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.     

Gender differences in progression to AIDS and death from HIV seroconversion in a cohort of injecting drug users from 1986 to 2001

BACKGROUND: Although the consensus is that gender does not influence HIV progression, its relevance may depend on the setting. AIM: To study gender differences in HIV progression to AIDS and death from 1986 to 2001 in a cohort of injecting drug user (IDU) seroconverters in Spain. METHODS: Risk of AIDS and death in persons infected for the same length of time were compared through Kaplan-Meier, allowing for late entry, and Cox regression adjusting for gender, age, and calendar period (before 1992, 1992-1995, 1996-1998, 1999-2001) fitted as time dependent covariates. RESULTS: Of 929 IDU, 24.7% were women. Median seroconversion year was 1993.3 for men and women. 44% of women and 34% of men received antiretroviral therapy. Risk of AIDS was lower in women in univariate (hazard ratio (HR) 0.72; 95%CI:0.51 to 1.01) and multivariate analyses (HR 0.73 95%CI:0.52 to 1.03). A 46% reduction in risk of AIDS for period 1999-2001 compared with 1992-1995 was seen in both men and women (HR: 0.56 (95%CI:0.36 to 0.87). As for mortality, women's risk of death was lower univariately (HR 0.67 95%CI:0.45 to 0.99) although compared with 1992-95, men experienced a 34% reduction in mortality during 1999-2001 (HR 0.66 95%CI:0.40 to 1.01), which was not statistically significant in women. CONCLUSIONS: HIV progression was lower in female IDU before and after 1997 and their uptake of antiretroviral therapy was higher than male IDU. The inability to detect a reduction in mortality for women during 1999-2001 is probably attributable to lack of power. Differences in severity of addiction, drug using patterns, and competing causes of death may explain these findings.     

HIV/AIDS among men who have sex with men and inject drugs--United States, 1985-1998

Men who have sex with men and inject drugs (MSM/IDU) pose unique challenges for human immunodeficiency virus (HIV) risk reduction efforts because they have multiple risks for HIV acquisition and transmission. This report presents 1) the demographic characteristics of MSM/IDU diagnosed with acquired immunodeficiency syndrome (AIDS) in 1998 and MSM/IDU living with AIDS as of December 31, 1998; 2) trends in AIDS incidence among MSM/IDU from 1985 to 1998; and 3) information on selected behaviors from interviews of MSM/IDU who had AIDS diagnosed from 1996 to 1998 in 12 states. The findings indicate that 1) over half of MSM/IDU with AIDS were non-Hispanic blacks and Hispanics, and most MSM/IDU with AIDS were reported from large metropolitan statistical areas (MSAs); 2) AIDS incidence has declined since 1996; and 3) a high prevalence of drug-related and sexual risk behaviors occurred among MSM/IDU with AIDS.     

The changing age of HIV: sexual risk among older African American women living in rural communities

BACKGROUND: African American women aged 50 and older are disproportionately affected by the HIV/AIDS epidemic. Despite African Americans making up 11% of all older women in the United States, in 2001, they accounted for more than 50% of AIDS cases among older women and more than 65% of HIV cases among older women. Using the AIDS Risk Reduction Model as a conceptual framework, this study investigated HIV risk behavior among older rural African American women (mean age = 58 years). METHODS: A cross-sectional survey was conducted (n = 181) in three rural counties in South Carolina. RESULTS: Most (67%) of the women had at least one sex partner in the past five years, and of these, more than half (59.5%) reported at least one sexual risk behavior. High-risk behavior was associated with less education, lower condom use self-efficacy, more peers who discussed HIV-related risk behavior, and less comfort communicating with partners about sex. CONCLUSIONS: A significant proportion of older African American women living in rural counties are at increased risk for HIV infection, suggesting an urgent need for HIV prevention efforts to target this population.     

