new HIV diagnoses, 12,711 (75.3%) were linked successfully to HIV primary care. Through expanded HIV testing activities, substantial numbers of persons previously unaware of their HIV infection were identified and linked to care. Health departments should continue to partner with clinical-care providers to provide routine HIV screening, especially in populations disproportionately affected by HIV.     

Racial/ethnic disparities in diagnoses of HIV/AIDS--33 states, 2001-2005

During 2001-2004, blacks accounted for 51% of newly diagnosed human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) infections in the United States. This report updates HIV/AIDS diagnoses during 2001-2005 among black adults and adolescents and other racial/ethnic populations reported to CDC through June 2006 by 33 states that had used confidential, name-based reporting of HIV and AIDS cases since at least 2001. Of the estimated 184,991 adult and adolescent HIV infections diagnosed during 2001-2005, more (51%) occurred among blacks than among all other racial/ethnic populations combined. Most (62%) new HIV/AIDS diagnoses were among persons aged 25-44 years; in this age group, blacks accounted for 48% of new HIV/AIDS diagnoses. New interventions and mobilization of the broader community are needed to reduce the disproportionate impact of HIV/AIDS on blacks in the United States.     

HIV prevalence estimates--United States, 2006

Accurate and timely data on the number of persons in the United States living with human immunodeficiency virus (HIV) infection (HIV prevalence) are needed to guide planning for disease prevention, program evaluation, and resource allocation. However, overall HIV prevalence cannot be measured directly because a proportion of persons infected with HIV have neither been diagnosed nor reported to local surveillance programs. In addition, national HIV prevalence data are incomplete because local reporting systems for confidential, name-based HIV reporting have been fully implemented only since April 2008. With the advent of highly active antiretroviral therapies that delay the progression of HIV to acquired immunodeficiency syndrome (AIDS), and of AIDS to death, and changes in the AIDS case definition to include an immunologic diagnosis, earlier back-calculation methods from the 1990s for estimating HIV prevalence based on the number of reported AIDS cases are no longer reliable. With 80% of states reporting name-based HIV diagnoses as of January 2006, an extended back-calculation method now can be used to estimate HIV prevalence more accurately. Based on this method, CDC now estimates that 1.1 million adults and adolescents (prevalence rate: 447.8 per 100,000 population) were living with diagnosed or undiagnosed HIV infection in the United States at the end of 2006. The majority of those living with HIV were nonwhite (65.4%), and nearly half (48.1%) were men who have sex with men (MSM). The HIV prevalence rates for blacks (1,715.1 per 100,000) and Hispanics (585.3 per 100,000) were, respectively, 7.6 and 2.6 times the rate for whites (224.3 per 100,000).     

HIV prevalence, unrecognized infection, and HIV testing among men who have sex with men--five U.S. cities, June 2004-April 2005

Well into the third decade of the human immunodeficiency virus (HIV) epidemic, rates of HIV infection remain high, especially among minority populations. Of newly diagnosed HIV infections in the United States during 2003, CDC estimated that approximately 63% were among men who were infected through sexual contact with other men, 50% were among blacks, 32% were among whites, and 16% were among Hispanics. Studies of HIV infection among young men who have sex with men (MSM) in the mid to late 1990s revealed high rates of HIV prevalence, incidence, and unrecognized infection, particularly among young black MSM. To reassess those findings and previous HIV testing behaviors among MSM, CDC analyzed data from five of 17 cities participating in the National HIV Behavioral Surveillance (NHBS) system. This report summarizes preliminary findings from the HIV-testing component of NHBS, which indicated that, of MSM surveyed, 25% were infected with HIV, and 48% of those infected were unaware of their infection. To decrease HIV transmission, MSM should be encouraged to receive an HIV test at least annually, and prevention programs should improve means of reaching persons unaware of their HIV status, especially those in populations disproportionately at risk.     

