Surveillance of HIV Infection

This report includes data from case reports from 38 areas that had laws or regulations requiring confidential name-based HIV infection reporting for adults, adolescents and children, in addition to the reporting of AIDS. Data in this report are from cases reported according to the 2000 revised HIV surveillance case definition [1].

Surveillance of AIDS

AIDS cases are reported to CDC by all 50 states, the District of Columbia, and U.S. dependent areas, by use of a uniform surveillance case definition and case report form. Data in this report are from cases reported according to the 2000 revised HIV surveillance case definition [1]. Persons in whom HIV infection progresses to AIDS are reported as having AIDS.

Tabulation of Data

The supplemental report is organized in 2 sections: (1) cases of HIV/AIDS and AIDS and (2) persons living with HIV/AIDS or AIDS. Data estimating the number of persons with diagnoses of HIV/AIDS or AIDS and the number of persons living with HIV/AIDS or AIDS have been statistically adjusted to correct for delays in the reporting of cases. Unreported risk factors have been statistically redistributed to better present the trends in the epidemic and the distribution of risk factors among affected populations. 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. The racial/ethnic distribution of cases of HIV/AIDS reflects the racial/ethnic distribution of the 38 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, 2007.

Inclusion of Areas with Mature HIV Reporting Systems for Analysis of Cases of HIV Infection

The inclusion of areas with mature confidential name-based HIV reporting for the tabulation of HIV/AIDS data was based on the date that HIV infection reporting was implemented in the area and the ability to calculate 4 years of reporting delays in order to display trends reliably. This report includes the 38 areas with laws or regulations requiring confidential name-based HIV infection reporting since 2003. The 38 areas comprise 33 states (Alabama, Alaska, Arizona, Arkansas, Colorado, Florida, Idaho, Indiana, Iowa, Kansas, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming) and 5 U.S. dependent areas (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, 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 Classification of Federal Data on Race and Ethnicity. Implementation by January 1, 2003, was mandated. At a minimum, data on the following racial 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. In addition to data on race, data on 2 categories of ethnicity should be collected: Hispanic or Latino and not Hispanic or Latino.

This report is the first in which the new racial categories have been used for HIV/AIDS and AIDS surveillance data. In the most recent annual surveillance report (the 2006 HIV/AIDS Surveillance Report) [3], the numbers displayed for the Asian/Pacific Islander category are not comparable to the numbers displayed for the 2 new racial categories: (1) Asian and (2) Native Hawaiian and other Pacific Islander. The Asian category includes the cases in Asians/Pacific Islanders (referred to as legacy cases) that were reported before the implementation of the new racial categories in 2003 and a small proportion of cases in Asians/Pacific Islanders that were reported after 2003 but that were reported according to the old racial category (Asian/Pacific Islander).

Age

The designation 揳dults and adolescents� refers to persons aged 13 years and older; the designation 揷hildren� refers to persons less than 13 years of age. For tables concerning persons living with HIV infection or with AIDS, the age designation is based on the person抯 age as of December 31, 2006.

For all other tables, the age designation (for example, 揳dults and adolescents�) or the specific age group (for example, 20� years) is based on the person抯 age at the time of the first documented positive result of an HIV antibody test (for persons with a diagnosis of HIV infection) or the person抯 age at the time AIDS was diagnosed.

Geographic Designations

The areas 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

U.S. dependent areas: American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands

Persons Living with HIV Infection or AIDS

Tabulations of persons living with HIV/AIDS or with AIDS do not reflect actual counts of cases reported to the surveillance system. Rather, the estimates are based on numbers of reported cases, which have been adjusted for delays in the reporting of cases and deaths.

Transmission Categories

For surveillance purposes, cases of HIV/AIDS and AIDS are counted only once in a hierarchy of transmission categories. Persons with more than one reported risk factor for HIV are classified in the transmission 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 transmission category.

Persons whose transmission 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 transmission category is classified as high-risk heterosexual contact are persons who report specific heterosexual contact with a person known to have, or to be at high 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 HIV infection unless they meet the criteria for high-risk heterosexual contact stated in the preceding paragraph. Similar to other cases among persons who were reported without information about a behavioral or transfusion risk factor for HIV infection, these cases are now classified (in the absence of other risk factor information that would classify them in another transmission category) as 搉o risk factor reported or identified� [4].

Cases in persons with no reported exposure to HIV through any of the routes listed in the hierarchy of transmission categories are classified as 搉o risk factor reported or identified.� No identified risk factor (NIR) cases include cases that are being followed up by local health department officials; cases in persons whose exposure history is missing 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 risk factor was identified.

Rates

Rates per 100,000 population were calculated for the numbers of cases of HIV/AIDS and AIDS in 2006, as well as for persons living with HIV/AIDS at the end of 2006. The population denominators used to compute these rates for the 50 states and the District of Columbia were based on official intercensal estimates for 2006 from the U.S. Census Bureau [5]. These rates differ slightly from those in the 2006 HIV/AIDS Surveillance Report; in that report, the rates were based on bridged-race estimates for 2006 obtained from the National Center for Health Statistics [6].

References

1. CDC. Guidelines for national human immunodeficiency virus case surveillance, including monitoring for human immunodeficiency virus infection and acquired immunodeficiency syndrome. MMWR 1999;48(RR-13):29�.
2. Office of Management and Budget. Revisions to the standards for the classification of federal data on race and ethnicity. Federal Register 1997;62:58781�790. Accessed August 20, 2008.
3. CDC. HIV/AIDS Surveillance Report, 2006. Vol. 18. Atlanta: U.S. Department of Health and Human Services, CDC; 2008.
4. CDC. Current trends: heterosexually acquired AIDS桿nited States, 1993. MMWR 1994; 43(9):155�0.
5. U.S. Census Bureau. Population estimates [specific files; entire data set no longer available]. Published July 1, 2006. Accessed August 20, 2008.
6. National Center for Health Statistics. Bridged-race vintage 2006 postcensal population estimates for July 1, 2000朖uly 1, 2006, by year, county, single-year of age, bridged-race, Hispanic origin, and sex. Accessed August 20, 2008.