*Adjusted for reporting delays Quarter-Year of Diagnosis/Death

Num

ber of

Cas

es/D

eath

sEstimated Incidence of AIDS and Deaths of Adults

with AIDS*, January 1985 - June 2000, United States

0

5 , 0 0 0

1 0 , 0 0 0

1 5 , 0 0 0

2 0 , 0 0 0

2 5 , 0 0 0

1 9 8 5 1 9 8 6 1 9 8 7 1 9 8 8 1 9 8 9 1 9 9 0 1 9 9 1 1 9 9 2 1 9 9 3 1 9 9 4 1 9 9 5 1 9 9 6 1 9 9 7 1 9 9 8 1 9 9 9 2 0 0 0

Deaths

AIDS 1993 definitionimplementation

Estimated Incidence of AIDS and Deaths of Adults with AIDS, January 1985-June 2000, United States

The upper curve represents estimated AIDS incidence (number of new diagnoses); the lower one represents the estimated number of deaths of adults and adolescents with AIDS.

The peak in 1993 is due to the expansion of the AIDS surveillance case definition implemented in January 1993. In recent years, both AIDS incidence and deaths among

persons with AIDS have declined.

Declines in new AIDS diagnoses and deaths among persons with AIDS are primarily due to the success of highly active antiretrovira l therapies introduced in 1996.

AIDS Cases and DeathsReported 1981- 2000, United States

DeathsCases

Adults/Adolescents 765,559 442,882

Children (<13 years) 8,908 5,178

Total 774,467 448,060

% of Cases

58

58

AIDS Cases and Deaths, Reported 1981-2000, United States

From 1981 through 2000, 774,467 cases of AIDS were reported to CDC.

Among adults and adolescents, 442,882 of the 765,559 (58%) persons reported with AIDS have died. Among the 8,908 children younger than 13 years reported with AIDS, 5,178 (58%) have died.

Slides containing information on leading causes of death in the United States, including HIV infection and AIDS, are available at .http://www.cdc.gov/hiv/graphics/mortalit.htm

3

Num

ber

of C

ases

Age at Diagnosis

AIDS Cases by Age and SexReported 1981-2000, United States

0 10 20 30 40 50 60 70 80 90 100

Female N=134,441Male N=640,022

0

5 ,0 0 0

10,000

15,000

20,000

25,000

30,000

35,000

40,000

AIDS Cases by Age and Sex, Reported 1981-2000, United States

This slide shows the distribution of AIDS cases by age at diagnosis and sex. Since 1981, 774,467 cases of AIDS have been reported to CDC; 83% were in men and 17% in women.

In men, most cases were diagnosed between the ages of 30-55 years; in women, between the ages of 30-45. At the time of diagnosis, 45% of men and 43% of women with AIDS were in their 30s; and 16% of men and 21% of women had AIDS diagnosed while in their 20s.

Pers

ons

Estimated Number of Adults/Adolescents Living with AIDS, 1993 - 2000, by Sex, United States

250,000

300,000

200,000

150,000

100,000

50,000

01993 1994 1995 1996 1997 1998 1999 2000

Men

Women

Year

Estimated Number of Adults/Adolescents Living with AIDS, 1993-2000, By Sex, United States

This slide shows increases in the number of people living with AIDS from 1993 through 2000. The increase is primarily due to the introduction and widespread use of highly active antiretroviral therapy (HAART) in 1996, which has resulted in delays in the progression of AIDS to death. At the end of 2000, an estimated 338,978 people were living with AIDS; of these, 265,466 were men and 69,725 were women.

0

20,000

40,000

60,000

80,000

100,000

120,000

160,000

140,000

American Indian/Alaska Native

Black, not Hispanic

Hispanic

Asian/Pacific Islander

White, not Hispanic

1993 1994 1995 1996 1997 1998 1999 2000

Estimated Number of Persons Living with AIDS,1993 - 2000, by Race/Ethnicity, United States

Year

Pers

ons

Estimated Number of Persons Living with AIDS, 1993-2000,by Race/Ethnicity, United States

The estimated number of persons living with AIDS increased from approximately 174,000 at the end of 1993 to approximately 339,000 at the end of 2000.