Reported HIV status of tuberculosis patients--United States, 1993-2005

Knowing the human immunodeficiency virus (HIV) status of tuberculosis (TB) patients is essential to optimal patient management. TB is an acquired immunodeficiency syndrome (AIDS)-defining opportunistic condition. Patients with both TB and HIV infection are five times more likely to die during anti-TB treatment than patients who are not HIV infected (CDC, unpublished data, 2003). HIV infection is the greatest known risk factor for progression from latent TB infection to TB disease. In the United States, after TB exposure and infection, HIV-infected persons who do not receive appropriate treatment progress to TB disease over 5 years at a rate 10 times greater than that for persons not infected with HIV. In 1989, CDC recommended that all TB patients be offered HIV testing and, in 2006, called for routine HIV screening of all TB patients after the patient is notified that testing will be performed, unless the patient declines (opt-out screening). In addition to enabling optimal patient management, knowing the HIV status (i.e., positive or negative) of TB patients helps public health agencies to identify HIV-infected contacts of TB patients. Highly active antiretroviral therapy (HAART) can reduce the progression to TB disease, TB relapse, and death. To assess reported HIV status of TB patients and selected characteristics of TB patients with HIV infection, CDC analyzed data from the U.S. National TB Surveillance System for the period 1993-2005. This report summarizes the results of that analysis, which indicated that 1) reporting of HIV status among TB patients increased from 35% in 1993 to 68% in 2003, 2) HIV status of 31% of TB patients was unknown in 2005, 3) 9% of TB patients were HIV positive in 2005, and 4) groups of TB patients at greater risk for HIV infection included injection-drug users (IDUs), noninjection-drug users (NIDUs), homeless persons, non-Hispanic blacks, correctional-facility inmates, and alcohol abusers. Increased promotion of routine HIV testing and rapid HIV tests might increase acceptability of testing, which would allow health-care providers to know the HIV status of a greater percentage of TB patients and enable them to provide optimal care.     

Late versus early testing of HIV--16 Sites,United States, 2000-2003

Knowledge of human immunodeficiency virus (HIV) serostatus has been an important element of HIV-prevention and -treatment efforts. In 2000, among the estimated 850,000-950,000 persons living with HIV in the United States, approximately one fourth (180,000-280,000) were unaware that they were HIV infected. In addition, many persons with HIV are tested late in the course of infection, usually as a result of illness. During 1994-1999, among persons who had HIV diagnosed, 43% were tested late in the infection (i.e., had acquired immunodeficiency syndrome [AIDS] diagnosed within one year of HIV diagnosis). Late testing results in missed opportunities for prevention and treatment of HIV. To characterize HIV-testing patterns among HIV-infected persons, CDC analyzed data from a multisite interview project. During May 2000-February 2003, persons at 16 U.S. sites who were tested early in the course of HIV disease (early testers) were compared with persons who were tested late in the course of HIV disease (late testers). This report summarizes the results of the analysis, which indicate that late testers were more likely than early testers to be black or Hispanic, less educated, and exposed to HIV through heterosexual contact. Reducing the incidence of both new infections and HIV-associated morbidity and mortality will require earlier testing and improved access to prevention and care services for persons infected with HIV. A new CDC initiative, "Advancing HIV Prevention: New Strategies for a Changing Epidemic," is aimed at reducing barriers to early diagnosis of HIV infection and increasing access to quality medical care, treatment, and ongoing prevention services.     

Missed opportunities for earlier diagnosis of HIV infection--South Carolina, 1997-2005

In September 2006, CDC published revised recommendations for human immunodeficiency virus (HIV) testing in health-care settings to 1) increase early detection of HIV infection by expanding HIV screening of patients and 2) improve access to HIV care and prevention services (e.g., by conducting screening in locations such as emergency departments and urgent-care facilities, where persons who do not otherwise access HIV testing seek health-care services). HIV screening is now recommended for patients aged 13-64 years in all health-care settings after patients are notified that testing will be performed unless they decline (opt-out screening). This represents a substantial change from earlier recommendations to 1) offer HIV testing routinely to all patients only in health-care settings with high HIV prevalence and 2) conduct targeted screening on the basis of risk behaviors for patients in low-prevalence settings. This report examines HIV and acquired immunodeficiency syndrome (AIDS) case reporting in South Carolina before the 2006 recommendations were published. During 2001-2005, a total of 4,315 cases of HIV infection were reported in South Carolina. Of these, 41% were in persons (referred to as late testers) in whom AIDS was diagnosed within 1 year of their initial HIV diagnosis. Of these late testers, 73% made a total of 7,988 visits to a South Carolina health-care facility during 1997-2005 before their first reported positive HIV test. The diagnoses reported for 79% of these visits were not likely to prompt HIV testing under a risk-based testing strategy. These findings suggest that routine, opt-out HIV screening of all patients in health-care settings, rather than risk-based HIV testing, might result in substantially earlier HIV diagnoses in South Carolina.     