Determinants of progression to AIDS or death after HIV diagnosis, United States, 1996 to 2001

PURPOSE: The aim of the study is to determine factors associated with disease progression after human immunodeficiency virus (HIV) infection diagnosis. METHODS: We applied generalized linear models with Poisson errors to obtain adjusted relative excess risk for death for persons diagnosed with acquired immunodeficiency syndrome (AIDS) or HIV infection (with or without concurrent AIDS) during 1996 to 2001. We examined differences in time between HIV diagnosis and AIDS by using standardized Kaplan-Meier survival methods. RESULTS: Relative excess risk for death within 3 years after AIDS diagnosis was significantly greater for non-Hispanic blacks (1.15; 95% confidence interval [CI], 1.12-1.18), American Indians (1.33; 95% CI, 1.16-1.52), and Hispanics (1.16; 95% CI, 1.13-1.20) compared with whites. Risk for death also was greater among injection drug users (men, 1.50; 95% CI, 1.46-1.54; women, 1.57; 95% CI, 1.51-1.62) compared with men who have sex with men and among those diagnosed at older ages compared with younger persons. Similar disparities between groups in risk for death were observed from HIV diagnosis. Risk for progression from HIV to AIDS was greater for nonwhites, men, and older persons compared with whites, women, and younger persons, respectively. CONCLUSIONS: Interventions should target those at excess risk for death or morbidity to ensure access to quality care and adherence to treatment to slow disease progression.     

Hospital-based surveillance of HIV infection: Epidemiological trends in BOrdeaux,France, 1983–1989

A hospital-based surveillance system of infection by the human immunodeficiency virus (HIV) has been implemented in nine wards of the Bordeaux University Hospital by the Groupe d'Epidémiologie Clinique du SIDA en Aquitaine (GECSA). The aim was to systematically collect clinical, biological and epidemiological data on HIV-infected patients who were followed by physicians from the participating hospitals. The analysis of the data at enrollment was performed on the 1,242 patients whose infection was diagnosed between January 1983 and December 1989. The male to female ratio was 2.5:1 and the proportion of women has increased over time. For men, 39.8% were homosexual or bisexual, 36.9% were intravenous drug users (IVDU's) and 2.6% had both risk behaviours. For women, the most frequently reported high-risk behaviour was IVDU (50.3%), followed by heterosexual contacts with an HIV-infected or at-risk person (HET) (28.6%). The distribution of risk behaviour has changed over time, with an increase in the proportion of HET and a decrease in the proportion of IVDU's for both sexes. The proportion of patients included that fulfilled the definition for AIDS was 18.9%. Based on this system, the incidence rate of diagnosis of HIV infection in the Aquitaine region, regardless of the clinical stage of the infection was estimated to be at least 63.4 per million inhabitants and per year in 1988-1989. The GECSA surveillance system points out some of the specificities of the progression of the HIV epidemic in the Aquitaine region.(ABSTRACT TRUNCATED AT 250 WORDS)     

Reconstruction of human immunodeficiency virus (HIV) sub-epidemics in Italian regions

BACKGROUND: The spread of human immunodeficiency virus (HIV) infections is likely to consist of sub-epidemics in local areas and/or risk groups. Small-area risk group specific analyses may thus be a suitable means of better understanding and controlling the epidemic course. METHODS: An age, period, and cohort back-calculation method was used to reconstruct region-specific epidemics of HIV infection. The HIV infection incidence rates were estimated for individual Italian regions by using as denominator the specific risk category population (i.e. intravenous drug user population [IDU], homosexual/ bisexual population [MSWM], and Italian general population for heterosexual contacts [HST]). Incidence rates obtained in this way represent the risk of HIV infection conditional to belonging to the specific sub-group of the population. RESULTS: The HIV epidemic is heterogeneous in terms of gender, risk category and region. The highest risk of HIV infection has been estimated in the Lombardia region (North-West area) among men belonging to the IDU category in 1985. In recent years, a trend of decrease in HIV has been estimated, especially among IDU and MSWM. For the HST category, some regions have shown trends of great increase, particularly on the island of Sardegna and the regions of Puglia and Sicilia (Southern Italy). In 1987, most HIV infections were observed among IDU (39-90%), while in 1992 the MSWM and HST categories made the greatest contribution to the HIV epidemic. CONCLUSIONS: The results stress the idea of sub-epidemics rather than a single epidemic affecting the entire country. Some Southern regions emerge as areas in which the spread of HIV infections, although still at a rather low level, should cause considerable concern, particularly the trend of new infections by heterosexual transmission involving the general population. Detailed information on levels and trends of HIV infection epidemics at the local level are essential for surveillance purposes and for planning health care facilities, and can highlight areas in which preventive measures can be effective.     