Increases in the number of persons living with AIDS were observed in racial/ethnic groups, including Asian/Pacific Islanders and American Indian/Alaska Natives. These latter two groups are represented on a different scale on slide 6.

At the end of 1997, the number of non-Hispanic blacks exceeded that of non-Hispanic whites living with AIDS.

Year

Pers

ons

1993 1994 1995 1996 19970

200019991998

2,500

3,000

2,000

1,500

1,000

500

American Indian/Alaska Native

Asian/Pacific Islander

Estimated Number of Asian/Pacific Islanders and American Indian/ Alaska Natives Living with AIDS,

1993 - 2000, United States

Estimated Number of Asian/Pacific Islanders and American Indian/Alaska Natives, Living with AIDS, 1993-2000, United States

The estimated number of Asian/Pacific Islanders and American Indian/Alaska Natives living with AIDS are shown on the previous slide with the other racial/ethnic groups and separately on this slide with a different scale for the y-axis. From the end of 1993 through 2000, the number of Asian/Pacific Islanders living with AIDS increased from approximately 1,300 to 2,840, and the number of American Indian/Alaska Natives living with AIDS increased from approximately 570 to 1,185.

Slides containing more information on HIV and AIDS in racial and ethnic minorities are available at http://www.cdc.gov/hiv/graphics/minority.htm.

U.S. dependencies and possessions

Midwest

NortheastSouth

1995 1996 1997 1998 1999 200019941993

20,000

40,000

60,000

Year

120,000

140,000

100,000

80,000

0

Estimated Number of Persons Living with AIDS,1993 - 2000, by Region, United States

WestPers

ons

Estimated Number of Persons Living with AIDS, 1993-2000,By Region, United States

The estimated number of persons living with AIDS in each region of the United States increased from 1993 through 2000.

The increase is primarily due to the introduction and widespread use of highly active antiretroviral therapy (HAART) in 1996, which has resulted in delays in the progression of AIDS to death.

In 2000, an estimated 128,740 (38%) persons living with AIDS resided in the South, 101,209 (30%) resided in the Northeast, 66,340 (20%) resided in the West, 32,816 (10%) resided in the Midwest, and 9,873 (3%) resided in the U.S. dependencies, possessions, and associated nations.

1 9 8 6 1 9 8 8 1 9 9 0 1 9 9 2 1 9 9 4 1 9 9 6 1 9 9 8 2 0 0 0

0

10

20

30

40

50

60

70

Year of Report

Perc

ent o

f Cas

es

American Indian/Alaska Native

Black, not Hispanic

Hispanic

Asian/Pacific Islander

White, not Hispanic

Proportion of AIDS Cases, by Race/Ethnicity and Year of Report,1985 - 2000, United States

Proportion of AIDS Cases, by Race/Ethnicity and Year of Report,1985-2000, United States

The proportional distribution of AIDS cases among racial/ethnic groups has changed since the beginning of the epidemic. The proportion of cases newly reported among non-Hispanic whites has decreased, while it has increased among non-Hispanic blacks and Hispanics.

The proportion of cases reported among Asian/Pacific Islanders and American Indian/Alaska Natives has remained relatively constant at approximately 1% of all cases.

Of persons reported with AIDS in 2000, 47% were non-Hispanic black, 32% were non-Hispanic white, 19% were Hispanic, 1% were Asian/Pacific Islander, and less than 1% were American Indian/Alaska Native.

Slides containing more information on HIV and AIDS in racial and ethnic minorities are available at http://www.cdc.gov/hiv/graphics/minority.htm.

0

10

20

30

40

50

60

70

1986 1988 1990 1992 1994 1996Year of Diagnosis

Perc

ent o

f Case

sProportion of Estimated* Adult/Adolescent AIDS Cases

by Exposure Category and Year of Diagnosis, 1985 - 2000, United States

*Data adjusted for reporting delays and proportional redistribution of cases reported without a risk.

1998 2000

MSM & IDU

Men who have sex with men (MSM)

Injection drug use (IDU)

Heterosexual contact

Proportion of Estimated Adult/Adolescent AIDS Cases, by Exposure Category and Year of Diagnosis, 1985-2000, United States

The data on this slide are estimates based on AIDS cases reported to CDC, statistically adjusted for reporting delays and the redistribution of cases initially reported without risk.

