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Where people reside when they are diagnosed with HIV infection or AIDS has been an important question throughout the epidemic. Along with identification of early epicenters of HIV transmission, HIV surveillance data have allowed the Centers for Disease Control and Prevention (CDC) to monitor the geographic dispersion of HIV in the United States and guide efforts to prevent and control disease.
There are many ways to characterize and define areas by population size; this report uses the Office of Management and Budget designations for metropolitan statistical areas. Persons diagnosed and reported with either HIV or AIDS are assigned, based on the place of residence at diagnosis, to a large metropolitan area (population greater than or equal to 500,000), a medium-size metropolitan area (population 50,000 to 499,999), or a nonmetropolitan area (population of less than 50,000). Historically, the majority of HIV and AIDS cases in the United States have been diagnosed in large metropolitan areas.
Population areas are generally defined as “urban” if they have a population greater than or equal to 50,000. The AIDS epidemic in the United States is still predominately urban: in 2006, 82% of AIDS cases were reported from large metropolitan areas and 11% were reported from medium-size metropolitan areas. However, there is a growing number of people diagnosed and living with HIV infection in nonmetropolitan (i.e., rural) areas. In 2006, 2,696 cases of AIDS were reported among adults and adolescents (age 13 years and older) from rural areas and 26,154 adults and adolescents were estimated to be living with AIDS in rural areas. While the numbers may be small in comparison to urban areas, there are many challenges facing persons diagnosed and living with HIV infection in rural areas today.
As of 2006, data from the U.S. Census showed 65% of the general population of the United States was living in large metropolitan areas, 19% in medium-size metropolitan areas, and 17% in nonmetropolitan areas. Overall distribution of population by geographic region was: 18% in the Northeast, 36% in the South, 22% in the Midwest, and 23% in the West. (See Technical Notes for a description of the states in each region.)
In 2006, 67% of all rural AIDS cases among adults and adolescents were reported from the South, 14% were reported from the Midwest, 12% were reported from the Northeast, and 7% were reported from the West. There were also differences in the percentage of rural cases within each geographic region: in the Northeast and West 3% of all AIDS cases in 2006 were reported from rural areas, in the Midwest this was 8%, and in the South this was 10%
Data for this supplement were collected by state and local health departments using the HIV/AIDS Reporting System. Data on AIDS cases by year of report are included from the 50 states and District of Columbia; data on cases of HIV infection (not AIDS) by year of report are included from the 46 states that had implemented name-based HIV infection reporting as of December 2006. The supplement also includes estimated data on diagnoses of HIV infection (not AIDS) from the 33 states that have had confidential name-based HIV infection reporting for a sufficient length of time (at least 4 years) to allow for stabilization of data collection and for adjustment of data to monitor trends (see Technical Notes). Data on transmission category have been statistically adjusted to redistribute cases in persons initially reported without an identified risk factor (see Technical Notes). Data are presented by either state or geographic region to highlight similarities and differences. Although greater numbers of cases generally correspond to large metropolitan areas, the importance of cases in the medium-size metropolitan and nonmetropolitan (rural) areas should be noted. Persons with HIV or AIDS who reside in rural areas may be geographically dispersed throughout an entire state; this dispersion may pose unique challenges to the delivery of HIV-related services.
Table 1 displays AIDS cases by state of residence at diagnosis and the population size of the area of residence, reported in 2006 and cumulative. In 2006, New York reported the highest number of AIDS cases (5,436) and North Dakota reported the lowest number (6).
Table 2 shows reported AIDS rates (per 100,000 population) in 2006, by geographic region and population size. The highest rates by each population size—large metropolitan, medium metropolitan, and nonmetropolitan—occurred in the South.
Table 3 displays reported AIDS cases by geographic region, race/ethnicity, and population size, cumulative through 2006. The cumulative number of reported AIDS cases was highest among blacks/African Americans in large metropolitan areas from the South and Northeast. This table also shows that the greatest numbers of cumulative AIDS cases were from the South, regardless of the population size. In
Table 4, blacks/African Americans had the highest rate of AIDS cases reported in 2006 in all four geographic regions of the country.
Table 5 shows reported AIDS cases and rates in 2006 by geographic region and race/ethnicity, comparing rural areas versus urban areas. The greatest number of AIDS cases among blacks/African Americans in rural areas (1,118) was reported from the South. The reported AIDS rate for blacks/African Americans in rural areas was highest in the Northeast, followed by the Midwest, South, and West; the reported AIDS rates for Hispanics/Latinos in rural areas followed a similar pattern.
Figure 1 is a graphical representation of AIDS cases by geographic region, race/ethnicity, and population size, reported in 2006. The percent distribution of estimated AIDS cases among males by geographic region, population size, and HIV transmission category are displayed in
Figure 2. Male-to-male sexual contact accounted for the greatest percentage of cases for all regions and all areas of residence. In the Northeast, injection drug use accounted for one-quarter to one-third of estimated AIDS cases, depending on the population size. In
Figure 3, the percent distribution of estimated AIDS cases among females is displayed by geographic region, population size, and HIV transmission category. For females, high-risk heterosexual contact (defined as heterosexual contact with a person known to have, or to be at high-risk for, HIV infection [such as an injection drug user]) represents the majority of cases for all geographic regions and areas of residence. As with men, injection drug use represents a higher percentage of cases in the Northeast compared to other geographic regions.
Figure 4 displays the percent of reported AIDS cases among men by geographic region, population size, and race/ethnicity in 2006;
Figure 5 shows similar data for women.
Figure 6 shows the distribution of reported AIDS cases by population size from 1994 through 2006; the distribution has remained fairly consistent over that time period.
Figures 7 and 8 show the reported AIDS and HIV infection (not AIDS) cases, respectively, in rural areas by state of residence in 2006; Figure 7 also shows the percentage of rural AIDS cases by state. Finally,
Figure 9 displays the estimated number of adults and adolescents living with HIV infection (not AIDS) or AIDS at the end of 2006 in nonmetropolitan areas by area of residence.
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