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The
Supplement to HIV/AIDS Surveillance (SHAS), a cross-sectional interview
project begun in 1990, is designed to
collect behavioral surveillance data beyond what is found on the standard
HIV/AIDS case report form. The study has been reviewed and approved by institutional
review boards (IRBs) at the CDC and local levels. HIV-infected persons who
are age 18 years and older, who are reported through routine disease surveillance
to participating state and local health departments, and who, at some sites,
attend a participating health care facility, are eligible for interview.
During the period covered by this report, 12 health departments participated
in SHAS. Participants are enrolled through 1 of 3 methods: (a) facility-based
recruitment of all eligible persons seeking treatment at selected health
care facilities in Denver (Colorado), Hartford and New Haven (Connecticut),
Jacksonville, Miami and Tampa (Florida), Atlanta (Georgia), Detroit (Michigan),
and Jersey City and Paterson (New Jersey); (b) population-based recruitment
of all eligible persons in Arizona, Delaware, New Mexico and South Carolina
(3 health districts); and (c) population-based recruitment of a 30% sample
of men who have sex with men (MSM) and 100% of all other eligible persons
in the state of Washington and Los Angeles County, California. At 7 sites
(Arizona, Denver, Detroit, Florida, New Jersey, New Mexico and South Carolina)
persons with HIV and AIDS were interviewed; at the remaining sites only persons
with AIDS were interviewed. (Florida began reporting cases of HIV infection
[not AIDS] in July 1997 and New Mexico instituted their HIV reporting in
January 1998.) After obtaining informed consent, trained interviewers administer
a standard questionnaire in either English or Spanish. The data collection
modules include questions about demographics, drug and alcohol use, sexual
behaviors, HIV diagnosis and treatment, and use of social services.
Over time the project questionnaire has been modified to collect data on emerging
issues related to the HIV epidemic. Data in this report are from SHAS interviews
conducted from June 1997 through December 2000. Highly active antiretroviral
therapies (HAART) became widely available in the mid-1990s, and soon after,
questions on the use of, and adherence to, these therapies were added to the
SHAS questionnaire.
Table 2 shows the demographic characteristics of SHAS participants. By use
of a recoding algorithm, persons are assigned into the Hispanic race/ethnicity
category if they considered themselves to be Hispanic or Latino, regardless
of the racial category they designated. Behavioral data from SHAS are used
to refine the HIV exposure risk recorded in the national HIV/AIDS Reporting
System (HARS). In HARS, the category of exposure to HIV is determined primarily
through review of medical records. For surveillance purposes, HIV infection
cases and AIDS cases are counted only once in a hierarchy of exposure categories.
Persons with more than one reported mode of exposure to HIV infection are classified
in the exposure category listed first in the hierarchy (except for men with
a history of both male-to-male sexual contact and injection drug use; they
are assigned to a separate exposure category). Risk behavior reported in SHAS
(for example, injection drug use, male-to-male sexual contact, or heterosexual
contact with an HIV-infected person) is used to reclassify a person without
a designated risk in HARS into the appropriate risk category in the hierarchy.
Behavioral data from SHAS were used to reclassify risk for 154 persons.
Tables
3,
4 and
5 report
data on sexual risk behaviors among 3 racial/ethnic groups: non-Hispanic white,
non-Hispanic black, and Hispanic, by type of sex
partner during the 12 months before the SHAS interview. The group reported
as “Men with male sex partners” comprises men who had sex exclusively
with men as well as those who had sex with both men and women. The group reported
as “Men with female sex partners” comprises men who reported sex
exclusively with women; the group reported as “Women with male sex partners” comprises
women who reported sex exclusively with men as well as those who had sex with
both men and women. In Tables
3, 4,
5, “inconsistent
condom use” is
defined as using condoms less than half the time (includes “sometimes” and “never”).
Figure 3 displays proportions of persons who reported having ever being treated
for a sexually transmitted disease (STD), by race/ethnicity and type of sex
partner. The array of STDs making up the question include: gonorrhea (genital,
oral or rectal), syphilis, trichomoniasis, Chlamydia, anal/genital warts, anal/genital
herpes, genital ulcers, pelvic inflammatory disease (for women only), and “other” STD.
Tables 7 and
8 show data on drug- and alcohol-use behavior by participants’ race/ethnicity
and age, respectively. “Possible alcohol abuse” is defined as 2
or more positive responses to the CAGE standardized questions, which are used
to screen for possible alcohol abuse (1): “Have you ever felt you should
Cut down on your drinking?”; “Have people Annoyed you by criticizing
your drinking?”; “Have you ever felt Guilty about your drinking?”; “Have
you ever had a drink first thing in the morning to steady your nerves or get
rid of a hang-over (Eyeopener)?”.
References
- Bush B, Shaw S, Cleary P, Delbanco TL, Aronson MD. Screening for alcohol
abuse using the CAGE questionnaire. Am J Med, 1987;82:231-235.
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