HIV surveillance--United States, 1981-2008

Within 1 year of the initial report in 1981 of a deadly new disease that occurred predominantly in previously healthy persons and was manifested by Pneumocystis carinii pneumonia and Kaposi's sarcoma, the disease had a name: acquired immune deficiency syndrome (AIDS). Within 2 years, the causative agent had been identified: human immunodeficiency virus (HIV). On the 30th anniversary of the epidemic, to characterize trends in HIV infection and AIDS in the United States during 1981-2008, CDC analyzed data from the National HIV Surveillance System. This report summarizes the results of that analysis, which indicated that, in the first 14 years, sharp increases were reported in the number of new AIDS diagnoses and deaths among persons aged≥13 years, reaching highs of 75,457 in 1992 and 50,628 in 1995, respectively. With introduction of highly active antiretroviral therapy, AIDS diagnoses and deaths declined substantially from 1995 to 1998 and remained stable from 1999 to 2008 at an average of 38,279 AIDS diagnoses and 17,489 deaths per year, respectively. Despite the decline in AIDS cases and deaths, at the end of 2008 an estimated 1,178,350 persons were living with HIV, including 236,400 (20.1%) whose infection was undiagnosed. These findings underscore the importance of the National HIV/AIDS Strategy focus on reducing HIV risk behaviors, increasing opportunities for routine testing, and enhancing use of care (1).     

AIDS trends among Hispanics in the United States.

OBJECTIVES. In 1991 the incidence of acquired immunodeficiency syndrome (AIDS) in the United States was 31.6 per 100,000 population among Hispanics and 11.8 per 100,000 among non-Hispanic Whites. The purpose of this study was to further describe the AIDS epidemic among Hispanics by examining differences in risk factors among different Hispanic groups (as defined by birthplace). METHODS. AIDS cases reported to the Centers for Disease Control and Prevention from 1988 through 1991 were reviewed. RESULTS. For men, except for those born in Puerto Rico, the predominant exposure category was male-male sex. The proportion of cases due to injection drug use was 35% among Hispanic men born in the United States, 27% among men born in the Dominican Republic, and 61% among men born in Puerto Rico, but < 10% among other Hispanic men and non-Hispanic White men. For women the predominant exposure category was injection drug use among Hispanics born in the United States (56%) and Puerto Rico (46%) and among non-Hispanic Whites (42%). The proportion of cases associated with injection drug use was significantly lower (< 30%) among other Hispanic women. CONCLUSIONS. AIDS prevention strategies must be geared toward different exposure categories among different Hispanic groups.     

Addressing the HIV/AIDS Epidemic Among Puerto Rican People Who Inject Drugs: The Need for a Multiregion Approach

High levels of HIV risk behaviors and prevalence have been reported among Puerto Rican people who inject drugs (PRPWID) since early in the HIV epidemic. Advances in HIV prevention and treatment have reduced HIV among people who inject drugs (PWID) in the United States. We examined HIV-related data for PRPWID in Puerto Rico and the US Northeast to assess whether disparities continue.Injection drug use as a risk for HIV is still overrepresented among Puerto Ricans. Lower availability of syringe exchanges, drug abuse treatment, and antiretroviral treatment for PWID in Puerto Rico contribute to higher HIV risk and incidence.These disparities should be addressed by the development of a federally supported Northeast–Puerto Rico collaboration to facilitate and coordinate efforts throughout both regions.Behavioral, biomedical, and structural interventions have led to significant reductions in HIV incidence in the United States. More than 30 years since HIV was first reported, the possibility of an AIDS-free generation in the United States has recently emerged. Current research and policy efforts focus on identifying those who may be unaware of their infection to engage and maintain them in antiretroviral treatment, and aim to reduce health disparities among racial/ethnic groups.Despite great advances in HIV prevention and care, insufficient progress has been made among Puerto Rican people who inject drugs (PRPWID). Research on the HIV/AIDS epidemic among people who inject drugs (PWID) has documented higher levels of risk behaviors and prevalence among individuals identified as Puerto Rican than among other groups since early in the epidemic, and these disparities persist. Although Puerto Ricans in the island and the continental United States represent about 9% of the US Hispanic population,1 nearly 23% of incident HIV cases among Hispanics in 2006 were among those born in Puerto Rico.2 Injection drug use accounted for the majority of AIDS cases in Puerto Rico early in the epidemic,3 and currently more than 20% of new infections in Puerto Rico are attributed to injection drug use, a higher percentage than for any other region of the United States 4 and for any other Hispanic subgroup.5To meet the challenge of eradicating HIV in the United States, health disparities within subgroups at high risk for HIV must be addressed. Furthermore, the HIV treatment–as–prevention paradigm6 in use to reduce HIV transmission will not suffice in reducing comorbidities associated with injection drug use (e.g., hepatitis C, overdoses), also found at disproportionately high rates among PRPWID. We focused on Puerto Rico and the northeastern United States, where the majority of Puerto Ricans live,1 to examine the history of the epidemic among PRPWID, the current state of the epidemic, and the availability of HIV prevention and treatment services. We also describe other challenges to health for PRPWID and interventions recently adopted in Puerto Rico and provide recommendations to further reduce HIV in this population.     