The proportional distribution of AIDS cases by exposure category has shifted since the beginning of the epidemic. Whereas in 1985, men who have sex with men (MSM) accounted for the greatest proportion of diagnosed AIDS cases, the proportion has decreased from nearly 65% of cases diagnosed in 1985 to approximately 40% of cases diagnosed in 2000.

The proportion of estimated AIDS cases attributed to injection drug use increased between 1985 and 1994, then remained stable or declined, accounting for approximately 27% of diagnosed cases in 2000. The proportion of cases attributed to heterosexual transmission was 27% in 2000. The remaining cases comprised those attributed to hemophilia, the receipt of blood or blood products, and those without an identified risk exposure.

5 3 %

2 6 %

6 %

1 4 %

Estimated AIDS Incidence* among Adults/Adolescents, Diagnosed in 2000, by Sex and Exposure Category,

United States

* Data adjusted for reporting delays and estimated proportional redistribution of cases initially reported without risk. Data reported through June 2001.

< 1 %

< 1 %

1 %

Exposure CategoryMen Women

Injection drug use (IDU)

Men who have sex with men

Hemophilia

Transfusion

Heterosexual contact

MSM/IDU

Other/not identified

6 4 %

3 3 %

2 %

1 %

1 %

Estimated AIDS Incidence among Adults/Adolescents, Diagnosed in 2000, By Sex and Exposure Category, United States

These pie charts show the distribution of exposure categories for AIDS cases diagnosed in 2000. These data have been adjusted for reporting delays, and the exposure category for cases initially reported without risk has been statistically redistributed.

Of AIDS cases diagnosed in 2000 in men, over half were estimated to be in men who have sex with men and another 25% in injection drug users. An estimated 14% of cases in men were attributed to heterosexual contact.

The majority (64%) of AIDS cases diagnosed in women in 2000 were attributed to heterosexual contact. One-third of AIDS cases diagnosed in women in 2000 were attributed to injection drug use.

AIDS Rates per 100,000 PopulationReported in 2000

9.5

<5

5 - 14.9

15+

Rate per 100,000

DE

MARICTNJ

MDDC

N H

VT6.2

2.5

22.928.2

18.2

18.99.7

27.7153.0

3 1 .1

1 5 .2

3 2 .7

1 3 .8

2 0 .2

1 5 .1

1 5 .2

1 2 .8

9 .0

3 .5

1 4 .03 .5

5 .3

4 .1

3 .2

3 .8

1 0 .2

4 .6

1 .1

0 .5

2 .2

1 .8

1 .7

8 .7

6 .1

1 4 .3

6 .8

7 .9

7 .34 .8

7 .3

8 .2

1 4 .2

7 .7

6 .4

5 .2

1 5 .2

1 0.9

8 .6

1 2 .6

3 .1

PR 35.4 VI 28.1 Guam 9.7

AIDS Rates per 100,000 Population, Reported in 2000

For cases reported in 2000, AIDS rates (cases per 100,000 population) are shown for each state, the District of Columbia, Puerto Rico, the Virgin Islands, and Guam.

Areas with the highest rates in 2000 were Washington, D.C., Puerto Rico, New York, and Florida. Other northeastern and southern states also have relatively high rates of reported AIDS cases. Every state reported some AIDS cases in 2000.

4 %

1 %

7 1 %

1 2 %

1 3 %

AIDS Cases N=42,156*

PopulationN=285,863,000

AIDS Cases Reported in 2000 and Estimated 2000 Population, by Race/Ethnicity, United States

White, not HispanicBlack, not HispanicHispanic

Asian/Pacific IslanderAmerican Indian/ Alaska Native

*Includes 117 persons with unknown race/ethnicity

< 1 %

1 %

3 2 %

4 7 %

1 9 %

AIDS Cases Reported in 2000 and Estimated 2000 Population, By Race/Ethnicity, United States

The pie chart on the left illustrates the distribution of AIDS cases reported in 2000 among racial/ethnic groups. The pie chart on the right shows the distribution of the U.S. population (including Puerto Rico and U.S. territories) in 2000.

