ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS)
AND HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION

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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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