肥东县2004～2011年HIV/AIDS报告病例流行特征分析

目的探讨肥东县HIV/AIDS的流行特征和相关因素,为制定艾滋病的防控措施提供科学依据。方法用描述流行病学的方法对肥东县2004～2011年报告的HIV/AIDS病例进行流行病学分析。结果累计报告户籍本地的HIV/AIDS 44例,其中HIV感染者16例,AIDS患者28例,死亡4例。艾滋病疫情分布在15个乡镇,报告病例以20～50岁男性青壮年为主,占93.18%;男性37人,女性7人,男女之比为5.29:1;职业以农民工为主,占45.45%;传播方式以性传播方式为主,占97.73%。结论肥东县艾滋病疫情呈现快速增长趋势,疫情分布广泛,疫情正在从高危人群向一般人群扩散,应采取以切断性传播为主的综合干预措施,预防控制艾滋病疫情的发展。     

Trends in AIDS among Hispanics in the United States, 1991-1996.

OBJECTIVES: This article describes recent trends in AIDS among US Hispanics. METHODS: Incidence rates were calculated from AIDS surveillance data for persons diagnosed from 1991 through 1996. Increases in the number of cases among Hispanics were calculated by linear regression. RESULTS: Of the 415,864 persons diagnosed with AIDS from 1991 through 1996, 19% were Hispanic. Among Hispanics with AIDS, 67% were born in the United States or Puerto Rico. The relative risk (RR) of AIDS for Hispanics compared with Whites was highest for women (RR = 7.0), followed by children (RR = 6.2) and men (RR = 2.8). Increases in the number of cases were higher among foreign-born Hispanics. CONCLUSIONS: An understanding of which Hispanic subgroups are at greatest risk for HIV infection is important for prevention efforts.     

Reduction in the perinatal HIV transmission: the experience at the Maternal Infant Studies Center and Gamma Projects at the University of Puerto Rico School of Medicine

The AIDS pandemic had a significant impact in Puerto Rico, especially among the heterosexual populations, in particular women. Women are one of the fastest growing risk groups with HIV/AIDS in the USA and constitute about half of the AIDS cases in the world. During the past 10 years Puerto Rico has ranked among the top 5 jurisdictions in the United States in AIDS cases rates, among men, women and children. In 1987 a universal prenatal HIV screening program was implemented in the University Hospital catchment area consisting of approximately 5,000 deliveries per year. Because of the early identification of pregnant women living with HIV, access to lifesaving clinical research and the implementation of multiple strategies and comprehensive care, the perinatal HIV transmission has been reduced to zero since 1997, with a blip of one case in 2002, and none since then. The availability and access to clinical and behavioral research has been one of the key elements for this success story. The programs involved and responsible for this spectacular outcome, namely the Maternal Infant Studies Center (CEMI-Spanish Acronym) and Gamma Projects at the University of Puerto Rico School of Medicine are described. The cost savings impact of stopping mother-infant perinatal HIV-1 transmission has been calculated to be approximately $34 to $58 million dollars in 10 years. The impact of the effectiveness of these programs in having healthy uninfected infants, prolonging and improving the quality of life of those living with HIV, and providing hope to families affected by this epidemic is incalculable.     

