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AIDS cases reported
1982-1996 cumulative 4,403
1996 610
Crude AIDS point prevalence rate: 31.7
(per 100,000 population) on December 31, 1996
Sex-specific AIDS point prevalence rate
(per 100,000 population) on December 31, 1996
Female 6.5
Male 58.5
Race-specific AIDS point prevalence rate
on December 31, 1996
White 22.4
Black 99.7
HIV-infected cases reported
Cumulative 2,731
1996 450
Crude HIV point prevalence rate 47.5
(per 100,000 population) on December 31, 1996
Sex-specific HIV point prevalence rate
on December 31, 1996
Female 14.4
Male 82.5
Race-specific HIV point prevalence rate
on December 31, 1996
White 32.8
Black 205.0
Crude HIV Disease rate 79.2
(HIV and AIDS)
Number of AIDS Cases Reported
While the number of AIDS cases reported in the United States in 1996 decreased from that reported in 1995, the number of cases reported in 1996 in Indiana increased. The increase in reported Indiana AIDS cases does not necessarily indicate an increase in AIDS diagnoses. Of the 610 AIDS cases reported in 1996, 314 (51.5%) were diagnosed with AIDS. The remainder were diagnosed prior to 1996 but not reported at that time. This delayed reporting pattern has been observed since the beginning of the epidemic.
AIDS-1
AIDS Cases Reported in 1993-1996
in United States and Indiana
1993 |
1994 |
1995 |
1996 |
|
U.S. |
106,618 |
80,691 |
73,767 |
69,151 |
Indiana |
895 |
626 |
485 |
610 |
In 1993 the case definition of AIDS was changed to include additional defining conditions including a CD4 lymphocyte count of less than 200 or <14%, cervical cancer, recurrent pneumonia (two or more episodes in a 12-month period), and pulmonary tuberculosis. The most frequent first indicator of severe immunosuppression (AIDS) reported in 1996 was a depressed CD4 count or percentage. Of the 610 AIDS cases reported, 311(51%) were initially diagnosed as AIDS due to the suppression of the CD4 count. This is a higher percentage than in previous years. In recent years, the CD4 count and percentage have been the most common criterion cited for diagnosis of AIDS: 1993 - 48%, 1994 - 45%, 1995 - 46%, and 1996 - 51%. Of those reported with AIDS in 1996, 223 (36.5%) were diagnosed as infected with the HIV at the same time they were diagnosed as having AIDS. Thus, a large proportion of positive individuals may not have known they were infected with HIV until they became symptomatic with AIDS.
Persons Living with HIV Disease
The number of people reportedly living with HIV disease (HIV infections and AIDS) continues to increase. During 1996, 5,381 people were living with HIV disease in Indiana. This figure includes infected persons who moved to Indiana.
AIDS-2
Number of Persons Living with HIV Disease
Indiana, 1992-1996
Year |
Total |
Number Increase |
1992 |
2,632 |
791 |
1993 |
3,959 |
1,327 |
1994 |
4,202 |
243 |
1995 |
4,880 |
678 |
1996 |
5,381 |
501 |
The number of reported cases does not account for all of the persons living with HIV disease. Although over 5,000 people have been diagnosed and reported, there are others who have tested positive for HIV, but are not receiving follow-up services. Also, there are those who are infected but do not know their HIV status. It was estimated in 1994 between 8,500 and 11,700 people in Indiana were living with HIV disease.
Pediatric HIV and AIDS
Pediatric HIV and AIDS cases are included in the numbers reported above. But there are additional children and families impacted by HIV infection even without a diagnosis of HIV disease. By the end of 1996, 122 children had been born to Indiana women infected with HIV. The diagnostic status of these children at the end of 1996 is summarized in AIDS-3. At least 37% of children born to known HIV-infected mothers have become HIV infected themselves. This figure reflects considerable reporting bias.
AIDS-3
Diagnostic Status of Children
Born to HIV-Infected Mothers
Indiana, Cumulative through 1996
Diagnostic Category
|
Total |
Exposed: born to a woman who is HIV positive, but testing has not yet determined child's HIV status
|
44 |
HIV Infected: HIV positive by laboratory testing
|
19 |
AIDS: meets case definition for pediatric AIDS
|
26 |
Seroreverter: mother is HIV positive, but child is HIV negative based on laboratory tests
|
33 |
Total
|
122 |
HIV Counseling and Testing
HIV counseling and testing (CT) is available in Indiana, either free of charge or for a nominal fee. CT sites are located throughout the state. The percentage of HIV-positive clients decreased in 1996 to 1.1%.
AIDS-4
Counseling and Testing Sites, Tests,
and HIV Positive Results
Indiana, 1992-1996
Year |
Number CT Sites |
Number Tests |
Number Positive |
Percent Positive |
1992 |
62 |
24,912 |
384 |
1.5 |
1993 |
124 |
28,203 |
361 |
1.3 |
1994 |
120 |
28,779 |
353 |
1.2 |
1995 |
149 |
31,608 |
446 |
1.4 |
1996 |
154 |
28,937 |
317 |
1.1 |
The percentage of tests that were done confidentially increased in 1996. Anonymous testing is also available. The proportion of clients electing anonymous testing declined from 1992 to 1996 (AIDS-5). Persons tested anonymously are not able to document their HIV status and therefore cannot access follow-up medical, social, or mental health services. Many CT sites also offer tuberculosis testing and immune function testing by CD4 count to those who test positive for the HIV. CT sites also refer clients for medical care, social services, and HIV care coordination. Other resources available at CTS sites are mental health care, housing advice, and legal services referral.