Rapid HIV testing in emergency departments--three U.S. sites, January 2005-March 2006

Approximately one fourth of the estimated 1 million persons living with human immunodeficiency virus (HIV) in the United States are unaware that they are infected with HIV and at risk for transmitting the virus to others. In April 2003, CDC announced a new initiative, Advancing HIV Prevention: New Strategies for a Changing Epidemic, aimed at reducing barriers to early diagnosis of HIV infection and increasing access of persons infected with HIV to medical care and prevention services. A priority strategy of this initiative is to make HIV testing a routine part of medical care. In April 2004, HIV testing was implemented in one emergency department (ED) in Los Angeles, California, and one in New York, New York, to determine the feasibility and acceptability of offering rapid HIV testing as a routine part of health care in EDs. In January 2005, an ED in Oakland, California, also began offering HIV testing routinely. This report summarizes the preliminary results of integrating rapid HIV testing into the health-care services routinely offered in the three EDs during January 2005-March 2006. Those results indicated that, of 9,365 persons tested, 97 (1.0%) ED patients had newly diagnosed HIV infection, and 85 (88%) of those 97 were linked after diagnosis to HIV care and treatment. EDs should consider integrating rapid HIV testing into their routine medical services to identify patients who are unaware that they are infected with HIV and link them to health and prevention services.     

HIV/AIDS among Hispanics--United States, 2001-2005

In the United States, Hispanics are affected disproportionately by human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). Although Hispanics accounted for 14.4% of the U.S. population in 2005, they accounted for 18.9% of persons who received an AIDS diagnosis. The rate of HIV diagnosis among Hispanics also remains disproportionately high; in 2005, the annual rate of HIV diagnosis for Hispanics was three times that for non-Hispanic whites. To better characterize HIV infection and AIDS among Hispanics in the United States, CDC analyzed selected characteristics of Hispanics in whom HIV infection was diagnosed during 2001-2005 and those living with AIDS in 2005. The results indicated that the mode of HIV infection for Hispanics varied by place of birth, suggesting that all HIV-prevention measures might not be equally effective among Hispanics and that HIV educational activities should address cultural and behavioral differences among Hispanic subgroups.     

HIV testing--United States, 2001

As of December 2001, a cumulative total of 816,149 cases of acquired immunodeficiency syndrome (AIDS) had been reported to CDC (1). One of CDC's national human immunodeficiency virus (HIV)--prevention goals for 2005 (Goal 2) is to increase the proportion of HIV-infected persons in the United States who know they are infected from an estimated 70% to 95% (2). A goal of the new CDC initiative, Advancing HIV Prevention: New Strategies for a Changing Epidemic, is to ensure that every HIV-infected person has the opportunity to be tested and has access to state-of-the-art medical care and prevention services needed to prevent HIV transmission (3). To characterize the prevalence of HIV-antibody testing among U.S. adults, CDC analyzed data from the 2001 Behavioral Risk Factor Surveillance System (BRFSS). The findings document variability in HIV testing prevalence by area and by sex within areas, underscoring the ongoing need to promote voluntary HIV counseling and testing that will provide persons with early knowledge of their HIV status and offer them access to appropriate counseling and treatment.     

Trends in HIV/AIDS diagnoses among men who have sex with men--33 states, 2001-2006

In 2008, CDC conducted an analysis of trends in diagnoses of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) among men who have sex with men (MSM) in the 33 states that have had confidential, name-based HIV case reporting since at least 2001. This report summarizes the results of that analysis, which indicated that the number of HIV/AIDS diagnoses among MSM overall during 2001-2006 increased 8.6% (estimated annual percentage change [EAPC] = 1.5). During 2001-2006, an estimated 214,379 persons had HIV/AIDS diagnosed in the 33 states. Of these diagnoses, 46% were in MSM, and 4% were in MSM who engaged in illicit injection-drug use (IDU) (i.e., MSM and IDU). To reduce the impact of HIV/AIDS in the United States, HIV prevention services that aim to reduce the risk for acquiring and transmitting infection among MSM and link infected MSM to treatment must be expanded.     

HIV Testing Among Men at Risk for Acquiring HIV Infection Before and After the 2006 CDC Recommendations

Objectives

Testing for human immunodeficiency virus (HIV) is the key first step in HIV treatment and prevention. In 2006, the Centers for Disease Control and Prevention (CDC) recommended annual HIV testing for people at high risk for HIV infection. We evaluated HIV testing among men with high-risk heterosexual (HRH) contact and sexually active men who have sex with men (MSM) before and after the CDC recommendations.