Changes in the AIDS epidemiologic situation in Puerto Rico following health care reform and the introduction of HAART.

OBJECTIVES: To compare the occurrence of AIDS as well as the sociodemographic and clinical profiles of AIDS patients in Puerto Rico before and after the introduction of highly active antiretroviral therapy (HAART) and the privatization of the island's public health care system. METHODS: We compared the incident AIDS cases for two three-year periods, 1992-1994 and 1998-2000, in four populations: (1) entire United States, (2) Puerto Rico, (3) Bayamón Health Region (located in north-central Puerto Rico, it includes 11 of the island's 78 municipalities), and (4) an HIV cohort enrolled at the Universidad Central del Caribe (UCC) School of Medicine. The UCC is located in Bayamón, Puerto Rico, within an academic medical complex that houses the teaching hospital (Ramón Ruíz Arnaú University Hospital), the ambulatory health care facilities (Immunology Clinics) for patients with HIV, and administrative buildings. This represents the major government-sponsored health care infrastructure within the Bayamón Health Region. RESULTS: Incident AIDS declined substantially between the two periods in each of the four populations studied. The 48.1% decline in Puerto Rico exceeded the 40.9% decline in the United States. The decline in Puerto Rico likely resulted from increased availability and implementation of HAART and the delivery of health care to HIV/AIDS patients in an integrated fashion within each regional ambulatory clinic. In spite of this improvement, the absolute number of patients with AIDS on the island remains high. Substantial resources for treatment and prevention are required. The proportion of new AIDS cases was lower among women, persons 40 years of age or older, the less educated, and those living alone. Injection drug use remains the predominant mode of transmission in Puerto Rico. CONCLUSIONS: Further gains in Puerto Rico's fight against AIDS will depend on the island's ability to reduce the transmission that occurs through injection drug use; the use of HAART on a larger number of vulnerable patients, particularly intravenous drug users; educational interventions to improve medication compliance in certain risk groups; and specific measures aimed at decreasing the rate of injection drug use.     

1994-2011年深圳市福田区艾滋病流行状况

目的 分析深圳市福田区1994 -2011年艾滋病流行状况.方法 运用描述性分析方法,对收集到的深圳市福田区1994 - 2011年间艾滋病疫情报告进行分析.结果 深圳市福田区1994-2011年间累计发现HIV/AIDS 798例,病例主要分布特征:年龄较为集中在20～40岁,以青壮年为主;多为暂住人口(65.3％);以男性为主(82.0％);以性接触感染为主(61.2％),而其中46.2％是经男男同性性接触感染.结论 1994 -2011年深圳市福田区艾滋病疫情在全人口中呈低流行态势,但在特定人群(如静脉注射吸毒人群、男男同性恋人群等)呈高流行态势,疫情正由高危人群向一般人群持续扩散.     

Mortality among Hispanic drug users in Puerto Rico

This paper assesses mortality rate for a cohort of drug users in Puerto Rico compared with that of the Island's general population, examining causes of death and estimating relative risk of death. Date and cause of death were obtained from death certificates during 1998. Vital status was confirmed through contact with subjects, family, and friends. HIV/AIDS was the major cause of death (47.7%), followed by homicide (14.6%), and accidental poisoning (6.3%). Females had higher relative risk of death than males in all age categories. Not living with a sex partner and not receiving drug treatment were related to higher mortality due to HIV/AIDS. Drug injection was the only variable explaining relative risk of death due to overdose. Puerto Rico needs to continue developing programs to prevent HIV/AIDS among drug users. Special attention should be given to young women, who appear to be in greatest need of programs to prevent early mortality.     

