Date: Thu, 13 Oct 1994 16:29:46 -0400 (EDT) From: "JOHN FANNING, CDC NAC" Subject: 1994 Surveillance Report CDC HIV/AIDS Surveillance Report, Vol. 6, No. 1. Mid-year Edition U.S. HIV and AIDS cases reported through June 1994 Report Description The U.S. HIV and AIDS case data presented below are extracted from the "HIV/AIDS Surveillance Report," published semi-annually by the Division of HIV/AIDS, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30333. In addition to the data presented here, the printed copy of the report contains maps and figures. Single copies of the printed report are available from: CDC National AIDS Clearinghouse P.O. Box 6003 Rockville, MD 20849-6003 (800) 458-5231 (800) 243-7012 (TTY/TDD) Notice to Readers: With this issue, the "HIV/AIDS Surveillance Report" will be published semi-annually as mid-year and year-end surveillance summaries. Suggested citation: Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 1994;6(no.1). Table 1. AIDS cases and annual rates per 100,000 population, by state, reported July 1992 through June 1993 and July 1993 through June 1994; and cumulative totals, by state and age group, through June 1994, United States July 1992- July 1993- June 1993 June 1994 Cumulative totals Adults/ Children State of residence No. Rate No. Rate adolescents < 13 years old Total Alabama 703 17.0 559 13.4 2,710 46 2,756 Alaska 31 5.3 74 12.4 222 3 225 Arizona 1,104 28.8 647 16.4 3,501 16 3,517 Arkansas 429 17.9 288 11.9 1,441 22 1,463 California 15,281 49.5 14,432 46.2 72,035 398 72,433 Colorado 1,087 31.4 881 24.7 4,205 22 4,227 Connecticut 1,457 44.4 1,306 39.8 5,272 127 5,399 Delaware 308 44.6 262 37.4 1,025 10 1,035 District of Columbia 1,078 184.2 1,580 273.1 6,414 90 6,504 Florida 9,113 67.6 7,742 56.6 37,979 876 38,855 Georgia 2,203 32.5 2,216 32.0 10,887 114 11,001 Hawaii 202 17.5 321 27.4 1,408 12 1,420 Idaho 66 6.2 57 5.2 248 2 250 Illinois 2,808 24.2 2,791 23.9 12,582 153 12,735 Indiana 758 13.4 729 12.8 3,023 25 3,048 Iowa 195 7.0 98 3.5 649 7 656 Kansas 304 12.1 271 10.7 1,231 8 1,239 Kentucky 297 7.9 298 7.9 1,359 13 1,372 Louisiana 1,205 28.2 1,225 28.5 5,903 83 5,986 Maine 78 6.3 137 11.1 507 4 511 Maryland 1,999 40.7 2,240 45.1 8,704 193 8,897 Massachusetts 1,909 31.9 2,040 33.9 8,527 145 8,672 Michigan 1,549 16.4 1,081 11.4 5,670 69 5,739 Minnesota 590 13.2 396 8.8 2,123 15 2,138 Mississippi 389 14.9 415 15.7 1,764 26 1,790 Missouri 1,636 31.5 823 15.7 5,257 37 5,294 Montana 27 3.3 30 3.6 152 2 154 Nebraska 153 9.6 106 6.6 530 6 536 Nevada 538 40.3 447 32.2 1,962 16 1,978 New Hampshire 93 8.3 90 8.0 446 6 452 New Jersey 3,393 43.4 5,285 67.1 21,974 522 22,496 New Mexico 279 17.6 163 10.1 948 3 951 New York 14,334 79.2 15,433 84.8 74,814 1,531 76,345 North Carolina 999 14.6 1,294 18.6 4,809 76 4,885 North Dakota 10 1.6 27 4.3 57 - 57 Ohio 1,192 10.8 1,330 12.0 5,835 73 5,908 Oklahoma 661 20.6 350 10.8 2,048 16 2,064 Oregon 661 22.2 579 19.1 2,651 11 2,662 Pennsylvania 2,149 17.9 2,823 23.4 11,224 151 11,375 Rhode Island 238 23.8 277 27.7 1,036 13 1,049 South