Non-Hispanic blacks and Hispanics are disproportionately affected by the AIDS epidemic in comparison with their proportional distribution in the general population.

In 2000, non-Hispanic blacks made up 12% of the population but accounted for 47% of reported AIDS cases. Hispanics made up 13% of the population but accounted for 19% of reported AIDS cases.

Non-Hispanic whites made up 71% of the U.S. population but accounted for 32% of reported AIDS cases.

More information on the HIV/AIDS epidemic and HIV prevention among lacks and Hispanics is available in a CDC fact sheet at .http://www.cdc.gov/hiv/pubs/facts.htm

AIDS Cases in Adult/Adolescent Men by Race/Ethnicity per 100,000 Population, Reported in 2000,

United States

Race/EthnicityWhite, not HispanicBlack, not HispanicHispanicAsian/Pacific IslanderAmerican Indian/Alaska Native

Total*

* Includes 97 men whose race/ethnicity is unknown.

Cases

11,466

13,218

6,285

300

13531,501

Rate

14

107

47

7

1728

AIDS Cases in Adult/Adolescent Men by Race/Ethnicity Per 100,000 Population, Reported in 2000, United States

In men, the number of AIDS cases reported in 2000 was similar for non-Hispanic blacks and whites, but the rate (cases per 100,000 population) for non-Hispanic blacks (107) was more than 7 times higher than for non-Hispanic whites (14).

More than 6,000 Hispanic men were reported with AIDS, with a rate of 47 cases per 100,000 population in 2000.

Relatively few cases were reported for Asian/Pacific Islander and American Indian/Alaska Native men, although the rate in American Indian/Alaska Native men (17) was higher than that reported for non-Hispanic white men.

AIDS Cases in Adult/Adolescent Women by Race/Ethnicity per 100,000 Population, Reported in 2000,

United States

Race/EthnicityWhite, not HispanicBlack, not HispanicHispanicAsian/Pacific IslanderAmerican Indian/Alaska NativeTotal*

Cases

1,895

6,545

1,855

77

6810,459

Rate

2

46

14

2

89

*Includes 19 women whose race/ethnicity is unknown.

AIDS Cases in Adult/Adolescent Women by Race/Ethnicity Per 100,000 Population, Reported in 2000, United States

Among women, the rate (AIDS cases per 100,000 population) for black non-Hispanic women (46) was 23 times higher than that for white non-Hispanic women (2).

Approximately 1,800 cases were reported among both white non-Hispanic and Hispanic women, but the rate for Hispanic women (14) was 7 times higher than that for white non-Hispanic women.

Relatively few cases were reported among Asian/Pacific Islander and American Indian/Alaska Native women.

AIDS Cases by Region and Size of Place of ResidenceReported in 2000, United States

NortheastN=11,853*

MidwestN=4,690*

South N=17,115*

WestN=7,002*

Metropolitanarea 50,000-500,000 population

Non-metropolitanarea

%

91.9 5.7 2.3

79.7 11.2 8.8

72.7 14.9 11.4

87.8 7.5 4.4

% %

Metropolitanarea >500,000population

* Includes cases with unknown metropolitan area of residence

AIDS Cases by Region and Size of Place of Residence,Reported in 2000, United States

In 2000, most AIDS cases were reported from the South or the Northeast. Within each region, most cases were reported from large metropolitan areas (with populations greater than 500,000).

States in the Midwest and the South reported the largest proportion of cases from smaller metropolitan areas (with populations between 50,000 and 500,000).

In 2000, the South was the region with the largest proportion of reported AIDS cases from nonmetropolitan areas.

Exposure CategoryMen who have sex with menInjection drug useMen who have sex with men and inject drugs Heterosexual ContactTransfusion recipientHemophilia casesOther/not identified**

Total* Data adjusted for reporting delays and proportional redistribution of risk for cases reported without a risk.Data as of June 2001** Includes patients whose medical record review is pending; patients who died, were lost to follow-up or declined interview; and patients with other or undetermined modes of exposure

Number

15,917

10,988

1,752

10,672

442199

14540,106

Percent

40

27

427

1<1

<1

Estimated* Adult/Adolescent AIDS Cases Diagnosed in 2000, by Exposure Category,

United States

Estimated Adult/Adolescent AIDS Cases Diagnosed in 2000, By Exposure Category, United States

This slide shows the estimated distribution of exposure categories among AIDS cases diagnosed in 2000 in the United States.

