RESUMO
OBJECTIVES: To describe trends in HIV diagnoses and prevalence among persons who inject drugs (PWID), and trend variations by jurisdiction. METHODS: We used National HIV Surveillance System data to estimate the number of HIV diagnoses made during 2008 through 2013, and measured trends by estimated annual percent change; and persons living with diagnosed HIV infection at year-end 2008 to 2012, and measured trends in prevalence by the 2012-2008 arithmetic difference. RESULTS: During 2008 through 2013, the number of HIV diagnoses was stable among all persons (< 2% per year), and decreased among PWID (> 10% per year) overall and in 10 jurisdictions. The Black-to-White PWID diagnosis ratio was 2 to 1. During 2008 through 2012, the number of persons living with diagnosed HIV infection increased overall, was stable among PWID, and decreased in 14 jurisdictions. CONCLUSIONS: Had the rate of decrease in diagnoses of HIV infection among PWID equaled that of all persons, an additional 1500 diagnoses would have occurred between 2008 and 2013. Prevalence was stable among PWID, and increased overall among all persons living with HIV infection. Pronounced racial inequities persist, particularly for Blacks, and appear to be diminishing.
Assuntos
Infecções por HIV/epidemiologia , Transtornos Relacionados ao Uso de Substâncias , Humanos , Porto Rico/epidemiologia , Assunção de Riscos , Estados Unidos/epidemiologiaRESUMO
The majority of persons infected with HIV live in large metropolitan areas and many such areas have implemented intensified HIV testing programs. A national indicator of HIV testing outcomes is late diagnosis of HIV infection (stage 3, AIDS). Based on National HIV Surveillance System data, 23.3 % of persons with HIV diagnosed in 2012 had a late diagnosis in large MSAs, 26.3 % in smaller MSAs, and 29.6 % in non-metropolitan areas. In the 105 large MSAs, the percentage diagnosed late ranged from 13.2 to 47.4 %. During 2003-2012, the percentage diagnosed late decreased in large MSAs (32.2-23.3 %), with significant decreases in 41 of 105 MSAs overall and among men who have sex with men. Sustained testing efforts may help to continue the decreasing trend in late-stage HIV diagnosis and provide opportunities for early care and treatment and potential reduction in HIV transmission.
Assuntos
Diagnóstico Tardio , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Programas de Rastreamento/psicologia , Adolescente , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Cidades , Etnicidade/estatística & dados numéricos , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância da População , Porto Rico/epidemiologia , Índice de Gravidade de Doença , Estados Unidos/epidemiologia , Adulto JovemRESUMO
HIV testing efforts increased in recent years to reduce the percentage of persons with HIV unaware of their infection and to detect HIV early. An analysis of CD4 data from national HIV surveillance indicates that diagnosis delays decreased during 2003-2011; on average, persons diagnosed in 2011 had been infected 5.6 years before their diagnosis compared with 7.0 years among those diagnosed in 2003. Diagnosis delays were longer among females, blacks, Hispanics/Latinos, and older persons, but shorter among men who have sex with men, compared with their counterparts. Continued efforts to implement routine testing can help reduce diagnosis delays.
Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/transmissão , HIV/isolamento & purificação , Adolescente , Adulto , Idoso , Testes Diagnósticos de Rotina/métodos , Testes Diagnósticos de Rotina/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Estados Unidos , Adulto JovemRESUMO
CONTEXT: Persons born outside the United States comprise about 13% of the US population, and the challenges these persons face in accessing health care may lead to poorer human immunodeficiency virus (HIV) disease outcomes. OBJECTIVE: To describe the epidemiology of HIV among persons born outside the United States and among US-born persons diagnosed in the United States. DESIGN, SETTING, AND PARTICIPANTS: Analysis of the estimated number of US-born persons and persons born outside the United States diagnosed with HIV from 2007 through 2010 in 46 states and 5 US territories, the demographic characteristics, and the HIV transmission risk factors reported to the National HIV Surveillance System. Foreign-born persons were defined as persons born outside the United States and its territories, inclusive of naturalized citizens. MAIN OUTCOME MEASURE: Diagnosis of HIV infection. RESULTS: From 2007 through 2010, HIV was diagnosed in 191,697 persons in the US population; of these, 16.2% (95% CI, 16.0%-16.3%) (n = 30,995) were born outside the United States. Of the 25,255 persons with a specified country or region of birth outside the United States, 14.5% (n = 3656) were from Africa, 41.0% (n = 10,343) were from Central America (including Mexico), and 21.5% (n = 5418) were from the Caribbean. The 4 states (California, Florida, New York, and Texas) reporting the highest numbers of persons born outside the United States and diagnosed with HIV were also the top 4 reporters of HIV cases overall. Among persons born outside the United States with HIV, 73.5% (n = 22,773) were male. Among whites, 1841 of 55,574 (3.3%) of HIV diagnoses were in persons born outside the United States; in blacks, 8614 of 86,547 diagnoses (10.0%); in Hispanics, 17,913 of 42,431 diagnoses (42.2%); and in Asians, 1987 of 3088 diagnoses (64.3%). The percentage infected through heterosexual contact was 39.4% among persons born outside the United States vs 27.2% for US-born persons. CONCLUSIONS: Among persons in 46 US states and 5 US territories who received a diagnosis of HIV from 2007 through 2010, 16.2% were born outside the United States. Compared with US-born persons diagnosed with HIV, persons born outside the United States had different epidemiologic characteristics.
Assuntos
Infecções por HIV/etnologia , Infecções por HIV/epidemiologia , Vigilância da População , Adolescente , Adulto , África/etnologia , Fatores Etários , Região do Caribe/etnologia , América Central/etnologia , Criança , Feminino , Infecções por HIV/transmissão , Heterossexualidade , Hispânico ou Latino/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais , Estados Unidos/epidemiologia , Adulto JovemRESUMO
BACKGROUND: In the United States, Hispanics are disproportionately affected by HIV infection. However, Hispanic subgroups of varied national origin differ culturally and HIV may impact them differently. METHODS: We used information on Hispanics/Latinos diagnosed with HIV during 2006-2009 in 40 states and Puerto Rico, and aged ≥13 years, reported to the Centers for Disease Control and Prevention through June 2010, to examine the distribution of disease by selected characteristics, including place of birth and place of residence at diagnosis. We used Poisson regression to calculate the estimated annual percent change in the rate of HIV diagnoses and estimated prevalence ratios of a short HIV-to-AIDS interval (AIDS diagnosis within 12 months of HIV diagnosis). Analyses were adjusted for reporting delays and missing risk factor information. RESULTS: During 2006-2009, HIV infection was diagnosed among 33,498 Hispanics/Latinos. From 2006 to 2009, the annual rate of diagnoses decreased among Hispanics/Latinos [estimated annual percent change = -4.3%; 95% confidence interval (CI) = -6.5 to -2.0) including men (-2.8%; 95% CI = -5.2 to -0.4) and women (-9.8%; 95% CI = -13.2 to -6.3). The rate of HIV diagnosis remained stable by place of birth but decreased among Puerto Ricans (-13.1%; 95% CI = -17.0 to -9.0). Among Hispanics/Latinos, a short HIV-to-AIDS interval was more common in nonurban areas than in urban areas. DISCUSSION: Diagnosis of HIV infection among Hispanics/Latinos decreased and HIV-to-AIDS intervals varied by place of birth and area of residence. To continue to decrease the incidence of HIV infection among Hispanics, prevention programs need to address cultural and regional differences.
Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hispânico ou Latino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Porto Rico/epidemiologia , Fatores de Risco , Estados Unidos/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: Haitian-born persons have been historically stigmatized for introducing HIV to North America; however, no previous study has reported on the national HIV surveillance trends among this foreign-born group. METHODS: Annual AIDS cases were estimated for adults and adolescents (aged >12 years) from all 50 US states and the District of Columbia who were diagnosed between 1985 and 2007, and who reported 'Haiti' as country of birth to the Centers for Disease Control and Prevention. HIV data (with or without AIDS) for Haitian-born adults and adolescents diagnosed between 2004 and 2007 were obtained from 34 US states. Denominators for AIDS rates by race/ethnicity are from postcensal estimates, the American Community Survey of the US Census Bureau and the Haitian Consulates. RESULTS: In 2007, Haitian-born persons constituted 1.2% of US AIDS cases, yet accounted for 0.18% of the total US population based on the American Community Survey estimates, which suggests a seven-fold overrepresentation in the CDC AIDS surveillance data. However, when using population estimates from the Haitian Consulate, the overrepresentation ranges from three-to-four-fold, which is similar to the AIDS rate for blacks/African-Americans. CONCLUSION: The importance of having accurate denominators to estimate the AIDS rate for the Haitian population is paramount.
Assuntos
Infecções por HIV/epidemiologia , HIV-1/imunologia , Adulto , District of Columbia/epidemiologia , Etnicidade , Feminino , Infecções por HIV/etnologia , Infecções por HIV/transmissão , Haiti/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância de Evento Sentinela , Estigma Social , Estados Unidos/epidemiologia , Estados Unidos/etnologiaRESUMO
The population at the U.S.-Mexico border has experienced growth, more than double the U.S. national average. Movements of populations in this region have contributed to increased incidence of certain infectious diseases. We used information on persons diagnosed with HIV during 2003 to 2006 and aged 13 years or older (n = 4,279) reported to the Centers for Disease Control and Prevention for 45 U.S. border counties. We estimated the annual percent change and rates with Poisson regression. Overall, 47% of persons diagnosed with HIV in the border region were Hispanic; 39% nonHispanic white; and 10% nonHispanic black. During 2003 to 2006, HIV diagnoses increased 7.8% per year. Increases were observed among males, particularly among men who have sex with men. Among females, HIV diagnoses remained stable but decreased among females in nonborder regions. The number of HIV diagnoses at the border has increased. To decrease incidence of HIV disease it is necessary to develop prevention and education programs specific to this region.
Assuntos
Sorodiagnóstico da AIDS/estatística & dados numéricos , Infecções por HIV/epidemiologia , Sorodiagnóstico da AIDS/tendências , Adolescente , Adulto , Distribuição por Idade , Feminino , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Hispânico ou Latino , Humanos , Estimativa de Kaplan-Meier , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Vigilância da População , Fatores de Risco , Assunção de Riscos , Distribuição por Sexo , Comportamento Sexual , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Hispanic subgroups of varied national origin differ culturally; overall, Hispanics in the United States are disproportionately affected by HIV infection. METHODS: We analyzed cases of HIV infection that were diagnosed among Hispanics in 33 states and US-dependent areas during 2003-2006 and reported to the Centers for Disease Control and Prevention through June 2007. We used Poisson regression to calculate the estimated annual percent change in the number and rate of HIV diagnoses and used logistic regression to analyze the association between birthplace and a short (<12 months) HIV-to-AIDS interval. RESULTS: HIV infection was diagnosed among 30,415 Hispanics. Of 24,313 with reported birthplace, 61% were born outside the continental United States. The annual number of diagnoses increased among Mexican-born males [estimated annual percent change = 8.8%; 95% confidence interval (CI) = 3.5 to 14.5] and Central American-born males (18.6%; 95% CI = 9.4 to 28.6) and females (24.6%; 95% CI = 8.8 to 42.7) but decreased among US-born Hispanic females (-8.2%; 95% CI = -13.3 to -2.8). A short HIV-to-AIDS interval was more common among Mexican-born Hispanics than among US-born Hispanics. DISCUSSION: Diagnosis trends and HIV-to-AIDS intervals varied by place of birth. To decrease the incidence of HIV infection among Hispanics, prevention programs need to address cultural differences.