Carolina 1,116 31.0 1,189 32.6 3,848 44 3,892 South Dakota 23 3.2 17 2.4 72 3 75 Tennessee 850 16.9 860 16.9 3,353 31 3,384 Texas 6,149 34.8 5,886 32.6 27,714 237 27,951 Utah 278 15.3 136 7.3 921 20 941 Vermont 28 4.9 81 14.1 212 3 215 Virginia 1,366 21.4 1,377 21.2 5,715 99 5,814 Washington 1,168 22.7 1,187 22.6 5,476 20 5,496 West Virginia 76 4.2 79 4.3 425 5 430 Wisconsin 627 12.6 400 7.9 1,959 22 1,981 Wyoming 37 8.0 21 4.5 112 - 112 Subtotal 83,224 32.6 82,376 31.9 382,939 5,426 388,365 Guam 2 1.5 1 0.7 14 - 14 Pacific Islands, U.S. - - - - 2 - 2 Puerto Rico 2,572 71.7 2,688 74.3 12,546 299 12,845 Virgin Islands, U.S. 43 41.8 37 35.8 172 6 178 Total (1) 85,944 33.2 85,260 32.6 396,015 5,734 401,749 (1) Totals include 345 persons whose state of residence is unknown. Table 2. AIDS cases and annual rates per 100,000 population, by metropolitan area with 500,000 or more population, reported July 1992 through June 1993, July 1993 through June 1994; and cumulative totals, by area and age group, through June 1994, United States July 1992- July 1993- June 1993 June 1994 Cumulative totals Adults/ Children Metropolitan area of residence No. Rate No. Rate adolescents < 13 years old Total Akron, Ohio 38 5.7 62 9.2 264 - 264 Albany-Schenectady, N.Y. 214 24.5 148 16.8 779 17 796 Albuquerque, N.Mex. 170 27.6 79 12.5 542 1 543 Allentown, Pa. 72 11.9 98 16.0 356 5 361 Ann Arbor, Mich. 48 9.5 39 7.6 211 4 215 Atlanta, Ga. 1,500 47.7 1,483 45.9 7,913 59 7,972 Austin, Tex. 497 55.2 530 57.1 2,107 16 2,123 Bakersfield, Calif. 130 22.1 130 21.5 440 3 443 Baltimore, Md. 1,388 57.0 1,481 60.5 5,553 142 5,695 Baton Rouge, La. 135 24.7 170 30.7 614 12 626 Bergen-Passaic, N.J. 398 30.8 798 61.4 2,886 57 2,943 Birmingham, Ala. 248 28.9 193 22.2 865 11 876 Boston, Mass. 1,693 29.9 1,765 31.0 7,599 129 7,728 Buffalo, N.Y. 197 16.5 104 8.7 746 10 756 Charleston, S.C. 239 45.2 188 35.0 761 8 769 Charlotte, N.C. 233 19.2 259 20.9 970 10 980 Chicago, Ill. 2,443 32.3 2,424 31.8 10,987 138 11,125 Cincinnati, Ohio 186 11.9 216 13.7 922 12 934 Cleveland, Ohio 368 16.6 338 15.2 1,624 29 1,653 Columbus, Ohio 243 17.4 355 25.1 1,308 6 1,314 Dallas, Tex. 1,655 59.2 1,187 41.6 6,735 27 6,762 Dayton, Ohio 123 12.8 96 9.9 553 8 561 Denver, Colo. 917 53.5 674 38.1 3,434 15 3,449 Detroit, Mich. 1,094 25.4 656 15.2 3,921 51 3,972 El Paso, Tex. 109 17.3 83 12.8 368 2 370 Fort Lauderdale, Fla. 1,068 82.1 1,136 86.3 5,929 120 6,049 Fort Worth, Tex. 375 26.4 318 22.0 1,548 15 1,563 Fresno, Calif. 150 18.6 158 19.2 614 7 621 Gary, Ind. 80 13.0 76 12.2 306 2 308 Grand Rapids, Mich. 112 11.6 85 8.7 393 3 396 Greensboro, N.C. 148 13.7 167 15.3 766 12 778 Greenville, S.C. 215 25.2 234 27.2 680 2 682 Harrisburg, Pa. 64 10.6 107 17.6 396 5 401 Hartford, Conn. 422 37.6 588 52.4 1,767 28 1,795 Honolulu, Hawaii 164 19.0 226 26.0 1,050 9 1,059 Houston, Tex. 2,144 60.7 2,075 57.1 10,584 91 10,675 Indianapolis, Ind. 344 24.2 415 28.7 1,506 10 1,516 Jacksonville, Fla. 793 83.2 348 35.9 2,273 52 2,325 Jersey City, N.J. 414 74.6 783 140.6 3,461 82 3,543 Kansas City, Mo. 728 45.0 361 22.1 2,477 11 2,488 Knoxville, Tenn. 59 9.7 108 17.3 319 2 321 Las Vegas, Nev. 424 43.7 344 33.7 1,517 15 1,532 Little Rock, Ark. 173 32.9 98 18.4 548 9 557 Los Angeles, Calif. 