Approximately 40% of the estimated 40,106 AIDS cases diagnosed in adults in 2000 were in men who have sex with men (MSM). An additional 4% of cases were attributed to MSM who also inject drugs.

Injection drug use accounted for 27% of cases. Exposure to HIV through heterosexual contact also accounted for 27% of reported cases.

Exposure Category Heterosexual male IDUFemale IDUMen who have sex with men IDU

Heterosexual sex partners of IDUs

Children whose mothers are IDUsor sex partners of IDUs

Number

5,922

2,609

1,548

1,496

60

11,635

Percent

51

22

13

13

1

AIDS Cases Associated with Injection Drug Use, by Exposure Category Reported in 2000,

United States

Total

AIDS Cases Associated with Injection Drug Use, by Exposure Category, Reported in 2000, United States

Over 11,000 AIDS cases reported in 2000 were associated with injection drug use. Over 86% of cases associated with injection drug use reported in 2000 were in persons who inject drugs.

Approximately 13% of cases associated with injection drug use were in heterosexual partners of an injection drug user, and an additional 1% were in perinatally infected children whose mothers were injection drug users or sex partners of an injection drug user.

AIDS Cases Associated with Injection Drug Use* and Rate per 100,000 Population, by Race/Ethnicity,

Reported in 2000, United States

Race/EthnicityWhite, not HispanicBlack, not HispanicHispanicAsian/Pacific IslanderAmerican Indian/Alaska Native

* Includes injection drug users (IDU), MSM-IDU, heterosexual partners of IDUs, and children whose mothers are IDUs or sex partners of IDUs

** Total includes 15 cases with unknown race/ethnicity

Cases

2,894

5,935

2,684

35

72

11,635

Rate

1

18

8

0.3

9

4Total**

AIDS Cases Associated with Injection Drug Use and Rate per 100,000 Population,By Race/Ethnicity, Reported in 2000, United States

In 2000, over 11,000 reported AIDS cases were associated with injection drug use. This includes persons who were injection drug users, sexual contacts of an injection drug user or born to a mother who was an injection drug user or a sex partner of an injection drug user.

Approximately half of the cases associated with injection drug use were in non-Hispanic blacks; the rate (cases per 100,000 population) in non-Hispanic blacks was 18. Most of the remaining cases were in non-Hispanic whites or Hispanics, although the rate in Hispanics (8) was higher than the rate in non-Hispanic whites (1).

The rate in American Indian/Alaska Natives was 9, although the number of cases was relatively small. Both the number of cases and the rate (0.3) in Asian/Pacific Islanders was low.

1

MARI

NJDEMDDC

CT

0

160

3

10

42

2 4

0

2 6

1 5

0

1 0

61 1

3

2 4 00

2

1

0

1

0

0

0

0

0

0

2

1

1

0

0

11

0

1

1 1

3

1

2

3

4

3

7

0

AIDS Cases in C hildren Reported in 2000N= 196

<5

5 - 10

10>

N umber of Cases

10

PR 2 VI 0 Guam 0

AIDS Cases in Children, Reported in 2000

In 2000, 196 cases of AIDS were reported in children younger than 13 years of age, a decrease from 263 in 1999. Most of these cases were perinatally acquired.

New York, California, and Florida reported the largest number of cases, followed by New Jersey, Pennsylvania, Illinois, and Texas. In 2000, 19 states did not report any pediatric AIDS cases.

