The June 2007 revision of the
2005 HIV/AIDS Surveillance Report includes revised and corrected data on estimated AIDS cases for the period 2001 to 2005. Errors in the numbers of estimated AIDS cases included in the original version of the report are corrected in the Commentary,
Tables 1–6 and
8–12,
Figure 1, and
Maps 1 and
2 of the revised report. The errors did not affect reported cases of HIV or AIDS. The errors in the numbers also affected data used in the March 9, 2007 MMWR titled
Racial/Ethnic Disparities in Diagnoses of HIV/AIDS —33 States, 2001–2005. Errors in the estimated number of cases in the original article are corrected in the revised MMWR text and
Tables 1–3. Further information on the error made in the estimation of AIDS cases for 2001 to 2005 and the corrections made can be found at
http://www.cdc.gov/hiv/datarevision.htm |
During
2001–2004, blacks* accounted for 51% of
newly diagnosed human immunodeficiency virus
(HIV)/acquired immunodeficiency syndrome
(AIDS) infections in the United States
[1].
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 184,170 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.
For this report,
cases of HIV or AIDS were analyzed together
as HIV/AIDS (i.e., HIV infection with or
without AIDS) and counted by year of
diagnosis. Cases were classified according
to the following transmission categories: 1)
male-to-male sexual contact (i.e., among men
who have sex with men [MSM]); 2)
injection-drug use (IDU); 3) MSM with IDU;
4) high-risk heterosexual contact (i.e.,
with a person of the opposite sex known to
be HIV infected or at high risk for HIV/AIDS
[e.g., MSM or injection-drug user]); and 5)
other (e.g., hemophilia or blood
transfusion) and all risk factors not
reported or not identified. The estimated
number of HIV/AIDS diagnoses for each
racial/ethnic population by transmission
category and selected characteristic was
calculated. For 2005, estimated diagnosis
rates per 100,000 population were calculated
for each racial/ethnic population, and rate
ratios (RRs) comparing other populations
with whites were determined. In addition,
estimated HIV§ prevalence and
AIDS¶ prevalence rates for blacks
living with HIV or AIDS at the end of 2005
were calculated. Prevalence estimates were
derived from reported cases and adjusted for
delays in reporting and deaths [2].**
Estimated HIV and AIDS prevalence rates per
100,000 population were calculated for each
state and the District of Columbia (DC).
Although adult and adolescent blacks
accounted for 13% of the population in the
33 states during 2001–2005 [3], they accounted for
50.5% of the 184,170 new HIV/AIDS diagnoses;
whites accounted for 72% of the population
and 29.3% of diagnoses, and Hispanics
accounted for 13% of the population and
18.1% of diagnoses. Among racial/ethnic
populations, blacks accounted for the
largest percentages of cases diagnosed in
both males (43.9%) and females (67.2%) (Table
1).
During
2001—2005, blacks had the largest
percentage of HIV/AIDS diagnoses in all age
groups and in the IDU and high-risk
heterosexual transmission categories (Table
1). Among men and women with IDU and
persons with high-risk heterosexual contact,
more than half were black (men: 54.0% and
65.7%, respectively; women: 58.9% and 69.5%,
respectively). More MSM with HIV/AIDS
diagnoses were white (42.8%), with smaller
proportions of blacks (36.1%) and Hispanics
(19.0%).
During
2001–2005, adults aged 25–44 years
accounted for a majority of HIV/AIDS
diagnoses regardless of racial/ethnic
population (Table
1). Among persons aged 25–34 and 35–44
years, blacks accounted for the greatest
proportion of cases (48.0% and 47.4%,
respectively). By region,††
blacks accounted for the majority of
diagnoses in the South (54.4%) and Northeast
(52.0%) (Table
1). Black males accounted for more new
HIV/AIDS diagnoses than males of any other
racial/ethnic population in the South
(47.5%) and Northeast (46.0%). Among
females, blacks accounted for the majority
of HIV/AIDS diagnoses in the South (71.5%),
Northeast (64.3%), and Midwest (63.5%),
compared with other racial/ethnic
populations.