5,194 57.4 4,780 52.7 24,957 157 25,114 Louisville, Ky. 148 15.3 130 13.3 595 8 603 Memphis, Tenn. 330 31.9 311 29.7 1,190 11 1,201 Miami, Fla. 2,456 122.3 2,884 141.9 11,911 320 12,231 Middlesex, N.J. 325 31.0 364 34.3 1,789 47 1,836 Milwaukee, Wis. 322 22.2 219 15.0 1,053 14 1,067 Minneapolis-Saint Paul, Minn. 526 20.1 337 12.7 1,872 12 1,884 Mobile, Ala. 135 27.2 88 17.4 565 8 573 Monmouth-Ocean City, N.J. 335 33.4 332 32.7 1,521 42 1,563 Nashville, Tenn. 249 24.3 245 23.5 1,027 12 1,039 Nassau-Suffolk, N.Y. 946 35.8 580 21.8 3,579 71 3,650 New Haven, Conn. 905 55.5 609 37.4 3,058 94 3,152 New Orleans, La. 630 48.4 672 51.4 3,474 46 3,520 New York, N.Y. 11,769 137.6 13,705 160.0 64,459 1,380 65,839 Newark, N.J. 1,245 64.7 2,168 112.3 8,955 232 9,187 Norfolk, Va. 274 18.3 372 24.4 1,282 30 1,312 Oakland, Calif. 1,087 50.6 978 45.2 4,858 29 4,887 Oklahoma City, Okla. 286 29.1 140 14.1 954 2 956 Omaha, Nebr. 117 17.8 70 10.6 378 1 379 Orange County, Calif. 589 23.7 568 22.7 3,234 22 3,256 Orlando, Fla. 859 65.8 431 32.2 2,584 49 2,633 Philadelphia, Pa. 1,733 35.1 2,272 45.8 8,743 118 8,861 Phoenix, Ariz. 780 33.5 431 18.0 2,520 10 2,530 Pittsburgh, Pa. 192 8.0 269 11.2 1,273 8 1,281 Portland, Oreg. 612 38.1 444 27.0 2,258 8 2,266 Providence, R.I. 221 24.2 261 28.6 972 12 984 Raleigh-Durham, N.C. 187 20.6 264 28.2 1,015 19 1,034 Richmond, Va. 359 40.1 260 28.6 1,209 15 1,224 Riverside-San Bernardino, Calif. 882 31.2 987 33.8 3,428 33 3,461 Rochester, N.Y. 227 21.0 194 17.8 909 8 917 Sacramento, Calif. 403 28.4 435 30.1 1,779 18 1,797 Saint Louis, Mo. 772 30.7 442 17.4 2,548 23 2,571 Salt Lake City, Utah 248 22.0 119 10.3 816 14 830 San Antonio, Tex. 329 23.9 642 45.7 2,063 19 2,082 San Diego, Calif. 1,395 53.6 1,224 46.5 5,800 35 5,835 San Francisco, Calif. 3,817 234.7 3,459 213.0 19,659 29 19,688 San Jose, Calif. 398 26.0 476 31.1 1,849 11 1,860 San Juan, P.R. 1,696 90.4 1,596 84.2 7,890 197 8,087 Sarasota, Fla. 131 26.3 183 36.6 708 15 723 Scranton, Pa. 53 8.3 35 5.5 220 3 223 Seattle, Wash. 897 42.2 772 35.7 4,019 12 4,031 Springfield, Mass. 178 29.7 270 44.9 791 15 806 Stockton, Calif. 80 15.9 136 26.6 400 12 412 Syracuse, N.Y. 170 22.6 98 12.9 588 6 594 Tacoma, Wash. 92 14.8 127 20.1 428 7 435 Tampa-Saint Petersburg, Fla. 1,311 62.2 782 37.0 4,303 64 4,367 Toledo, Ohio 83 13.5 51 8.3 305 6 311 Tucson, Ariz. 254 36.8 166 23.5 743 5 748 Tulsa, Okla. 217 29.7 119 16.0 629 5 634 Ventura, Calif. 