The underrecognition of HIV infection in women in an inner-city emergency room.

OBJECTIVES. This study analyzed the recognition of human immunodeficiency virus (HIV) infection and associated factors in women and men attending an emergency room in the Bronx, New York, NY. METHODS. From April 16, 1989, to May 5, 1989, the emergency room records of 2102 consecutive patients 13 years of age or older were reviewed and, for 856 patients undergoing venipuncture, linked anonymously to results of HIV antibody tested in excess blood. RESULTS. HIV seroprevalence was 7.8% in women and 14.6% in men. Among seropositive women, 5.0% had acquired immunodeficiency syndrome (AIDS), compared with 26.0% of men. Excluding patients with AIDS, HIV infection was recognized in 13.2% of women and 27.0% of men. HIV infection was recognized only in women aged 25 through 44 years. In men, recognition occurred in all age groups. Clinical presentation did not distinguish the seropositive from seronegative women. Risk assessments were recorded less frequently for women (11.2%) than men (15.9%). For 92.5% of persons with any behavioral risk assessment, injecting drug use was the only behavior assessed. CONCLUSIONS. HIV infection is underrecognized in women, in part, because of a lower prevalence of AIDS. Universal HIV risk assessment, which includes heterosexual behaviors, may help increase recognition of HIV in women and opportunities for early intervention.     

Knowledge of partner risk and secondary transmission of HIV

BACKGROUND: The number and proportion of people living longer with HIV and the proportion of people infected heterosexually have increased. We measured the frequency with which people with heterosexually acquired AIDS knew their partners' risk behaviors, the extent of secondary heterosexual transmission of HIV, and characterized people at risk for secondary heterosexual transmission. METHODS: For each of five sites (Alabama, California, Florida, New Jersey, and Texas) and for New York City, a sample of adults with AIDS was interviewed. Primary heterosexual transmission was contact with a partner who had a known risk factor for HIV infection. Secondary transmission was contact with an HIV-positive partner not known to have a risk for HIV. RESULTS: Among men, 35% knew that a sexual partner was HIV infected, 56% of women knew that a sexual partner was HIV infected. Among women, 12% knew that a partner was bisexual. Overall, 79% (460 of 581) reported a partner with a primary risk for HIV; among men, 236 of 293 (81%), and among women, 224 of 288 (78%) reported a partner with a primary risk. People categorized with secondary transmission were significantly more likely to be black and never married. People categorized with secondary transmission were more frequently women (53%), had less than a high school education (48%), and a history of drug use (52%). Men categorized with secondary transmission of HIV had a mean of 22 heterosexual partners; women had a mean of 16 partners. CONCLUSIONS: We found that many heterosexuals with AIDS did not know their sexual partners' risk for HIV, and that secondary heterosexual transmission probably results in a small proportion of all AIDS cases in the U.S.     

中山市HIV感染者流行病学分析和随访调查

目的　通过对中山市艾滋病病毒 (HIV)感染者的分析和随访 ,了解其HIV的传播途径、高危行为和生存现状 ,为干预HIV传播提供依椐。方法　于 1992～ 2 0 0 3年每年对中山市新发现的HIV感染者建立档案 ,制订个人健康咨询随访表 ,2 0 0 0年起每年进行一次咨询随访 ,了解其健康状况、去向及家属感染状况。结果　共新发现HIV感染者 72 5例 (其中艾滋病患者 12例 ) ,感染途经以静脉吸毒为主 ,占 89 93% ,有偿献血、单采浆及受血感染占 2 6 2 % ,性接触感染占 6 90 %。咨询随访前后吸毒者共用针具率分别为 98 4 7% (6 4 2 / 6 5 2 )、5 6 2 5 % (171/ 30 4 ) ,差异有显著性 (P <0 0 1) ,咨询随访三年后仅 2人坚持戒毒。咨询随访前非婚性行为发生率为 2 4 0 0 % (15 8/ 6 5 8) ,15 8例有非婚性行为者咨询随访前后从不使用安全套分别占 80 38%、4 5 5 7% ,差异有显著性 (P <0 0 1)。 1999～ 2 0 0 3年随访者共发生相关疾病死亡 96例 (其中新发现及发展为艾滋病患者死亡 2 2例 ) ,入院治疗仅 6 1人次。结论　中山市HIV感染途经以静脉吸毒为主 ,并存在性传播的危险 ,感染者生活质量低。应加强HIV感染者健康教育 ,减少二代感染 ,并帮助感染者进行抗病毒治疗 ,提高HIV感染者生活质量。     