A Comparative Study of Mortality Among Puerto Rican Injection Drug Users in East Harlem, New York, and Bayamon, Puerto Rico

Drug users have been found to be at high risk of mortality but the mortality experience of Hispanic drug users remains understudied. This study assessed mortality among Puerto Rican injection drug users (IDUs) in New York City (NY), and in Puerto Rico (PR). Study subjects were 637 IDUs from NY and 319 IDUs from PR. Mortality was ascertained using data from the National Death Index. Annual mortality rate of the NY cohort was 1.3 per 100 person years compared to the PR cohort with a rate of 4.8. Compared to the Hispanic population of New York City, the standardized mortality ratio (SMR) of the NY cohort was 4.4. Compared to the population of Puerto Rico, the SMR of the PR cohort was 16.2. The four principal causes of death were: NY—HIV/AIDS (50.0%), drug overdoses (13.3%), cardiovascular conditions (13.3%), and pulmonary conditions (10.0%); PR—HIV/AIDS (37.0%), drug overdoses (24.1%), sepsis (13.0%), and homicide (11.1%). Modeling time to death using Cox proportional hazards regression, the relative risk of mortality of the PR cohort as compared to the NY cohort was 9.2. The other covariates found to be significantly associated with time to death were age, gender, education, social isolation, intoxication with alcohol, and HIV seropositivity. The large disparity in mortality rates found in this study suggests that health disparities research should be expanded to identify intra-group disparities. Furthermore, these results point to an urgent need to reduce excess mortality among IDUs in Puerto Rico.     

HIV and AIDS--United States, 1981-2000

The acquired immunodeficiency syndrome (AIDS) epidemic has had a substantial impact on the health and economy of many nations. Since the first AIDS cases were reported in the United States in June 1981, the number of cases and deaths among persons with AIDS increased rapidly during the 1980s followed by substantial declines in new cases and deaths in the late 1990s. This report describes the changes in the characteristics of persons with AIDS since 1981. The greatest impact of the epidemic is among men who have sex with men (MSM) and among racial/ethnic minorities, with increases in the number of cases among women and of cases attributed to heterosexual transmission. The number of persons living with AIDS has increased as deaths have declined. Controlling the epidemic requires sustained prevention programs in all of these affected communities, particularly programs targeting MSM, women, and injection drug users.     

HIV in the United States at the turn of the century: an epidemic in transition.

OBJECTIVES: The current status of and changes in the HIV epidemic in the United States are described. METHODS: Surveillance data were used to evaluate time trends in AIDS diagnoses and deaths. Estimates of HIV incidence were derived from studies done during the 1990s; time trends in recent HIV incidence were inferred from HIV diagnoses and seroprevalence rates among young persons. RESULTS: Numbers of deaths and AIDS diagnoses decreased dramatically during 1996 and 1997 but stabilized or declined only slightly during 1998 and 1999. Proportional decreases were smallest among African American women, women in the South, and persons infected through heterosexual contact, HIV incidence has been roughly constant since 1992 in most populations with time trend data, remains highest among men who have sex with men and injection drug users, and typically is higher among African Americans than other racial/ethnic groups. CONCLUSIONS: The epidemic increasingly affects women minorities, persons infected through heterosexual contact, and the poor. Renewed interest and investment in HIV and AIDS surveillance and surveillance of behaviors associated with HIV transmission are essential to direct resources for prevention to populations with greatest need and to evaluate intervention programs.     

Acute hemorrhagic conjunctivitis outbreak caused by Coxsackievirus A24--Puerto Rico, 2003

Acute hemorrhagic conjunctivitis (AHC) is an epidemic form of highly contagious conjunctivitis and is characterized by sudden onset of painful, swollen, red eyes, with conjunctival hemorrhaging and excessive tearing. Since 1981, when AHC was first detected in the Western Hemisphere, three major epidemics had occurred until 2003, all affecting the Caribbean. During August-October 2003, a fourth epidemic occurred in Puerto Rico (2000 population: 3.8 million). This report summarizes the outbreak investigation conducted by the Puerto Rico Department of Health (PRDOH), which documented an estimated 490,000 persons with illness, including >51,000 cases reported by physicians; demonstrated laboratory evidence of Coxsackievirus A24 (CA24); and determined that school-aged children (i.e., aged 5-18 years) and those living in crowded urban areas were at highest risk. To control outbreaks of AHC, prevention methods (e.g., frequent hand washing and avoidance of sharing towels and bedding) should be targeted to groups at highest risk, and information should be disseminated after the first report of AHC in the area.     