122 17.8 77 11.2 432 2 434 Washington, D.C. 2,031 46.6 2,748 62.1 11,326 163 11,489 West Palm Beach, Fla. 831 92.3 591 64.7 3,380 118 3,498 Wichita, Kans. 86 17.2 72 14.2 330 2 332 Wilmington, Del. 235 44.3 219 40.9 787 9 796 Youngstown, Ohio 28 4.6 31 5.1 172 - 172 Metropolitan areas with 500,000 or more population 71,992 45.0 71,418 44.2 336,179 4,855 341,034 Central counties 70,638 48.2 70,097 47.4 330,397 4,761 335,158 Outlying counties 1,354 10.1 1,321 9.6 5,782 94 5,876 Metropolitan areas with 50,000 to 500,000 population 8,882 19.1 8,456 18.0 37,597 545 38,142 Central counties 8,417 20.3 7,945 18.9 35,322 498 35,820 Outlying counties 465 9.2 511 9.9 2,275 47 2,322 Non-metropolitan areas 4,691 8.9 4,736 8.9 20,357 313 20,670 Total (1) 85,944 33.2 85,260 32.5 396,015 5,734 401,749 (1) Totals include 1,903 persons whose area of residence is unknown. Table 3. AIDS cases by age group, exposure category, and sex, reported July 1992 through June 1993, July 1993 through June 1994; and cumulative totals, by age group and exposure category, through June 1994, United States Males Females Totals (1) July 1992- July 1993- July 1992- July 1993- July 1992- July 1993- Cumulative Adult/adolescent June 1993 June 1994 June 1993 June 1994 June 1993 June 1994 Total (2) exposure category No. (%) No. (%) No. (%) No. (%) No. (%) No. (%) No. (%) Men who have sex with men 42,120 (58) 37,991 (54) - - - - 42,120 (49) 37,991 (45) 211,779 (53) Injecting drug use 16,782 (23) 17,441 (25) 6,090 (49) 6,138 (43) 22,872 (27) 23,581 (28) 98,367 (25) Men who have sex with men and inject drugs 5,413 ( 7) 4,165 ( 6) - - - - 5,413 ( 6) 4,165 ( 5) 25,447 ( 6) Hemophilia/coagulation disorder 895 ( 1) 586 ( 1) 21 ( 0) 17 ( 0) 916 ( 1) 603 ( 1) 3,404 ( 1) Heterosexual contact: 2,604 ( 4) 2,838 ( 4) 4,709 (38) 5,457 (38) 7,313 ( 9) 8,296 (10) 27,281 ( 7) Sex with injecting drug user 1,075 959 2,381 2,197 3,456 3,156 14,239 Sex with bisexual male - - 393 414 393 414 1,601 Sex with person with hemophilia 8 4 54 56 62 60 235 Sex with transfusion recipient with HIV infection 54 60 100 81 154 141 574 Sex with HIV-infected person, risk not specified 1,467 1,815 1,781 2,709 3,248 4,525 10,632 Receipt of blood transfusion, blood components, or tissue (3) 611 ( 1) 498 ( 1) 447 ( 4) 375 ( 3) 1,058 ( 1) 873 ( 1) 6,548 ( 2) Other/risk not reported or identified (4) 4,142 ( 6) 6,436 ( 9) 1,288 (10) 2,322 (16) 5,430 ( 6) 8,759 (10) 23,189 ( 6) Adult/adolescent subtotal 72,567 (100) 69,955 (100) 12,555 (100) 14,309 (100) 85,122 (100) 84,268 (100) 396,015 (100) Pediatric (<13 years old) exposure category Hemophilia/coagulation disorder 18 ( 4) 14 ( 3) - - 1 ( 0) 18 ( 2) 15 ( 2) 214 ( 4) Mother with/at risk for HIV infection: 383 (91) 438 (90) 391 (97) 470 (93) 774 (94) 908 (92) 5,095 (89) Injecting drug use 136 134 134 150 270 284 2,192 Sex with an injecting drug user 62 75 58 62 120 137 969 Sex with a bisexual male 5 5 3 6 8 11 97 Sex with person with hemophilia 1 1 4 1 5 2 23 Sex with transfusion recipient with HIV infection 1 3 1 1 2 4 24 Sex with HIV-infected person, risk not specified 44 60 58 71 102 131 462 Receipt of blood transfusion, blood components, or tissue 17 12 10 8 27 20 123 Has HIV infection, risk not specified 117 148 123 171 240 319 1,205 Receipt of blood transfusion, blood components, or tissue 16 ( 4) 14 ( 3) 7 ( 2) 15 ( 3) 23 ( 3) 29 ( 3) 348 ( 6) Risk not reported or identified 3 ( 1) 21 ( 4) 4 ( 1) 19 ( 4) 7 ( 1) 40 ( 4) 77 ( 1) Pediatric subtotal 420 (100) 