This report includes data from case reports from 35 areas that had laws or regulations requiring confidential reporting, by name, for adults and adolescents and/or children with confirmed HIV infection (not AIDS), in addition to the reporting of persons with AIDS. Persons in whom HIV infection progresses to AIDS are reported as having AIDS; these persons are deleted from the HIV infection (not AIDS) tables and added to the AIDS tables.

Surveillance of AIDS

AIDS cases are reported to CDC by all 50 states, the District of Columbia, and U.S. dependencies, possessions, and associated nations, by use of a uniform surveillance case definition and case report form. In this report, cases were reported according to the 2000 surveillance case definition [1].

Tabulation of Data

The supplemental report is organized in 2 sections: (1) cases of HIV/AIDS or AIDS and (2) persons living with HIV infection (not AIDS), AIDS, or HIV/AIDS. Data estimating the number of persons with diagnoses of HIV/AIDS or AIDS and the number of persons living with HIV infection (not AIDS), AIDS, or HIV/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 distribution of races/ethnicities in the 35 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, 2005. Data for the U.S. dependencies, possessions, and associated nations are included in the table totals unless their exclusion is specified in a footnote.

Inclusion of areas with mature HIV reporting systems for analysis of cases of HIV/AIDS and of HIV infection (not AIDS)
The inclusion of areas with mature confidential name-based HIV infection reporting for the tabulation of HIV/AIDS and HIV infection (not AIDS) data was based on the date HIV 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 35 areas with laws or regulations requiring confidential name-based HIV infection reporting since 2000: 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, Wyoming, Guam, and the U.S. Virgin Islands.

Race/ethnicity
In the Federal Register of October 30, 1997 [2], the Office of Management and Budget announced the Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity, also known as Statistical Policy Directive 15. These standards, which superseded the 1977 standards, reflect a change in federal policy regarding the collection of race and ethnicity data; implementation by January 1, 2003, was mandated. At a minimum, data on the following race 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. Regardless of race, 2 ethnicity categories should be collected: Hispanic and not Hispanic.

Because data for this report were compiled from reports to CDC through June 2005, information on race/ethnicity may have been collected under 2 systems. The race/ethnicity categories in the system used through December 2005 are maintained in this report because most case reports were submitted under that system. Persons who reported multiple racial categories or whose race was unknown are included in the cumulative totals. Also, persons reported as non-Hispanic may include persons whose ethnicity was not reported.

Age groups and age category
Age groups of persons living with HIV infection (not AIDS) or with AIDS are based on the person's age as of December 31, 2004. All other age groups are based on (1) the person's age at the first documented positive result of an HIV antibody test—for persons with a diagnosis of HIV infection (not AIDS), and (2) the person's age at AIDS diagnosis—for persons with a diagnosis of AIDS.

The age category for adults and adolescents comprises persons aged 13 years and older; the age category for children comprises children aged less than 13 years.

Geographic designations
Regions 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. dependencies, possessions, and associated nations: American Samoa, the Commonwealth of the Northern Mariana Islands, the Federated States of Micronesia, Guam, Puerto Rico, the Republic of the Marshall Islands, the Republic of Palau, and the U.S. Virgin Islands

Tables of persons living with HIV infection (not AIDS) or AIDS
Estimates of the numbers of persons living with HIV infection (not AIDS) or with AIDS were derived by subtracting the estimated cumulative number of deaths of persons with HIV infection (not AIDS) or AIDS from the estimated cumulative number of persons with a diagnosis of HIV infection (not AIDS) or AIDS. Estimated diagnoses and deaths have been adjusted for reporting delays, but not for incomplete reporting. Annual estimates are given for the most recent year for which reliable estimates are available [3].

Transmission Categories
For surveillance purposes, cases of HIV/AIDS, HIV infection (not AIDS), and AIDS are counted only once in a hierarchy of transmission categories. Persons with more than 1 reported risk factor for HIV infection 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 with, or 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 “no 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 “no 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 but for whom no risk factor was identified.

References

• CDC. Guidelines for national human immunodeficiency virus case surveillance, including monitoring for human immunodeficiency virus infection and acquired immunodeficiency syndrome. MMWR 1999;48(No. RR-13):29–31.
• Office of Management and Budget. Revisions to the standards for the classification of federal data on race and ethnicity. Federal Register 1997;62:58781–58790. Available at: http://www.whitehouse.gov/omb/fedreg/ombdir15.html.
• Karon JM, Devine OJ, Morgan WM. Predicting AIDS incidence by extrapolating from recent trends. In: Castillo-Chavez C, ed. Mathematical and Statistical Approaches to AIDS Epidemiology. Berlin: Springer-Verlag; 1989:83:58–88. Lecture Notes in Biomathematics.
• CDC. Current trends: heterosexually acquired AIDS—United States, 1993. MMWR 1994;43:155–160.