AIDS-5
Counseling and Testing Sites
Percent Anonymous and Confidential Tests, Indiana, 1992-1996
Year
|
% Anonymous |
% Confidential |
1992 |
45 |
55 |
1993 |
37 |
62 |
1994 |
35 |
64 |
1995 |
35 |
65 |
1996 |
33 |
67 |
Even though CT clients are self-selected, the demographic distribution of CT clients with positive tests for HIV are similar to that of cases reported by sources other than CT sites.
Demographics
Age
Demographic patterns of HIV disease in Indiana continue to change slowly. The age at which HIV is first diagnosed is highest in the 30-39 age group. The age at first diagnosis of AIDS is also highest in the 30-39 age group (AIDS-6). Given that most people are not tested for HIV at the inception of the infection, the number of persons in their twenties testing positive indicates that a high proportion of these persons were probably infected during adolescence. The age distribution of AIDS cases in Indiana mirrors that of the nation as a whole. The largest age group to be tested at CT sites is 20-29 (40% of all tests): the age group with the highest percentage of positive HIV tests is 30-39 year olds (48% of all positive tests).
AIDS-6
HIV and AIDS Reports by Age Group
Indiana, 1996
HIV |
AIDS |
|||
Age Group |
No. |
% |
No. |
% |
0-12 |
3 |
1 |
3 |
0 |
13-19 |
16 |
3 |
4 |
1 |
20-29 |
135 |
30 |
104 |
17 |
30-39 |
198 |
44 |
310 |
51 |
40-49 |
81 |
18 |
138 |
23 |
³ 50 |
17 |
4 |
51 |
8 |
Total |
450 |
610 |
Sex
Approximately 83% of all HIV cases in Indiana are in males. But, the proportion of female HIV cases continues to be higher than that for AIDS. In 1996, females comprised 11% of all reported AIDS cases in Indiana, and 17% of all reported HIV cases. The increase in the proportion of females reported with HIV infection indicates a more rapid increase in HIV disease in women than in men. In the U.S., 20% of the 1996 reported AIDS cases were female and 29.5% of the HIV infection cases were female. HIV infection is not reported in every state. It is reported in 26 states plus three states report only pediatric cases. Therefore, the U.S. HIV infection data do not represent the entire U.S.. The 1996 Indiana sex-specific rate per 100,000 for HIV disease reports in males was 32.8 and 4.9 for females.
AIDS - 7
HIV and AIDS by Sex
Indiana and United States, 1996
Indiana HIV |
Indiana AIDS |
U.S. AIDS |
|||
Sex |
No. |
% |
No. |
% |
% |
Male |
375 |
83 |
540 |
89 |
80 |
Female |
75 |
17 |
70 |
11 |
20 |
Total |
450 |
100 |
610 |
100 |
100 |
Race/Ethnicity
Although approximately 56% of the total number of cases are White, Blacks have a higher rate of infection. Hispanics are also increasing as a proportion of reported cases. The number of Asian, Pacific Islanders, American Indians, and Alaskan Natives reported in Indiana are too small to be compared in a statistically meaningful manner. These groups comprise less than one percent of reports.
In reporting the race/ethnicity of persons with HIV disease, the White race is reported as White, non-Hispanic; the Black race is reported as Black, non-Hispanic. Hispanic ethnicity is reported as the person identifies themselves to health care professionals, or as the health care professionals believe the person to be. There is no comparable census data for the Hispanic ethnicity as it is reported for HIV disease. Therefore, the accuracy of rates for Hispanics is suspect. Even though White and Black races are counted in the census to include White Hispanic and Black Hispanic, the White and Black census data are used here in computing race-specific rates.
AIDS - 8
HIV* and AIDS** Cases by Race/Ethnicity
Percent of Reported Cases in Indiana, 1996
Race/Ethnicity
|
% of Indiana population |
% of HIV cases reported n=450 |
% of AIDS cases n=610 |
White
|
89.1 |
55.6 |
70.7 |
Black
|
8.1 |
40.0 |
25.6 |
Hispanic
|
2.0 |
3.6 |
3.1 |
* HIV includes those that have also been diagnosed with AIDS.
**In 1996 304 (50%) of the reported AIDS had not been reported previously with HIV infection.
In the U.S. as a whole, the racial/ethnic distribution of cases was different from that reported in Indiana. However, both indicate a continuing increase in the proportion of Blacks and Hispanics with HIV. Of all AIDS cases reported, 38.3% were White, 41.4% Black, and 18.9% Hispanic.
In Indiana the race-specific rate of HIV disease per 100,000 for Whites in 1996 was 13.3, for Blacks was 72.4, and for Hispanics was 30.4. For race and sex-specific rates the distinctions are broader and point to the populations most impacted by HIV disease. Black males and females have much higher rates than both Whites and Hispanics.