Among black
males and females, the age distribution of
persons who had HIV/AIDS diagnosed varied by
transmission category (Table
2). By transmission category, most
HIV/AIDS diagnoses of black male adults and
adolescents were classified as MSM (29,814
[51.4%]), followed by high-risk heterosexual
contact (14,686 [25.3%]), IDU (10,463
[18.0%]), MSM with IDU (2,715 [4.7%]), and
other (323 [0.6%]). Most HIV/AIDS diagnoses
among black female adults and adolescents
were classified as high-risk heterosexual
contact (28,114 [80.3%]), followed by IDU
(6,438 [18.4%]), and other (467 [1.3%]) (Table
2).
In 2005, the
estimated annual HIV/AIDS diagnosis rate
among black males was 124.8 per 100,000
population and among black females was 60.2
per 100,000, both higher than the rates for
all other racial/ethnic populations. Among
males, the annual HIV/AIDS diagnosis
black/white RR of 6.9 was higher than the
Hispanic/white RR of 3.1. Among females, the
black/white RR was 20.1, and the
Hispanic/white RR was 5.3.
In 2005, overall
estimated HIV (i.e., without AIDS) and AIDS
prevalences were higher among blacks than
among all other racial/ethnic populations.
Among blacks, the estimated HIV prevalence
(in 33 states) was 518 per 100,000
population, ranging from 106 (Alaska) to 865
(New Jersey); the estimated AIDS prevalence
(in the 50 states and DC) was 631 per
100,000 population and ranged from 79
(Wyoming) to 3,130 (DC) (Table
3).
Reported by:
T Durant, PhD, K McDavid, PhD, X Hu, MS,
P Sullivan, DVM, PhD, R Janssen, MD, Div of
HIV/AIDS Prevention; K Fenton, MD, PhD,
Office of the Director, National Center for
HIV/AIDS, Viral Hepatitis, STD, and TB
Prevention, CDC.
Editorial Note:
During 2001–2005, HIV/AIDS diagnoses,
diagnosis rates, and RRs were higher among
black males and females than among any other
racial/ethnic population in the United
States. In 2005, the annual rates of
HIV/AIDS diagnosis among black men and women
were seven and 20 times higher than rates
among white men and women, respectively. For
black men, sexual contact with men was the
primary mode of HIV infection; for black
women, high-risk heterosexual contact was
the primary mode. In a recent study of MSM
in five cities, 46% of blacks were infected
with HIV, compared with 21% of whites and
17% of Hispanics [4].
In 2004, HIV/AIDS was the fourth-leading
cause of death among blacks aged 25–44
years in the United States [5].
During 2001–2004, HIV diagnosis rates
among black males and females declined by
4.4% and 6.8%, respectively [1].
A 2007 study reported similar declines among
blacks in Florida [6].
These declines were observed among black
heterosexuals and injection-drug users but
not among MSM. Although these declines in
rates of new HIV diagnoses are encouraging,
they might not directly reflect trends in
HIV incidence because they are also affected
by changes in testing behavior and
surveillance practices. Regardless of the
trends, blacks remain disproportionately
affected by high rates of HIV/AIDS. Several
factors might contribute to these higher
rates (e.g., higher overall prevalence of
infection and undiagnosed infection among
MSM or greater likelihood among females of
high-risk heterosexual contact) [7].
The findings in this report are subject
to at least two limitations. First, the data
were reported from states with confidential,
name-based HIV/AIDS surveillance systems and
are not necessarily representative of all
persons in the United States testing
positive for HIV. Diagnoses of HIV/AIDS from
areas with historically high AIDS morbidity
that do not conduct confidential, name-based
surveillance (e.g., California, Illinois,
and DC) were not included. However, the
racial/ethnic disparities described in this
report are similar to disparities observed
among persons with AIDS from all 50 states [8].
Second, the findings might be affected by
statistical adjustments made for reporting
delays and for cases reported with no
identified risk factor. Such cases were
reclassified based on data obtained from
follow-up investigations and were assumed to
constitute a representative sample of all
cases initially reported without a risk
factor. However, this assumption might not
be valid, potentially affecting the accuracy
of the estimated distribution of cases by
transmission category.