487 (100) 402 (100) 505 (100) 822 (100) 992 (100) 5,734 (100) Total 72,987 70,442 12,957 14,814 85,944 85,260 401,749 (1) Includes 4 persons whose sex is unknown. (2) Includes 7 persons known to be infected with human immunodeficiency virus type 2 (HIV-2). See JAMA 1992;267:2775-9. (3) Twenty-seven adults/adolescents and 2 children developed AIDS after receiving blood screened negative for HIV antibody. Eight additional adults developed AIDS after receiving tissue or organs from HIV-infected donors. Three of the 8 received tissue or organs from a donor who was negative for HIV antibody at the time of donation. See N Engl J Med 1992;326:726-32. (4) "Other" refers to 15 health-care workers who developed AIDS after occupational exposure to HIV-infected blood, as documented by evidence of seroconversion; to 4 patients who developed AIDS after exposure to HIV within the health-care setting; to 7 persons who acquired HIV infection perinatally and were diagnosed with AIDS after age 13; and to 1 person with intentional self-inoculation of blood from an HIV-infected person. "Risk not reported or identified" refers to persons under investigation; persons who died, were lost to follow-up, or who declined interview; and persons who do not report one of the exposures listed above after interview. See Figure 6. Table 4. Male adult/adolescent AIDS cases by exposure category and race/ethnicity, reported July 1993 through June 1994, and cumulative totals through June 1994, United States White, not Hispanic Black, not Hispanic Hispanic July 1993- Cumulative July 1993- Cumulative July 1993- Cumulative June 1994 total June 1994 total June 1994 total Exposure category No. (%) No. (%) No. (%) No. (%) No. (%) No. (%) Men who have sex with men 23,829 (73) 142,906 (77) 8,330 (35) 40,500 (41) 5,232 (41) 25,645 (45) Injecting drug use 3,536 (11) 15,104 ( 8) 8,931 (38) 36,426 (37) 4,900 (38) 21,854 (38) Men who have sex with men and inject drugs 2,169 ( 7) 13,995 ( 8) 1,292 ( 5) 7,434 ( 7) 649 ( 5) 3,787 ( 7) Hemophilia/coagulation disorder 439 ( 1) 2,677 ( 1) 77 ( 0) 310 ( 0) 55 ( 0) 267 ( 0) Heterosexual contact: 602 ( 2) 2,080 ( 1) 1,537 ( 7) 4,963 ( 5) 675 ( 5) 1,958 ( 3) Sex with an injecting drug user 215 977 562 2,519 178 747 Sex with person with hemophilia 1 14 - 3 3 6 Sex with transfusion recipient with HIV infection 17 82 16 72 25 52 Sex with HIV-infected person, risk not specified 369 1,007 959 2,369 469 1,153 Receipt of blood tranfusion, blood components, or tissue 265 ( 1) 2,623 ( 1) 151 ( 1) 732 ( 1) 65 ( 1) 420 ( 1) Risk not reported or identified (1) 1,968 ( 6) 5,111 ( 3) 3,206 (14) 9,137 ( 9) 1,161 ( 9) 3,057 ( 5) Total 32,808 (100) 184,496 (100) 23,524 (100) 99,502 (100) 12,737 (100) 56,988 (100) Asian/Pacific Islander American Indian/Alaska Native Cumulative totals (2) July 1993- Cumulative July 1993- Cumulative July 1993- Cumulative June 1994 total June 1994 total June 1994 total Exposure category No. (%) No. (%) No. (%) No. (%) No. (%) No. (%) Men who have sex with men 436 (76) 1,898 (79) 113 (57) 493 (62) 