Gender differences in HIV progression to AIDS and death in industrialized countries: slower disease progression following HIV seroconversion in women

To evaluate sex differences in human immunodeficiency virus (HIV) disease progression before (pre-1997) and after (1997-2006) introduction of highly active antiretroviral therapy, the authors used data from a collaboration of 23 HIV seroconverter cohort studies from Europe, Australia, and Canada restricted to the 6,923 seroconverters infected through injecting drug use and sex between men and women. Within a competing risk framework, they used Cox proportional hazards models allowing for late entry to evaluate sex differences in time from HIV seroconversion to death, to acquired immunodeficiency syndrome (AIDS), and to each first AIDS-defining disease and death without AIDS. While no significant sex differences were found before 1997, from 1997 onward, women had a lower risk of AIDS (adjusted cumulative relative risk (aCRR) = 0.76, 95% confidence interval (CI): 0.63, 0.90) and death (adjusted hazard ratio = 0.68, 95% CI: 0.56, 0.82) than men did. Compared with men, women also had lower risks of AIDS dementia complex (aCRR = 0.23, 95% CI: 0.07, 0.74), tuberculosis (aCRR = 0.60, 95% CI: 0.39, 0.92), Kaposi's sarcoma (aCRR = 0.27, 95% CI: 0.07, 0.99), lymphomas (aCRR = 0.47, 95% CI: 0.23, 0.96), and death without AIDS (aCRR = 0.74, 95% CI: 0.56, 0.98). Sex differences in HIV disease progression have become larger and statistically significant in the era of highly active antiretroviral therapy, supporting a stronger impact of health interventions among women.     

Implementation of named HIV reporting--New York City, 2001

Since 1981, population-based surveillance data on acquired immunodeficiency syndrome (AIDS) have been used in New York City (NYC) to monitor the human immunodeficiency virus (HIV) epidemic. In June 2000, the NYC Department of Health and Mental Hygiene (NYCDOHMH) began tracking diagnoses of HIV (non-AIDS) in addition to AIDS diagnoses. This report describes epidemiologic data from the first full calendar year of named HIV reporting in NYC. The findings indicate that, compared with persons living with AIDS (PLWA), persons who had HIV diagnosed during 2001 were more likely to be female, non-Hispanic black, younger (i.e., aged <45 years), and residents of the Bronx or Brooklyn. These newly available data describe the NYC population with HIV infection more accurately than data on PLWA and can be used to redirect HIV-prevention efforts to better target persons at highest risk for acquiring HIV infection.     

Women, drugs and HIV/AIDS: results of a multicentre European study

BACKGROUND: In the light of rising human immunodeficiency virus (HIV) incidence rates amongst women in Western Europe, a multicentred, cross-sectional study was undertaken to explore the multitude of possible factors associated with HIV in a population of female injecting drug users (IDU). METHODS: Face-to-face interviews were conducted with 1198 female IDU recruited from a variety of settings in Paris, Madrid, Rome, London and Berlin. Their HIV status was determined from antibody testing of blood or saliva samples or from written confirmation of HIV test results from a physician. A hierarchical logistic regression model was used to identify direct and indirect associations between socioeconomic factors, marginalization and risk behaviour with HIV prevalence. RESULTS: The HIV prevalence in the sample of female IDU was 27.8% (range: 1.4% in London and 52.6% in Madrid). Factors independently associated with HIV prevalence in the regression analysis included: age >25 years (OR = 2.0-2.9), left full-time education before age 14 (OR = 2.4), no fixed address (OR = 2.2), previous imprisonment (OR = 1.4), commercial sex (OR = 1.3), having a regular HIV positive sexual partner (OR = 6.6), ever shared needles (OR = 1.5) and any sexually transmitted disease (STD) infection in the last year (OR = 1.7). CONCLUSIONS: The sexual behaviour and partners of female IDU in Western Europe are as important a component in explaining the HIV epidemic in this population as other risk factors, including high-risk drug taking behaviour. Homeless IDU women may be an important residual risk group warranting future preventive interventions and women with a history of STD should be a particular target for health education. Differences in HIV prevalence across cities are very large and may be related to differences in harm reduction policies.     