Methods

We used data from the National Survey of Family Growth, 2002 and 2006–2010, to assess proportions of HRH respondents and MSM reporting HIV testing in the prior 12 months, compare rates of testing before and after release of the 2006 CDC HIV testing guidelines, and examine demographic variables and receipt of health-care services as correlates of HIV testing.

Results

Among MSM, the proportion tested was 37.2% (95% confidence interval [CI] 28.2, 47.2) in 2002, 38.2% (95% CI 25.9, 52.2) in 2006–2008, and 41.7% (95% CI 29.2, 55.3) in 2008–2010; among HRH respondents, the proportion was 23.7% (95% CI 20.5, 27.3) in 2002, 24.5% (95% CI 20.9, 28.7) in 2006–2008, and 23.9% (95% CI 20.2, 28.1) in 2008–2010. HIV testing was more likely among MSM and HRH respondents who received testing or treatment for sexually transmitted disease in the prior 12 months, received a physical examination in the prior 12 months (MSM only), or were incarcerated in the prior 12 months.

Conclusions

The rate of annual HIV testing was low for men with sexual risk for HIV infection, and little improvement took place from 2002 to 2006–2010. Interventions aimed at men at risk, especially MSM, in both nonmedical and health-care settings, likely could increase HIV testing.New infections of human immunodeficiency virus (HIV) occur in the United States at a rate of approximately 50,000 per year, driven mostly by sexual transmission, particularly among men who have sex with men (MSM).¹ In 2010, male-to-male sexual contact accounted for 63% of new HIV infections (78% among males), and heterosexual contact accounted for 25% of new HIV infections (11% among males).^1,2 Although overall incidence has been relatively stable since 2006, among young MSM, particularly young black MSM, new infections continue to increase.^1,3An estimated 14% of adults and adolescents living with HIV infection in the United States are undiagnosed, of whom 11% are males with high-risk heterosexual (HRH) contact and 62% are MSM.⁴ To increase the proportion of HIV-infected people who are aware of their status and link them to treatment and prevention services, the Centers for Disease Control and Prevention (CDC) recommended in 2006 that all people aged 13–64 years be tested at least once for HIV infection and that people at high risk for HIV infection, including men with HRH contact and sexually active MSM,⁵ be tested annually.Using data from multiple waves of a nationally representative survey, we examined the percentage of HRH and MSM respondents who reported having been tested for HIV in the prior 12 months. We compared rates of testing before and after the revised HIV testing guidelines⁵ were released by CDC in 2006. Additionally, because the 2006 CDC guidelines recommended that HIV screening be conducted as part of routine clinical care in all health-care settings,⁵ we examined HIV testing among men stratified by their reported use of health-care services in the prior 12 months and by several sociodemographic variables.     

Increase in newly diagnosed HIV infections among young black men who have sex with men--Milwaukee County, Wisconsin, 1999-2008

During 2001-2006, new human immunodeficiency virus (HIV) diagnoses among black men aged 13-24 years who have sex with men (MSM) in 33 states increased by 93%. The Wisconsin Division of Public Health (WDPH) recently reported to CDC a 144% increase during 2000-2008 in HIV diagnoses among black MSM aged 15-29 years in Milwaukee County. In October 2009, the City of Milwaukee Health Department (MHD), WDPH, and CDC investigated whether the increase in HIV infections among young black MSM in Milwaukee represented increased HIV transmission or simply better identification of prevalent infections. This report describes the results of that investigation, which indicated that a new "social networks" HIV testing strategy and the recent expansion of better targeted HIV testing efforts accounted for few diagnoses among young black MSM and occurred after HIV diagnoses increased, respectively. Therefore, although some diagnoses were made because of intensified testing, an increase in HIV transmission likely occurred. Moreover, an increase in syphilis diagnoses among young black MSM in Milwaukee preceded the increase in HIV diagnoses, which suggests that changes in risk behavior or sexual networks might explain the increase. These findings highlight the need for new or improved interventions promoting prevention education, early HIV detection, and entry to care for young HIV-infected and at-risk black MSM in Milwaukee.     