37,991 (54) 211,779 (61) Injecting drug use 27 ( 5) 103 ( 4) 26 (13) 90 (11) 17,441 (25) 73,705 (21) Men who have sex with men and inject drugs 20 ( 3) 74 ( 3) 28 (14) 133 (17) 4,165 ( 6) 25,447 ( 7) Hemophilia/coagulation disorder 6 ( 1) 38 ( 2) 8 ( 4) 22 ( 3) 586 ( 1) 3,321 ( 1) Heterosexual contact: 16 ( 3) 40 ( 2) 5 ( 3) 14 ( 2) 2,838 ( 4) 9,063 ( 3) Sex with an injecting drug user 3 14 - 5 959 4,263 Sex with person with hemophilia - - - - 4 23 Sex with transfusion recipient with HIV infection 1 3 1 1 60 211 Sex with HIV-infected person, risk not specified 12 23 4 8 1,815 4,566 Receipt of blood tranfusion, blood components, or tissue 12 ( 2) 79 ( 3) 1 ( 1) 7 ( 1) 498 ( 1) 3,872 ( 1) Risk not reported or identified 58 (10) 179 ( 7) 16 ( 8) 30 ( 4) 6,436 ( 9) 17,589 ( 5) Total 575 (100) 2,411 (100) 197 (100) 789 (100) 69,955 (100) 344,776 (100) (1) See Figure 6. (2) Includes 590 men whose race/ethnicity is unknown. Table 5. Female adult/adolescent AIDS cases by exposure category and race/ethnicity, reported July 1993 through June 1994, and cumulative totals, through June 1994, United States White, not Hispanic Black, not Hispanic Hispanic July 1993- Cumulative July 1993- Cumulative July 1993- Cumulative June 1994 total June 1994 total June 1994 total Exposure category No. (%) No. (%) No. (%) No. (%) No. (%) No. (%) Injecting drug use 1,326 (42) 5,426 (43) 3,510 (44) 14,160 (51) 1,273 (42) 4,923 (47) Hemophilia/coagulation disorder 11 ( 0) 56 ( 0) 5 ( 0) 20 ( 0) 1 ( 0) 6 ( 0) Heterosexual contact: 1,238 (39) 4,536 (36) 2,801 (35) 9,014 (33) 1,361 (45) 4,479 (43) Sex with injecting drug user 516 2,131 1,075 4,968 583 2,798 Sex with bisexual male 159 766 174 576 73 220 Sex with person with hemophilia 41 168 8 26 6 14 Sex with transfusion recipient with HIV infection 30 203 26 79 23 67 Sex with HIV-infected person, risk not specified 492 1,268 1,518 3,365 676 1,380 Receipt of blood tranfusion, blood components, or tissue 151 ( 5) 1,489 (12) 155 ( 2) 725 ( 3) 61 ( 2) 389 ( 4) Risk not reported or identified (1) 461 (14) 1,047 ( 8) 1,520 (19) 3,762 (14) 316 (10) 722 ( 7) Total 3,187 (100) 12,554 (100) 7,991 (100) 27,681 (100) 3,012 (100) 10,519 (100) Asian/Pacific Islander American Indian/Alaska Native Cumulative totals (2) July 1993- Cumulative July 1993- Cumulative July 1993- Cumulative June 1994 total June 1994 total June 1994 total Exposure category No. (%) No. (%) No. (%) No. (%) No. (%) No. (%) Injecting drug use 8 (13) 43 (16) 15 (34) 65 (47) 6,138 (43) 24,660 (48) Hemophilia/coagulation disorder - - 1 ( 0) - - - - 17 ( 0) 83 ( 0) Heterosexual contact: 32 (52) 118 (45) 20 (45) 46 (33) 5,457 (38) 18,217 (36) Sex with injecting drug user 11 35 12 30 2,197 9,976 Sex with bisexual male 8 34 - 3 414 1,601 Sex with person with hemophilia - 2 1 2 56 212 Sex with transfusion recipient with HIV infection 1 12 - - 81 363 Sex with HIV-infected person, risk not specified 12 35 7 11 2,709 6,065 Receipt of blood tranfusion, blood components, or tissue 7 (11) 62 (23) 1 ( 2) 10 ( 7) 375 ( 3) 2,676 ( 5) Risk not reported