HIV seroprevalence and exposure categories among adolescents tested at a sexually transmitted clinic diseases. Madrid, 1986-2000]

OBJECTIVE: To describe the time-trend in exposure categories and HIV seroprevalence among adolescents who underwent to voluntary testing in the period 1986-2000. METHODS: This study covered all adolescents, aged 13 to 19 years, at their first test for HIV in a sexually transmitted disease clinic in Madrid. Gender, age and HIV risk behaviours were collected. HIV diagnosis relies on ELISA test and Western blot confirmation. Time trends in HIV seroprevalence and exposure categories were analysed. RESULTS: A total of 1327 adolescents, 52% women and 22% under 18 years, were studied. The annual number of adolescents remained through the time, but injecting drug users (IDU) and IDU partners declined and female sex workers rose. 108 adolescents were diagnosed with HIV infection -71% were IDU-. HIV seroprevalence was 8.1% -31.3% in IDU-. It declined from 18.2% in 1986 to 1.5% in 1995, and after then it held steady under 4%. This decline involved several risk categories and was statistically significant in homo/bisexual men and female sex workers. The logistic regression analysis, adjusting for changes in exposure categories, showed an annual reduction in HIV seroprevalence (OR = 0.87; 95% CI, 0.81-0.94). CONCLUSIONS: HIV seroprevalence has decreased due to the fall of new young IDU and the decrease of seroprevalence within several exposure categories. HIV infections and risk behaviours continue happened among adolescents.     

Sexual relationships,secondary syringe exchange,and gender differences in HIV risk among drug injectors

Injection drug use continues to place women at risk for human immunodeficiency virus (HIV) through both risky injecting practices and risky sexual behavior with male injection drug users (IDUs). Although attendance at syringe-exchange programs (SEPs) is protective against HIV, a recent study found that women attending SEPs who exchanged syringes for other people (secondary exchange) were at greater risk for HIV seroconversion, potentially through risky sexual behavior. We examined this question in a sample of 531 IDUs (175 women and 356 men) attending 23 SEPs in California in 2001. Findings indicated that women were more likely than men to engage in secondary exchange and were more likely to have IDU sexual partners. In multivariate analysis among women, secondary exchange was independently associated with distributive syringe sharing, not engaging in receptive sharing, and not exchanging sex for money or drugs. Multivariate analysis among men found that having an IDU sexual partner was associated with secondary exchange. Women’s sexual risk behavior was not associated with secondary exchange, and although women’s secondary exchange was associated with individual protection for injection-related behaviors, it may increase network risk. More information on network members is needed to understand gender differences in secondary exchange. Dr. Bluthenthal is with the Health Program and Drug Policy Research Center, RAND. and Drew Center on AIDS Research, Education, and Services (CARES), Department of Psychiatry, Charles R. Drew University of Medicine and Science.     

Increasing Intention to Comply with Pharmaceutical Product Instructions: An Exploratory Study Investigating the Rolesof Frame and Plain Language

ABSTRACT

Purpose: The purpose of this study was to describe the coverage and portrayal of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) risk factors as framed in newspapers targeting Aboriginal (First Nations, Métis, and Inuit) peoples in Canada.

Methods: From a sample of 31 Aboriginal newspapers published in English from 1996 to 2000, 14 newspapers were randomly selected. Of the 167 articles published on HIV/AIDS during this time period, all anecdotal (n = 34) and an approximate 25% random sample of scientific (n = 32) articles were analyzed using both quantitative (coding reliability and frequencies) and qualitative (in-depth content analysis) analyses.

Results: Individual risk factors for HIV/AIDS were described in 74% (49/66) of the articles and included unprotected sexual intercourse (20/49 or 41%), sharing of needles for injection drug use (IDU; 16/49 or 33%), infected blood transfusions (3/49 or 6%), and vertical transmission from mother to baby (10/49 or 20%). Additional risk factors of alcohol use and poverty were mentioned in 29% and 25% of the articles. In addition to the well-recognized HIV/AIDS risk groups of prostitutes and homosexual men, sexual abuse victims, prisoners, and women were identified in Aboriginal newspapers as being at risk. Although Aboriginal women were identified as being at high risk, the newspaper coverage also emphasized their lack of knowledge regarding HIV/AIDS. Heterosexual men were not mentioned as being at risk for HIV/AIDS in the newspaper articles.