Sunburn prevalence among adults in the United States, 1999

BACKGROUND: Exposure to high levels of sunlight, such as a sunburn, is a strong determinant of melanoma risk. METHODS: To describe statewide and U.S. estimates of sunburn prevalence in the United States and determine demographic and behavioral predictors of sunburn, we analyzed data from the 1999 Behavioral Risk Factor Surveillance System, a population-based telephone survey conducted in all 50 states, the District of Columbia, and Puerto Rico. RESULTS: Of 156,354 adults aged > or =18 years, 31.7% (95% confidence interval, 31.3%-32.1%) reported a sunburn in the past year; of adults aged 18 to 29 years, 57.5% reported such a sunburn. Reporting was highest among white, non-Hispanic males (44.1%), followed by white non-Hispanic females (35.3%), and lowest among black non-Hispanic males and females (5.1% and 5.3%, respectively). Statewide period prevalence of sunburn among whites was highest (>45%) in Wisconsin, Utah, Wyoming, Washington, DC, and Indiana, and lowest (<30%) in Puerto Rico, Arizona, Tennessee, Oklahoma, and New York. CONCLUSIONS: Nationwide and statewide skin cancer prevention efforts should target young adults. Periodic monitoring of sunburn is important in evaluating the effectiveness of those efforts.     

Cancer incidence in the Puerto Rican-born population of Long Island, New York.

BACKGROUND. There are apparently no published data on cancer incidence in the Puerto Rican-born populations of the northeastern United States. METHODS. Standardized incidence ratios (SIRs) were calculated for 1980 through 1986 for the Puerto Rican-born population in Long Island (New York). RESULTS. Significantly reduced SIRs were found for males (SIR = 0.77) but not for females (SIR = 0.91), using expected numbers derived from incidence rates for all areas in the Surveillance, Epidemiology and End Results (SEER) Program (excluding Puerto Rico). Using incidence rates for Puerto Rico to obtain expected numbers, there was evidence for the retention of elevated SIRs for stomach cancer (both sexes) and for significantly elevated SIRs for lung cancer (both sexes), colon-rectum cancer (females), prostate cancer, and breast and uterine corpus cancer. Using rates for SEER areas, the SIRs for lung cancer approached 1.00, in contrast to other US Puerto Rican-born populations. CONCLUSION. The data indicate the need for surveys on smoking and other health-related behaviors in the population studied and provide further evidence for heterogeneity in cancer patterns in US Puerto Rican-born populations.     

菏泽市HIV感染者/AIDS病人流行病学分析

[目的]了解菏泽市艾滋病流行现状,为制定防制对策提供科学依据。[方法]对菏泽市2000～2006年艾滋病血清学监测确认的HIV感染者/AIDS病人的有关资料进行分析。[结果]到2006年底,菏泽市累计报告HIV感染者/AIDS病人195例。其中男性108例,占55.38%,女性87例,占44.62%;职业以农民为主,182例,占93.33%;75.90%的感染者为20～49岁的青壮年。主要传播途径为经血液传播（140例,占71.80%,其中单采血浆者113例,占57.95%;输全血及血液制品者27例,占13.85%）;其次是经性接触传播,26例（13.33%）。[结论]菏泽市近年艾滋病疫情发展明显加快,HIV感染者/AIDS病人主要为1994～1997年在地下采供血机构有偿供血的当地农民,按照艾滋病平均潜伏期8～10年来推测,近两年正是发病和死亡高峰期。     

Homicides among children and young adults--Puerto Rico, 1999-2003

Interpersonal violence causes substantial morbidity and mortality worldwide and poses a considerable economic burden, equivalent to 4%-5% of the gross national product in certain countries. The Commonwealth of Puerto Rico is a U.S. territory with a 2004 population of approximately 3.9 million. In Puerto Rico, homicides were the 12th leading cause of death overall in 2003, ranking fifth among males and 15th among females. This report summarizes an analysis of death certificate data on violent deaths of children and young adults in Puerto Rico during 1999-2003, which determined that 93% of homicide victims aged <30 years were young males, the most common method of homicide was assault by firearm discharge, and the rate of homicide among males aged 25-29 years increased during the period. To address this problem, the Puerto Rican government has initiated a comprehensive strategy that includes enhancing an integrated surveillance system for fatal and nonfatal assault, supporting research on interpersonal violence, and establishing local prevention programs (e.g., violence prevention curricula in selected schools).     

