1997 INDIANA REPORT OF DISEASES

Back to 1997 Indiana Report of Diseases

Acquired Immune Deficiency
Syndrome and HIV Infection

HIV Disease
(Acquired Immune Deficiency Syndrome (AIDS)
and Human Immunodeficiency Virus (HIV))

Rates per 100,000 population on December 31, 1997

AIDS cases reported:

1982-1997 cumulative 4,901
1997 505

Crude AIDS point prevalence rate: 36.9

Sex-specific AIDS point prevalence rate:

Female 7.9
Male 67.7

Race-specific AIDS point prevalence rate:

White 28.8
Black 121.0

HIV-infected cases reported:

Cumulative 2,961
1997 420

Crude HIV point prevalence rate: 51.5

Sex-specific HIV point prevalence rate:

Female 16.4
Male 88.6

Race-specific HIV point prevalence rate:

White 35.2
Black 223.7

Crude HIV Disease rate

88.4 per 100,000 population (HIV and AIDS)

Number of AIDS Cases Reported

The number of AIDS cases reported in 1997 decreased from the number reported in 1996 in Indiana (Table 1). The number of AIDS cases reported in the United States in 1997 was less than the number reported in 1996 and 1995. The decrease in reported AIDS cases does not necessarily indicate a decrease in AIDS diagnoses in 1997, but that is the trend nationwide. Of the 505 AIDS cases reported in 1997, 270 (53%) were diagnosed with AIDS in 1997. This reflects the reporting pattern in previous years. The remaining reports were diagnosed from 1991 to 1996.

	1994	1995	1996	1997
Table 1. AIDS Cases Reported in 1994-1997 in United States and Indiana
U.S.	80,691	73,767	69,151	60,634
Indiana	626	485	610	505

In 1993, the case definition of AIDS was changed to include additional defining conditions including a CD4 count of less than 200, or 14%, cervical cancer, and pulmonary tuberculosis. The most frequent first indicator of severe immunosuppression (AIDS) reported in 1997 was a depressed CD4 count or percentage. Of the 505 AIDS cases reported, 308 (61%) were initially diagnosed as AIDS due to the suppression of the CD4. This is a higher percentage than in previous years: 1993 - 48%, 1994 - 45%, 1995 - 46%, and 1996 - 51%. Of those reported with AIDS in 1997, 246 (49%) were diagnosed as infected with the HIV at the same time they were diagnosed as having AIDS (Table 2). These people did not know they were infected with the HIV until they became symptomatic with AIDS. They were not receiving medical care prior to becoming severely immunosuppressed.

Persons Living with HIV Disease

Table 2. Number of Persons Living with HIV Disease Indiana, 1992-1997
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
1997	5,557	176

The number of people reportedly living with HIV disease (HIV infections and AIDS) continues to increase. During 1997, 5,557 people were living with HIV disease in Indiana. This figure includes infected persons who moved to Indiana. The number of people moving "home" has slowed in recent years.

The number of reported cases does not account for all of the people living with HIV disease. In addition to the over 5,500 people that have been diagnosed and reported, there are others who have tested positive for the HIV, but are not receiving follow-up services, plus those who are infected but do not know their HIV status. It was estimated that between 8,500 and 11,700 people in Indiana were living with HIV disease in 1994 (latest estimate).

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 1997 there had been 155 children born to women in Indiana who had HIV disease. The diagnostic status of these children at the end of 1997 is summarized in Table 3.

Diagnostic Category	Total
Table 3. Diagnostic Status of Children Born to HIV-Infected Mothers Indiana, Cumulative through 1997
Exposed: born to woman who is HIV positive, but testing has not yet determined child's HIV status	63
HIV Infected: HIV positive by laboratory testing	72
AIDS: meets case definition for pediatric AIDS	17
Seroreverter: mother is HIV positive, but child is HIV negative based on laboratory tests	3
Total	155

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 1997 to 1.3% (Table 4). In previous years the number of HIV positive tests of previously HIV positive clients usually accounted for half of the positive tests, and again in 1997 50% of the positive tests were for previously HIV positive clients.

Table 4.
Counseling and Testing Sites, Tests,
and HIV Positive Results
Indiana, 1993-1997

Year	Number CT Sites	Number Tests	Number Positive	Percent Positive
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
1997	154	24,835	318	1.3

The percentage of tests that were done confidentially increased in 1997 (Table 5). Anonymous testing is also available. The proportion of clients electing anonymous testing declined from 1993 to 1997 (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 counseling and testing (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 CT sites are mental health care, housing advice, and legal services referral.

Table 5. Counseling and Testing Sites Percent Anonymous and Confidential Tests Indiana, 1993-1997
Year	% Anonymous	% Confidential
1993	37	62
1994	35	64
1995	35	65
1996	33	67
1997	28	72

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.

Demographics

Age

Demographic patterns of HIV disease in Indiana continue to change slowly (Table 6). 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 the 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 (44% of all positive tests).