AIDS - 9
HIV Disease Race- and Race-Specific Rates/100,000
Indiana, 1996
Sex-Race/Ethnicity Category
|
Number |
Rate/100,000 |
||
White Male
|
613 |
25.6 |
||
White Female
|
68 |
2.6 |
||
Black Male
|
266 |
121.1 |
||
Black Female
|
70 |
28.6 |
||
Hispanic Male
|
30 |
51.5 |
||
Hispanic Female
|
5 |
8.8 |
Mode of Transmission (Risk Factor)
In Indiana the major risk factor remains men who have sex with men (MSM). Even though MSM was the most frequent risk factor reported in 1996 for persons reported with AIDS, it has declined from 70% in 1992, 66% in 1993, 60% in 1994, 65% in 1995, to 58% in 1996. For those reported with HIV infection, MSM was 50%. The apparent reduction among those with HIV infection should be tempered because 26% reported no risk factor. Racial and ethnic differences also appear when comparing risk factors. For White males, 78% reported MSM as the risk factor. Among Black males, 59% reported MSM, and among Hispanic males, 56% reported MSM. In the U.S., 50% of males reported MSM.
For all AIDS cases in Indiana, a prominent risk factor appears to be sharing contaminated needles for injecting drugs (IDU). See AIDS-10 and AIDS-11. A difference in IDU is apparent among racial and ethnic populations. See AIDS - 12.
It is typical for new reports to not contain a risk factor, especially HIV infection reports. The risk factors are reported later. If the risk factors were all identified the transmission pattern may be slightly different.
AIDS - 10
Mode of Transmission
Percentage of HIV and AIDS Reports
Adult and Adolescent, Indiana and US, 1996
Risk Factor |
Indiana percent |
U.S. percent |
|
HIV |
AIDS |
AIDS |
|
MSM
|
50 |
58 |
40 |
IDU
|
8 |
12 |
25 |
MSM and IDU
|
3 |
6 |
4 |
Coagulation Disorder
|
0 |
0 |
0 |
Heterosexual Contact
|
12 |
8 |
13 |
Transfusion
|
0 |
1 |
1 |
Not Reported
|
26 |
14 |
17 |
AIDS - 11
Risk Factor Distribution
Percent of Adult and Adolescent AIDS
Indiana, 1992 - 1996
Risk Factor |
1992
|
1993 |
1994 |
1995 |
1996 |
MSM
|
70 |
66 |
60 |
65 |
58 |
IDU
|
9 |
10 |
12 |
11 |
12 |
MSM and IDU
|
8 |
7 |
6 |
7 |
6 |
Coagulation Disorder |
1 |
2 |
1 |
0 |
0 |
Heterosexual Contact |
7 |
7 |
7 |
7 |
8 |
Transfusion
|
3 |
2 |
2 |
1 |
1 |
Not Reported
|
2 |
6 |
12 |
9 |
14 |
AIDS - 12
Risk Factor Distribution
by Race/Ethnicity and Sex
Percent Adult and Adolescent AIDS
Indiana, 1996
Risk Factor
|
White |
Black |
Hispanic |
Male |
n=395 |
n=122 |
n=17 |
MSM
|
68 |
58 |
47 |
IDU
|
7 |
13 |
41 |
MSM and IDU
|
8 |
6 |
6 |
Coagulation Disorder |
1 |
0 |
0 |
Heterosexual Contact |
3 |
6 |
0 |
Transfusion
|
1 |
0 |
0 |
Not Reported
|
12 |
17 |
6 |
Female |
n=36 |
n=31 |
n=<5* |
IDU
|
28 |
26 |
|
Heterosexual Contact |
53 |
39 |
|
Transfusion
|
8 |
6 |
|
Not Reported
|
11 |
29 |
*
Cells of less than 5, including 0, are not included in order to protect the identity of HIV infected people.Risk factors separated by race/ethnicity are significant for program and services planning in those communities. While Blacks in Indiana represent 8.1% of the population, 25.6% of the 1996 AIDS reports, and 40% of the HIV reports in Indiana have been among Blacks.
Transmission of HIV via blood components and whole blood has remained low in Indiana. The blood related AIDS cases reported were not transfused in the year reported, but reported several years later. The last HIV contaminated blood transfusion in Indiana to an Indiana resident was in 1986.
AIDS Related Deaths
There have been 2,673 deaths reported in Indiana residents with HIV disease. The number of people with AIDS who died in 1996 was lower than the number that died in 1995. This is a change in the former pattern of more and more people dying each year with AIDS. It was reported in the February 28, 1997 issue of Morbidity and Mortality Weekly Report (MMWR) that in the U.S. there was a 13% decline in the number of AIDS related deaths in the time frames of January-June, 1995 and January-June, 1996. For the Midwest the decline was 11%. In Indiana the decline was 32% using reports received before 1997. Similar to the U.S., Indiana saw the largest declines among MSM, Whites, and males. Blacks had no change in the number reported for those time periods. All other groups decreased in number of persons with AIDS that died.
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