AIDS case reports, based on confidential name-based surveillance, are reported to CDC from all 50 states, the District of Columbia, U.S. dependencies and possessions, and independent nations in free association with the United States¹. Reporting of HIV and AIDS is regulated, legislated, or otherwise mandated by state health authorities. While CDC has advised that states use the same confidential name-based approach for HIV surveillance as is currently used for AIDS surveillance nationwide, the specific implementation decision rests with the individual state or territorial heath agencies. In most areas, both providers and laboratories are required to report cases of HIV and AIDS. When states elect to implement non-name-based HIV reporting, the selected coded patient identifier format is also mandated at the state level—frequently reflecting input from affected constituency groups, such as HIV infected persons and HIV/AIDS service providers. Based on differing state statutes and data collection practices, some states and territories have elected to implement coded patient identifiers constructed of portions of different personal identifiers.

HIV infection cases presented in this report are those cases reported to the participating state or territorial agencies through December 2000 and are based on the 2000 HIV case definition for public health surveillance*. Positive HIV test results for persons who tested anonymously are not included in these data.

The annual and cumulative numbers presented in this technical report are influenced by the duration of HIV reporting in each area, and the specific rules enacted in the implementation of reporting - particularly the reporting of prevalent (previously diagnosed but unreported) cases. Some states have opted to require the reporting of all persons diagnosed with HIV who are receiving care, including those initially diagnosed before the implementation of reporting. Other states have implemented systems to allow reporting of only newly diagnosed cases, and only at the time of first diagnosis. Therefore, for states that have recently implemented HIV reporting (in place less than two years) which includes the reporting of prevalent cases, the numbers of cases may represent the reporting of both prevalent and newly diagnosed cases. This may lead to higher annual reported case counts in initial reporting years than will be observed over time; as fewer prevalent cases remain to be reported, annual case counts more accurately represent incident diagnoses. Reported cases per 100,000 population using 2000 U.S. Census data are presented to allow a standard representation of the cases being reported among the different areas, and do not represent the incidence rate of HIV infection for those areas.

Some states also require that public health agencies receive notification of all HIV infected patients receiving care, including those already reported to public health. In addition, prior to statewide HIV reporting, some areas that implemented HIV reporting using coded patient identifiers had collected reports of HIV infection from selected populations; therefore, cumulative HIV case counts may include cases reported prior to the initiation of mandated HIV reporting (Table 5). In these situations, duplicate reporting of patients can occur over time and will require accurate methods for matching the coded patient identifiers to maintain a de-duplicated HIV surveillance registry. A state with HIV infection reporting also may report persons testing positive in that state who are residents of other states. As data from the areas in this report do not undergo national de-duplication algorithms, some cases from states using coded patient identifiers may represent cases also, inadvertently, reported in other states. For these reasons, readers should not compare results between different States, and should use caution in interpreting the case counts and rates.

Reference

^*Centers for Disease Control and Prevention. 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):1-27.