HIV Viral Suppression, 37 States and the District of Columbia, 2014

Achieving viral suppression among HIV-positive persons is a critical component of HIV treatment and prevention, because it leads to improved health outcomes for the individual and reduced risk of HIV transmission. There is wide variation in viral suppression across jurisdictions, races/ethnicities, age groups, and transmission risk groups. This analysis uses HIV surveillance data to examine rates of viral suppression among people living with diagnosed HIV (PLWDH) in 38 jurisdictions with complete lab reporting. Among people who received a diagnosis in 2014, the percentage with viral suppression within 12 months of diagnosis and the average time to viral suppression was assessed. Overall, among PLWDH in 2014, 57.9% were virally suppressed, and, among people with HIV diagnosed in 2014, 68.2% were suppressed within 12 months of diagnosis with an average time to suppression of 6.9 months. All outcomes varied by jurisdiction, but most had similar patterns of disparities with a few exceptions. These data highlight the need for tailored interventions at the local level. In addition, jurisdictions with relatively low viral suppression among particular groups could adapt effective interventions from jurisdictions who have higher rates of suppression.     

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. As a result of advances in treatment with highly active antiretroviral therapy (HAART) since 1996, persons infected with HIV are living longer than before and progression to acquired immunodeficiency syndrome (AIDS) has decreased. Consequently, AIDS surveillance no longer provides accurate population-based monitoring of the current HIV epidemic. Therefore, CDC recommends that all states and territories adopt confidential, name-based surveillance systems to report HIV infection. This report describes the characteristics of persons for whom HIV infection was diagnosed during 2001-2004 and reported to 33 state and local health departments with name-based HIV reporting. The findings indicate that the rate of HIV diagnosis in these states decreased among non-Hispanic blacks from 2001 to 2004; however, the rate of HIV diagnosis among blacks remained disproportionately high. In 2004, the rate among blacks was 8.4 times higher than among whites. Improved knowledge of HIV status and access to care and prevention services is important to decrease the number of new HIV infections among those populations most affected.     

Disparities in diagnoses of HIV infection between blacks/African Americans and other racial/ethnic populations--37 states, 2005-2008

Blacks/African Americans have been affected disproportionately by human immunodeficiency virus (HIV) infection since early in the epidemic. Despite representing a smaller proportion (13.6%) of the U.S. population, blacks/African Americans accounted for half of the HIV diagnoses in adolescents and adults in 37 states during 2005-2008. Data from the National HIV Surveillance System were used to estimate numbers, percentages, and rates of HIV diagnoses in blacks/African Americans during 2005-2008. Those data were reported to CDC through June 2009 from 37 states with mature (in operation since at least January 2005) HIV surveillance systems. This report describes the results of those analyses, which indicated that during 2005-2008, blacks/African Americans were diagnosed with HIV infection more frequently than any other racial/ethnic population. During 2008, black/African American males and females were diagnosed with HIV infection at eight and 19 times the rates for white males and females and two and four times the rates for Hispanic/Latino males and females, respectively. In addition, the number of HIV diagnoses made each year among black/African American males increased during 2005-2008. The reduction of HIV-related health disparities has been identified as one of the three goals in the National HIV/AIDS Strategy. Reducing HIV risk behaviors and increasing access to testing and referral to health care can help eliminate disparities between blacks/African Americans and other racial/ethnic populations in the rates at which HIV infection is diagnosed.     

Screening HIV-infected persons for tuberculosis--Cambodia, January 2004-February 2005

Worldwide, tuberculosis (TB) is one of the most common causes of death among persons infected with human immunodeficiency virus (HIV). The World Health Organization recommends screening HIV-infected persons for TB disease after HIV diagnosis, before initiation of highly active antiretroviral therapy (HAART), and during routine follow-up care. In 2003, health officials in Banteay Meanchey Province, Cambodia, in conjunction with CDC and the U.S. Agency for International Development (USAID), began a pilot project to increase TB screening among persons with HIV infection. Subsequently, CDC analyzed and evaluated data from the first 14 months of the project. This report summarizes the results of that analysis, which determined that, during January 2004--February 2005, among persons with HIV infection at voluntary counseling and confidential testing (VCCT) clinics, 37% were screened for TB disease, and 24% of those screened had TB disease diagnosed. On the basis of these findings, the Provincial Health Department (PHD) took action to increase awareness of the risk for TB among HIV-infected persons. During the 3 months after these measures were implemented, the TB screening rate among persons with HIV infection increased to 61%. Evaluation of projects like the one conducted in Banteay Meanchey Province can help develop an evidence-based approach for removing barriers to screening HIV-infected persons for TB.