Table 6. HIV and AIDS Reports by Age Group Indiana, 1997
Age Group	HIV		AIDS
Age Group	No.	%	No.	%
0-12	8	2	1	0
13-19	16	3	3	1
20-29	164	34	90	18
30-39	183	38	248	46
40-49	73	15	125	25
³50	32	7	38	8
Total	476		505

Gender

Males continue to be the sex more affected by HIV disease in Indiana (Table 7). But, the proportion of female HIV cases continues to be higher than that for AIDS. In 1997, females comprised 13% of all reported AIDS cases in Indiana, and 21% 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., 22% of the 1997 reported AIDS cases were female and 30% of the HIV infection cases were female. The U.S. HIV infection data are not fully representative of the nation, as only 26 states require HIV reporting and another three require reporting of pediatric cases

	Indiana HIV		Indiana AIDS
Table 7. HIV and AIDS by Sex Indiana, 1997
Sex	No.	%	No.	%
Male	378	79	438	87
Female	98	21	67	13
Total	476	100	505	100

Race/Ethnicity

HIV disease cases in Indiana have been predominately White, but the increasing incidence of HIV disease in blacks has now caused the Black incidence rate to surpass the White incidence rate (Table 8). 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 compare. Cumulatively, they are less than one (1) percent of the reports.

In reporting the race/ethnicity of HIV disease, the White race is reported as White, non-Hispanic and 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.

Race/Ethnicity	% of Indiana population	% of HIV cases reported, n=476	% of AIDS cases n=505
Table 8. HIV and AIDS Cases by Race/Ethnicity Percent of Reported Cases in Indiana, 1997
White	89.1	60	65
Black	8.1	35	31
Hispanic	2.0	5	3

In Indiana the race-specific rate of HIV disease per 100,000 for Whites in 1997 was 8.8, for Blacks was 53.2, and for Hispanics was 26.3. 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

Race/Ethnicity and Sex	No.	Rate/100,000
Table 9. HIV Disease Race and Sex Rates/100,000 Indiana, 1997
White Male	529	20.4
White Female	84	3.1
Black Male	253	112.0
Black Female	74	29.4
Hispanic Male	31	46.8
Hispanic Female	7	11.1

Mode of Transmission (Risk Factor)

For adults and adolescents 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 1997 for persons reported with AIDS, it has declined from 70% of the 1992 reports of AIDS, to 66% in 1993, to 60% in 1994, 65% in 1995, and to 58% in 1997. For those reported with HIV infection, MSM was 50%. The apparent reduction among those reported with HIV infection should be tempered because 26% have not reported a risk factor at this time. 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 the increasingly reported risk factor appears to be sharing contaminated needles for injecting drugs (IDU). The small increase may be offset by the larger percentage of AIDS cases that have not reported a risk factor. See Tables 10 and 11.

Table 10. Mode of Transmission Percentage of HIV and AIDS Reports Adult and Adolescent Indiana and US, 1997
Risk Factor	Indiana percent		U.S. percent
Risk Factor	HIV	AIDS	AIDS
MSM	41	51	35
IDU	8	13	24
MSM and IDU	3	5	4
Coagulation Disorder	0	0	0
Heterosexual Contact	12	12	13
Transfusion	0	0	1
Not Reported	36	18	22

Risk Factor	1993	1994	1995	1996	1997
Table 11. Risk Factor Distribution Percent of Adult and Adolescent AIDS Indiana, 1993- 1997
MSM	66	60	65	58	51
IDU	10	12	11	12	13
MSM and IDU	7	6	7	6	5
Coagulation Disorder	2	1	0	0	0
Heterosexual Contact	7	7	7	8	12
Transfusion	2	2	1	1	0
Not Reported	6	12	9	14	18

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.

A difference in IDU is apparent among racial and ethnic populations. See Table 12.

Risk Factor	White	Black	Hispanic
Table 12. Risk Factor Distribution by Race/Ethnicity and Sex Percent Adult and Adolescent AIDS Indiana, 1997
Male	N=291	N=128	N=15
MSM	65	44	60
IDU	10	14	20
MSM and IDU	5	9	0
Coagulation Disorder	0	1	0
Heterosexual Contact	4	9	0
Transfusion	0	0	0
Not Reported	15	23	20
Female	N=36	N=31	N=0
IDU	14	32	0
Heterosexual Contact	67	42	0
Not Reported	19	26	0

Risk factors separated by race/ethnicity is significant for program and services planning in those communities. While Blacks in Indiana represent 8.1% of the population, 31% of the 1997 AIDS reports, and 35% 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 last HIV contaminated blood transfusion in Indiana to an Indiana resident was in 1986.

D. AIDS Related Deaths

There have been 2,880 deaths reported of Indiana residents with HIV disease. The number of people with AIDS that died in 1997 was less than the number that died in 1996. 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, 1997. 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 were reported dead.

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