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United State HIV/AIDS Statistics Summary
People living with AIDS
AIDS diagnoses and deaths
Who is affected by AIDS?
HIV statistics
Interpreting HIV & AIDS statistics for
the USA
Estimates and reporting delays
AIDS was first identified in the USA in 1981. The
epidemic has now spread to every part of the USA and to all sectors
of society.
It is thought that more than one million people are
living with HIV in the USA and that more than half a million have
died after developing AIDS.
Unfortunately, American HIV surveillance is far from
comprehensive so many statistics must be based on reports of AIDS
diagnoses. In interpreting such AIDS statistics, it is important to
remember that they do not correspond to new HIV infections.
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AIDS statistics
At the end of 2003, the CDC estimates that 405,926
persons were living with AIDS in the USA.
Of these,
• 36% were white
• 42% were black
• 20% were Hispanic
• 2% were of other race/ethnicity.
Of the adults and adolescents1 with AIDS, 77% were
men. Of these men,
• 58% were men who had sex with men (MSM)
• 22% were injection drug users (IDU)
• 11% were exposed through heterosexual contact
• 8% were both MSM and IDU.
Of the 88,815 adult and adolescent women with AIDS,
• 63% were exposed through heterosexual contact
• 35% were exposed through injection drug use.
An estimated 1,998 children were living with AIDS at
the end of 2003.
Persons with AIDS are surviving longer and are
contributing to a steady increase in the number of people living
with AIDS. This trend will continue as long as the number of people
with a new AIDS diagnosis exceeds the number of people dying each
year.
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In June 1981, the first cases of what is now known
as AIDS were reported in the USA. In the 1980s, there were rapid
increases in the number of AIDS cases and deaths of people with
AIDS. Cases peaked with the 1993 expansion of the case definition,
and then declined. The most dramatic drops in both cases and deaths
began in 1996, with the widespread use of antiretroviral therapy.
The rate of decrease in AIDS diagnoses slowed in the
late 1990s. After reaching a plateau, the number of diagnoses
increased slightly each year from 2001 to 2003. There were an
estimated 43,171 diagnoses in 2003. In total, an estimated 929,985
people have been diagnosed with AIDS.
The number of deaths among people with AIDS remained
relatively stable in the period 1999-2003. In the latter year, there
were an estimated 18,017 deaths. Since the beginning of the
epidemic, an estimated 524,060 people with AIDS have died in the
USA.
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During the 1990s, the epidemic shifted steadily
toward a growing proportion of AIDS cases among black people and
Hispanics and in women, and toward a decreasing proportion in MSM,
although this group remains the largest single exposure group. Black
people and Hispanics have been disproportionately affected since the
early years of the epidemic. In absolute numbers, blacks have
outnumbered whites in new AIDS diagnoses and deaths since 1996, and
in the number of people living with AIDS since 1998.
From 1999 to 2003, the estimated number of AIDS
cases decreased slightly among white people and increased slightly
among black people. Meanwhile the number of Hispanics diagnosed with
AIDS rose by an estimated 8%, and diagnoses in Asians/Pacific
Islanders and American Indians/Alaska Natives also increased.
In the period 1999-2003, the estimated number of
females diagnosed with AIDS increased by 15%, while male diagnoses
grew by just 1%. The estimated annual number of AIDS diagnoses in
people infected through heterosexual sex has risen each year since
1999, and MSM cases have been increasing since 2001. Meanwhile, IDU
cases have been declining in number.
During 2003 there were an estimated 59 paediatric
AIDS diagnoses; this is less than a third of the estimated number in
1999. The decline in paediatric AIDS incidence is associated with
the implementation of Public Health Service guidelines. These
guidelines include universal counselling and voluntary HIV testing
of pregnant women and the use of zidovudine by HIV-infected pregnant
women and their newborn infants.
The age group 35-44 years represented 41% of all
AIDS cases diagnosed in 2003. Nearly three-quarters of all people
who have died with AIDS did not live to the age of 45.
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HIV statistics
At the end of 2003, the CDC estimates that there
were 351,614 persons living with HIV/AIDS in the 33 areas which have
a history of confidential name-based HIV reporting. However, the
true number of people in the USA with HIV/AIDS is thought to be
between 1,039,000 and 1,185,000 million. The discrepancy between
these figures is due to several factors including:
• reporting of persons diagnosed with HIV has not
yet been implemented in all areas
• anonymous tests, including home tests, are
excluded from case reports
• one in every four people living with HIV is
unaware of their infection.
During 2003, an estimated 32,048 new diagnoses of
HIV infection were reported from the 33 areas with a history of
confidential name-based reporting. Of these, 72% were among adult or
adolescent males, 27% were among adult or adolescent females, and
less than 1% were among children under 13 years of age. Recent HIV
reports represent a mixture of people with recent infection and
others who may have been infected in the past but are only now being
diagnosed.
Guidelines for the surveillance of HIV and AIDS,
published in the USA in December 1999, recommend integrated HIV and
AIDS surveillance. In addition, both the adult and paediatric HIV
case definitions were updated to reflect current diagnostic methods
and clinical practice.
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Interpreting HIV & AIDS statistics for the USA
In order to monitor the spread of the American
epidemic and to assess the need for services and resources, there is
a need for accurate surveillance. In the USA, statistics on both HIV
and AIDS are collected by the Centers for Disease Control and
Prevention (CDC) and published in an annual report.
The CDC surveillance report includes data on the
number of people diagnosed with AIDS, the number living with AIDS
and the number of people with AIDS who have died. Such AIDS
statistics include not only the 50 states and the District of
Columbia but also Puerto Rico, Guam, the US Pacific Islands and the
US Virgin Islands. However, around 97.5% of the total number of
people living with AIDS reside within the 50 states or the District
of Columbia.
Historically, many states have only reported AIDS
cases. In recent years, the use of antiretroviral therapy has slowed
the progression of HIV in many infected persons and hence
contributed to a decline in AIDS incidence. This means that AIDS
surveillance data are less able to represent trends in the incidence
of HIV infection or the impact of the epidemic on the health-care
system. In response, more states are now implementing HIV reporting.
This enables state and local areas to estimate the size of the
population living with HIV/AIDS and to predict the services and
resources needed.
The CDC reports HIV diagnoses and the number of
people living with HIV, using only data collected through
confidential name-based reporting. As of the end of 2003,
confidential name-based HIV reporting has been implemented by just
36 states plus Puerto Rico, Guam, American Samoa, the Northern
Mariana Islands and the US Virgin Islands. Of these 41 areas, only
33 have been reporting for at least 5 years. The resulting lack of
comprehensive national HIV data is a serious problem. It is
therefore hoped that all states will soon be reporting HIV cases to
the CDC.
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There is often a delay between the time of diagnosis
of HIV or AIDS, or the time of death, and the time at which the
event is reported. Moreover, this delay may differ among different
categories of people. For this reason the CDC estimates the number
of diagnoses, deaths and people living with HIV or AIDS by adjusting
for reporting delays, taking into account the differences between
categories. The CDC also redistributes cases into exposure
categories if none was initially reported. No adjustment is made for
incomplete reporting. On this page, all numbers are CDC estimates
unless stated otherwise.
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