HIV Disease

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

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Rates presented are per 100,000 population and are based on the U.S. 2000 Census.

Trends

The number of reported cases of HIV and AIDS in 2000 increased for the first time since 1998. Figure HIV1 includes HIV disease case reports and infants exposed by HIV-infected mothers who were Indiana residents at the time of diagnosis or exposure.

The noticeable increase in 2000 may be due to identifying more persons who may have been infected for several years and were not previously tested or treated. The media paid more attention to HIV disease in 2000 than in previous years, e.g. National Get Tested Day, 20th Anniversary of AIDS, World AIDS Day, Indiana Black Expo Health Fair testing with an oral device, increased efforts at outreach and testing of those in the African American male community who have sex with other males, national increase in AIDS mortality, and discussion of mandatory HIV testing of pregnant women.

There is a disturbing trend both nationally and in Indiana about the value of early diagnosis. In 2000, in Indiana, 57.5% of the reported AIDS cases had never been tested for HIV infection until diagnosis or within three months of diagnosis of AIDS. Assuming that the average time from infection until diagnosis of AIDS is approximately 10 years, the opportunity for transmitting the disease is great. The ability to limit the damage of the virus is also minimized with a late-stage diagnosis. Of those who cannot identify their mode of exposure, the percent of late diagnoses is 72.6%. The behavior that transmitted the virus could have continued for the 10 years of infection and exposed other individuals.

Demographics

The disproportionate impact of HIV disease on the minority communities, or communities of color, is again evident in 2000. Table HIV2 shows the disparities among those cases reported in 2000. Indiana's Black population is about 8.4% and the Hispanic population is 3.5% of the total population in the 2000 census.

There are no national HIV infection data, but the number of AIDS cases reported in 2000 continued to decline from 1999: 46,143 to 42,156. The number of individuals who are living with HIV disease continued to increase in 2000. Table HIV3 shows the increase by year.

Figure HIV2 shows those living with HIV disease by the last known county of residence. These numbers include those who have migrated into the counties but do not include those that have migrated out of Indiana.

The number of deaths reported in 2000 (162) was less than the number identified in 1999 (426) but comparable to 1998 (156). Death with HIV disease is not reportable specifically, and reporting delays and mechanisms are not consistent or reliable for determining a trend. A major effort was made in 1999 to identify deaths among individuals infected with HIV.

In 2000, the 45 pediatric cases of HIV disease or exposure reflected mostly HIV-infected women who gave birth to an infant, exposing the infant to the mother's HIV antigen. Table HIV4 shows the current diagnostic status of those reported in 2000. Table HIV5 shows the risk factors for these infants.

Of the 45 children born to HIV-infected mothers, 39 of the mothers knew before delivery that they were infected. All 39 children received treatment after delivery. The age at diagnosis of HIV disease remains highest in young adults ages 30-39. 

Figure HIV3 shows the burden of this chronic communicable disease on those ages 20-49. These ages are also peak years for sexual activity, pregnancy, and drug use, which are the main modes of transmission.

The modes of HIV transmission remain nearly the same as previous years, with the exception of those that cannot yet identify the behavior/event that exposed them to HIV. The major risk factor remains among men who have sex with men (MSM). Injecting drug use is not as large a factor in Indiana as it is nationally. Of those cases reported in 2000, 39.8% were unable to identify their exposure, and increase from 1999 (Table HIV6).

Counseling and Testing Sites

There were 153 Counseling and Testing Sites that offered free, or at a minimal charge, HIV testing in 2000. There were 25,541 counseling sessions and 23,441 tests performed. Of these, 17,796 (76%) were confidential tests, and 5,477 (23%) were anonymous tests. These numbers do not represent people tested because some people were tested more than once. There were 11,547 people that had tested previously but not necessarily in 2000. 

Table HIV7 shows the number of tests and number and percent of positive test results by gender, race, age group, and risk factor.

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