Background: The prevalence of HIV/AIDS is higher among Canadian Aboriginals than in the general population. Local and community newspapers are an important channel for the dissemination of health information for isolated, rural, and Aboriginal communities.

Interpretation: The findings show that Aboriginal media identify high-risk groups and individualistic risk factors for HIV/AIDS, within a public health perspective. The articles also emphasize, however, Aboriginal people's lack of knowledge about disease transmission and the full spectrum of who is at risk.     

广东省1986～1999年艾滋病患者与艾滋病病毒感染者流行特征及趋势

目的：分析广东省艾滋病毒者与艾滋病毒感染者（HIV／AIDS）流行现状及影响因素,寻找控制措施,方法：分析全省的HIV常规、哨点、行为监测及实际实验室资料,结果：1996年底首次发现静脉吸毒者HIV阳性以来,HIV／AIDS报告数平均上升86．2％,静脉吸毒占的比例从1996年前的1．4％上升到1999年的91．0％,吸毒者61．3％为HIV－1C亚型,结论：HIV／AIDS疫情已进入快速增长期,静脉吸毒为主要传播途径;当前工作重点是预防HIV／AIDS从吸毒人群向吸以及一般人群传播,并开展行为监测和干预。     

The disclosure of celebrity HIV infection: its effects on public attitudes.

OBJECTIVES. Despite the magnitude of the acquired immunodeficiency syndrome (AIDS) epidemic, studies have shown low levels of public concern about human immunodeficiency virus (HIV)/AIDS. We investigated the effects of celebrity disclosure of HIV infection on the AIDS-related perceptions of urban men. METHODS. Measures of AIDS-related perceptions were collected from 361 men waiting for mass transportation in downtown Chicago; 252 were assessed at three time points prior to and 109 were assessed at two time points after professional basketball star Earvin "Magic" Johnson's disclosure of his HIV infection. RESULTS. Significant increases in concern about AIDS, interest in AIDS information, and talking with friends about AIDS occurred after celebrity disclosure of HIV infection. CONCLUSIONS. Celebrity disclosure of HIV seropositivity demonstrated a marked change in AIDS-related perceptions among the men surveyed. Changes in awareness due to celebrity disclosure may lead to increased readiness to reduce risk and could be viewed as a window of opportunity for HIV prevention efforts.     

Estimating the size of the HIV epidemic among injecting drug users in Amsterdam

Aim of this study was to assess the cumulative incidence of HIV-infection, AIDS and pre-AIDS death in the population of injecting drug users (IDU) in Amsterdam. By assuming equivalence, between a cohort of IDU and the IDU population, of the ratios of incidences of AIDS and pre-AIDS death to the number of HIV positive persons giving rise to these incidences, the numbers of HIV positive persons and pre-AIDS deaths in the population could be calculated, given that other parameters were known. Cohort study data on HIV prevalence and incidences of HIV infection, AIDS, and pre-AIDS death, were combined with national AIDS surveillance data. As of 1 October 1994, the estimated cumulative number of HIV positive IDU in Amsterdam was approximately 1280, far higher than a recent back-calculation estimate. Of the 1280, 204 HIV positive IDU had been diagnosed with AIDS, while about 270 had died pre- AIDS. The HIV prevalence of IDU residing in Amsterdam that were still alive and free of AIDS was hence estimated at around 800. Since the incidence of pre-AIDS death and AIDS exceeded the number of seroconversions during the past four years, the HIV epidemic among IDU in Amsterdam appears to be dwindling. A lower bound of the number of HIV positive IDU being alive, AIDS-free and living elsewhere in the Netherlands was roughly estimated at 600. Because of untimely deaths, only a limited number of HIV positive IDU can be expected to be diagnosed with AIDS in the future. Since these estimates are based upon some rather bold assumptions, they should be interpreted with caution and require further validation by independent sources.     

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.