The high rate of infection among blacks
highlights the need to scale up known,
effective HIV-prevention interventions and
to implement new, improved, and culturally
appropriate HIV/AIDS strategies. CDC, along
with public health partners and community
leaders, is announcing its Heightened
National Response to the HIV/AIDS Crisis
among African Americans to reduce the toll
of this disease. This response will focus on
four main areas: 1) expanding the reach of
prevention services, including ensuring that
federal prevention resources are expended
where the need is greatest; 2) increasing
opportunities for diagnosing and treating
HIV, including encouraging more blacks to
know their HIV serostatus; 3) developing
new, effective, prevention interventions,
including behavioral, social, and structural
interventions; and 4) mobilizing broader
action within communities to help change
community perceptions about HIV/AIDS, to
motivate blacks to seek early HIV diagnosis
and treatment, and to encourage healthy
behaviors and community norms that prevent
the spread of HIV.
CDC will expand its partnerships with
other federal agencies, state and local
health departments, academic institutions,
and community-based organizations to enhance
research, policy, prevention services,
testing, and linkage to care for blacks. CDC
and public health partners will work with
black faith, entertainment, media, civic,
education, and business leaders and others
who have not been historically involved in
HIV prevention to address community
awareness, perceptions, testing, and
behavior. A collective response involving
multiple sectors of society is required to
reduce transmission of HIV/AIDS among blacks
in the United States. Additional information
regarding CDC's Heightened National Response
to the HIV/AIDS Crisis among African
Americans is available at the
Heightened Response Web site.
References
-
CDC.
Racial/ethnic disparities in
diagnoses of HIV/AIDS—33 states,
2001–2004. MMWR 2006;55:121–5.
- Green T. Using surveillance data to
monitor trends in the AIDS epidemic.
Stat Med 1998;17:143–54.
-
US Census Bureau.
Population estimates: entire data set.
Washington, DC: US Census Bureau;
2001–2005.
-
CDC.
HIV prevalence, unrecognized
infection, and HIV testing among men who
have sex with men—five U.S. cities,
June 2004–April 2005. MMWR
2005;54:597–601.
- CDC.
Web-based Injury Statistics
Query and Reporting System (WISQARS).
Atlanta, GA: US Department of Health and
Human Services, CDC.
-
CDC.
HIV/AIDS among blacks—Florida,
1999–2004. MMWR 2007; 56:69–73.
- Millett G, Malebranche D, Mason B,
Spikes P. Focusing "down low": bisexual
black men, HIV risk and heterosexual
transmission. J Natl Med Assoc 2005;97(7 Suppl):52S–59S.
-
CDC.
HIV/AIDS surveillance report, 2005.
Vol. 17. Rev ed. Atlanta, GA: US
Department of Health and Human Services,
CDC; 2007.
Notes
*
For this report, persons
identified as white, black, Asian/Pacific
Islander, American Indian/Alaska Native, or
of other/unknown race are all non-Hispanic.
Persons identified as Hispanic might be of
any race.
† 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.
§ Includes only persons living with HIV that had not progressed to AIDS.
These data were reported by the 33 U.S.
states with confidential, name-based HIV
reporting since at least 2001. Because HIV
can be diagnosed at any time in the disease
spectrum, the time between HIV and AIDS
diagnoses varies.
¶ Includes only persons living with AIDS. Cases were from the 50 U.S.
states and the District of Columbia (DC).
Because DC is not a state, caution should be
exercised when comparing DC AIDS rates with
those of the states.
**
Reporting delays (i.e., time between
diagnosis and report) can differ by
geographic location, age, sex, transmission
category, and racial/ethnic population.
Adjustments for reporting time were
calculated for HIV and AIDS cases using a
maximum likelihood statistical procedure
that accounts for differences in reporting
time for the preceding characteristics while
assuming the reporting delay has remained
constant over time. Adjustments also were
made for cases initially reported without
transmission category information.
Adjustments for adults and adolescents were
based on the redistribution of cases across
transmission categories by sex,
race/ethnicity, and geographic region for
cases diagnosed 3–10 years earlier and
initially classified as reported without
risk factor information but later
reclassified.
††
Northeast: New Jersey and New York.
Midwest: Indiana, Iowa, Kansas,
Michigan, Minnesota, Missouri, Nebraska,
North Dakota, Ohio, South Dakota, and
Wisconsin. South: Alabama, Arkansas,
Florida, Louisiana, Mississippi, North
Carolina, Oklahoma, South Carolina,
Tennessee, Texas, Virginia, and West
Virginia. West: Alaska, Arizona,
Colorado, Idaho, Nevada, New Mexico, Utah,
and Wyoming.
Table
1
Table
2
Table
3
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