or identified 14 (23) 41 (15) 8 (18) 17 (12) 2,322 (16) 5,599 (11) Total 61 (100) 265 (100) 44 (100) 138 (100) 14,309 (100) 51,235 (100) (1) See Figure 6. (2) Includes 78 women whose race/ethnicity is unknown. Table 6. Pediatric AIDS cases by exposure category and race/ethnicity, reported July 1993 through June 1994, and cumulative totals, through June 1994, United States White, not Hispanic Black, not Hispanic Hispanic July 1993- Cumulative July 1993- Cumulative July 1993- Cumulative June 1994 total June 1994 total June 1994 total Exposure category No. (%) No. (%) No. (%) No. (%) No. (%) No. (%) Hemophilia/coagulation disorder 8 ( 6) 144 (13) 5 ( 1) 31 ( 1) 2 ( 1) 35 ( 3) Mother with/at risk for HIV infection: 118 (85) 751 (70) 552 (93) 3,038 (95) 227 (92) 1,261 (90) Injecting drug use 42 329 161 1,296 78 550 Sex with injecting drug user 17 145 75 460 45 358 Sex with bisexual male 1 38 4 33 5 24 Sex with person with hemophilia 1 14 1 6 - 3 Sex with transfusion recipient with HIV infection 2 8 1 8 1 8 Sex with HIV-infected person, risk not specified 19 61 76 286 33 106 Receipt of blood transfusion, blood components, or tissue 6 35 11 62 3 26 Has HIV infection, risk not specified 30 121 223 887 62 186 Receipt of blood tranfusion, blood components, or tissue 8 ( 6) 173 (16) 7 ( 1) 80 ( 3) 12 ( 5) 85 ( 6) Risk not reported or identified (1) 5 ( 4) 12 ( 1) 29 ( 5) 50 ( 2) 6 ( 2) 15 ( 1) Total 139 (100) 1,080 (100) 593 (100) 3,199 (100) 247 (100) 1,396 (100) Asian/Pacific Islander American Indian/Alaska Native Cumulative totals (2) July 1993- Cumulative July 1993- Cumulative July 1993- Cumulative June 1994 total June 1994 total June 1994 total Exposure category No. (%) No. (%) No. (%) No. (%) No. (%) No. (%) Hemophilia/coagulation disorder - - 3 (10) - - 1 ( 6) 15 ( 2) 214 ( 4) Mother with/at risk for HIV infection: 8 (80) 18 (60) 1 (100) 16 (94) 908 (92) 5,095 (89) Injecting drug use 1 4 1 8 284 2,192 Sex with injecting drug user - 2 - 2 137 969 Sex with bisexual male 1 2 - - 11 97 Sex with person with hemophilia - - - - 2 23 Sex with transfusion recipient with HIV infection - - - - 4 24 Sex with HIV-infected person, risk not specified 2 4 - 2 131 462 Receipt of blood transfusion, blood components, or tissue - - - - 20 123 Has HIV infection, risk not specified 4 6 - 4 319 1,205 Receipt of blood tranfusion, blood components, or tissue 2 (20) 9 (30) - - - - 29 ( 3) 348 ( 6) Risk not reported or identified - - - - - - - - 40 ( 4) 77 ( 1) Total 10 (100) 30 (100) 1 (100) 17 (100) 992 (100) 5,734 (100) (1) See Figure 6, footnote 1. (2) Includes 12 children whose race/ethnicity is unknown. Table 7. AIDS cases in adolescents and adults under age 25, by sex and exposure category, reported July 1992 through June 1993, July 1993 through June 1994, and cumulative totals through June 1994, United States 13-19 years old 20-24 years old July 1992- July 1993- Cumulative July 1992- July 1993- Cumulative June 1993 June 1994 total June 1993 June 1994 total Male exposure category No. (%) No. (%) No. (%) No. (%) No. (%) No. (%) Men