Pediatric reporting only

1986

1992

1987 1998

1989

1989

1985

1995

1999

1988

1988

1985

1998

1985

1987

1988 1989

1993

1988 1988

19921990

1989

1986

1989

19901988

1992

1999

1988

NJ 1992

CT 1992

1997

Year of Initiation of Confidential HIV Case Surveillance*as of June 2001

* HIV cases reported by patient name

1999

2000

PR VI 1998 Guam 2000

Year of Initiation of Confidential HIV Case Surveillance, as of June 2001

Because AIDS incidence trends no longer reflect HIV incidence trends (due to effective antiretroviral therapy delaying progression of HIV infection to AIDS), HIV data are needed to meet federal, state, and local needs for monitoring trends and planning. As of June 2001, 37 areas had implemented confidential name-based HIV case surveillance. Oregon and Connecticut had implemented HIV case surveillance for pediatric cases only.

Several states had implemented non-name-based HIV surveillance systems, and others were considering different HIV reporting systems.

HIV (not AIDS) Cases Reported in 2000N=21,704*

*Includes 518 persons who were residents of areas without HIV infection surveillance but who were reported by areas with HIV infection surveillance and persons whose area of residence is unknown.

NJCT

1,455

2

5 ,8 1 0

4 5 9

5 9 7

8 4 14 ,2 0 4

4 5 0

6 0 1

1 9 8

1 1 9

2 2 7

2 9 7

6 0

2 1

4

4

4 4

0

2 9 66 5

2 6

1 2 5

2 2 0

2 4 5

3 4 8

6 4 4

3 19

8 4 6

4 9 8

1 ,0 1 1

7 6 96 82 3 4

ConfidentialHIV Reporting**

RequiredPediatric only

**HIV cases reported by patient name

PR VI 35 Guam 44

HIV (not AIDS) Cases, Reported in 2000

In 2000, 34 U.S. areas (including states, territories, and protectorates) conducted HIV case surveillance and reported cases of HIV infection in adults and children to CDC. Oregon and Connecticut reported only pediatric HIV cases. All U.S. areas report AIDS cases.

In 2000, over 21,000 HIV infection (not AIDS) cases were reported to CDC. In 2000, Florida, Texas, New Jersey, and North Carolina reported the largest number of HIV infection (not AIDS) cases.

PR

Adolescents 13-19 Years of Age Living with HIVInfection* and AIDS, Reported through 2000

HIV AIDS

NJDEMDDC

CTRIMA

N=1324** N=1540**

9

1

3

1

11

1

1

00

0

0

3

4

5

1

16

1011

27 430

12

55

17

20

1

13

16

22

1052

5217

29

80

4

9

8

33

2

0

10

17

9

5

43

2232

29

1866

59

104

45

316

68

84

96

4716

53

4

12

6

11438

69

29

46

411

232

118 2

VI

2

3

147

34

1

0

ConfidentialHIV Reporting**

RequiredPediatric only

0

00

Guam

* For areas with confidential HIV infection surveillance. Includes 44 residents of areas without HIV infection surveillance but who were reported by areas with HIV infection surveillance.

**Totals include cases missing state of residence data.***HIV cases reported by patient name

Adolescents 13-19 Years of Age Living with HIV Infection and AIDS, Reported through 2000

At the end of 2000, more than 1,500 adolescents, 13-19 years old, were living with AIDS in the United States.

In the 34 areas with name-based HIV infection surveillance systems, 1,953 adolescents were living with HIV, of whom 629 had AIDS.

The HIV data underestimate the total number of adolescents living with HIV in these 34 HIV reporting areas. Not all adolescents who are infected have been tested and only those who have been tested confidentially (rather than anonymously) are represented by these data.

Age at Diagnosis of HIV Infection or AIDS, Reported through 2000, United States

HIV* AIDSNumber

2,1345,580

53,26945,357

23,627

138,0118,044

<1313-19

30-3920-29

40-4950+

Age Number 8,9084,061

345,824128,727

202,901

774,46684,045

Percent24

3933

176

Percent11

4517

2611

*Data from 36 areas with confidential HIV infection surveillance

Age at diagnosis of HIV Infection or AIDS, Reported through 2000,United States

HIV (not AIDS) diagnoses occurred more frequently in younger persons than did AIDS diagnoses.

Data from 36 areas that conducted confidential HIV infection surveillance show that at the time of diagnosis, a larger proportion of persons with HIV (not AIDS) diagnosed were younger than 30 (39%) compared with the proportion of persons with AIDS diagnosed (19%).