HIV infection treatment costs under Medicaid in Michigan.

The Michigan Medicaid Program payment records generated in the period 1985-89 by 783 persons were analyzed for services related to human immunodeficiency virus (HIV) infection. Other data from death records and the Michigan AIDS Surveillance Registry were available for a subset of those persons. The average monthly payment in 1989 dollars for HIV-related services was $1,302.57. Services determined to be unrelated to HIV infection accounted for 12.5 percent of the total amount for health care received and another 2.5 percent was questionable. The average monthly expenditure for men was roughly twice that for women. The discrepancy did not exist among persons identified in the AIDS Surveillance Registry. Sex differences ceased to exist when Medicaid eligibility (disability versus Aid to Families with Dependent Children) was controlled for by analysis of variance. There were no significant differences between payments to those infected through male-to-male sexual contact and those infected through intravenous drug use. Payments for HIV treatments rose with age to about 40 years, and declined slightly among older adults. The sharpest rise was for those ages 19-25 years and 26-35 years. Large sex differences existed among those who received zidovudine (AZT), 61.4 percent of the men and 19.1 percent of the women. Controlling for Medicaid eligibility moderated those differences, but they remained statistically significant. Differences in zidovudine usage were not found between men and women in the subset identified in the AIDS Surveillance Registry nor among persons infected through male-to-male sexual contact and intravenous drug use.     

Epidemiological environment and response to the HIV epidemic in Bolivia]

With AIDS/HIV, early detection is of key importance to public health, as well as disseminating prevention information and providing timely and appropriate treatment. In Bolivia, at the end of 2006 approximately 50% had AIDS at the time of diagnosis, detection having occurred late in the illness. The HIV/AIDS epidemic in Bolivia is concentrated, with prevalence rates over 5% among the at-risk population, primarily men who have sex with men. From January 1984 through October 2006, the total number of HIV/AIDS cases reported in Bolivia rose to 2 190, with 1 239 HIV and 951 AIDS cases, and underreporting estimated to be over 70% country-wide. The United National Joint Program on AIDS (UNAIDS) estimated that by the end of 2006 there would be 6 700 people living with HIV/AIDS in Bolivia. In the context of this scenario, the article describes the challenges facing the HIV/AIDS program and the strategies developed to address the epidemic in Bolivia. In addition, the UNAIDS/PAHO strategies are stressed and must get underway for HIV/AIDS prevention and control activities in the country.     

Electronic record linkage to identify deaths among persons with AIDS--District of Columbia, 2000-2005

An estimated 1 million persons in the United States are living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS); approximately 500,000 persons with AIDS have died since 1981. In 2005, the District of Columbia (DC) had an estimated adult AIDS prevalence rate of 2%, one of the highest AIDS prevalence rates in the United States. Accurate death ascertainment is an important part of HIV/AIDS surveillance. Manual methods can substantially underestimate deaths by missing death certificates that do not mention HIV infection or deaths of residents that occur in other states. CDC and the Council of State and Territorial Epidemiologists (CSTE) recommend performing electronic record linkages to ascertain deaths annually as part of routine HIV/AIDS surveillance activities. In 2007, to identify all deaths that occurred during 2000-2005 among persons with AIDS who resided or received their diagnosis in DC, the HIV/AIDS Administration of the DC Department of Health, with assistance from CDC, performed an electronic record linkage. This report summarizes the results of that linkage, which determined that 54% of deaths among persons with AIDS had not been reported previously to the DC HIV/AIDS Reporting System (HARS). The results indicated that electronic record linkage for death ascertainment is necessary to more accurately estimate the prevalence of persons living with HIV/AIDS.