who have sex with men 90 (30) 75 (28) 396 (33) 1,342 (61) 1,213 (59) 7,569 (64) Injecting drug use 14 ( 5) 18 ( 7) 79 ( 7) 257 (12) 266 (13) 1,505 (13) Men who have sex with men and inject drugs 7 ( 2) 7 ( 3) 50 ( 4) 217 (10) 155 ( 8) 1,287 (11) Hemophilia/coagulation disorder 151 (51) 116 (43) 531 (44) 141 ( 6) 84 ( 4) 444 ( 4) Heterosexual contact: 11 ( 4) 9 ( 3) 27 ( 2) 94 ( 4) 96 ( 5) 349 ( 3) Sex with injecting drug user 6 3 13 40 27 160 Sex with person with hemophilia - 1 1 - - 1 Sex with transfusion recipient with HIV infection - - - 2 2 9 Sex with HIV-infected person, risk not specified 5 5 13 52 67 179 Receipt of blood tranfusion, blood components, or tissue 6 ( 2) 15 ( 6) 51 ( 4) 10 ( 0) 18 ( 1) 89 ( 1) Risk not reported or identified (1) 17 ( 6) 27 (10) 69 ( 6) 142 ( 6) 228 (11) 636 ( 5) Male subtotal 296 (100) 267 (100) 1,203 (100) 2,203 (100) 2,060 (100) 11,879 (100) Female exposure category Injecting drug use 11 ( 8) 17 (10) 105 (19) 257 (31) 200 (24) 1,121 (34) Hemophilia/coagulation disorder - - 2 ( 1) 6 ( 1) 4 ( 0) 2 ( 0) 10 ( 0) Heterosexual contact: 99 (70) 80 (47) 292 (52) 447 (54) 429 (51) 1,641 (49) Sex with injecting drug user 43 31 155 224 183 921 Sex with bisexual male 6 5 16 30 27 138 Sex with person with hemophilia 1 1 7 6 13 35 Sex with transfusion recipient with HIV infection - - 1 1 2 7 Sex with HIV-infected person, risk not specified 49 43 113 186 204 540 Receipt of blood tranfusion, blood components, or tissue 10 ( 7) 8 ( 5) 46 ( 8) 15 ( 2) 13 ( 2) 89 ( 3) Risk not reported or identified 21 (15) 65 (38) 116 (21) 109 (13) 200 (24) 464 (14) Female subtotal 141 (100) 172 (100) 565 (100) 832 (100) 844 (100) 3,325 (100) Total 437 439 1,768 3,035 2,904 15,204 (1) See Figure 6. Table 8. AIDS cases by sex, age at diagnosis, and race/ethnicity, reported through June 1994, United States White, not Black, not Asian/Pacific American Indian/ Male Hispanic Hispanic Hispanic Islander Alaska Native Total (1) Age at diagnosis (years) No. (%) No. (%) No. (%) No. (%) No. (%) No. (%) Under 5 363 ( 0) 1,378 ( 1) 565 ( 1) 11 ( 0) 9 ( 1) 2,328 ( 1) 5-12 256 ( 0) 229 ( 0) 169 ( 0) 7 ( 0) 1 ( 0) 663 ( 0) 13-19 570 ( 0) 368 ( 0) 239 ( 0) 14 ( 1) 12 ( 2) 1,203 ( 0) 20-24 5,462 ( 3) 3,937 ( 4) 2,339 ( 4) 88 ( 4) 36 ( 5) 11,879 ( 3) 25-29 26,676 (14) 14,287 (14) 9,292 (16) 318 (13) 164 (21) 50,819 (15) 30-34 43,248 (23) 22,703 (22) 14,076 (24) 521 (21) 217 (27) 80,890 (23) 35-39 41,089 (22) 23,403 (23) 12,783 (22) 525 (22) 153 (19) 78,102 (22) 40-44 29,597 (16) 16,460 (16) 8,532 (15) 430 (18) 110 (14) 55,228 (16) 45-49 17,456 ( 9) 8,600 ( 9) 4,617 ( 8) 240 (10) 46 ( 6) 31,009 ( 9) 50-54 9,355 ( 5) 4,657 ( 5) 2,414 ( 4) 126 ( 5) 24 ( 3) 16,601 ( 5) 55-59 5,344 ( 3) 2,611 ( 3) 1,410 ( 2) 74 ( 3) 12 ( 2) 9,479 ( 3) 60-64 3,109 ( 2) 1,392 ( 1) 738 ( 1) 31 ( 1) 10 ( 1) 5,287 ( 2) 65 or older 2,590 ( 1) 1,084 ( 1) 547 ( 1) 44 ( 2) 5 ( 1) 4,278 ( 1) Male subtotal 185,115 (100) 101,109 (100) 57,722 (100) 2,429 (100) 799 (100) 347,767 (100) Female Age at diagnosis (years) Under 5 360 ( 3) 1,362 ( 5) 535 ( 5) 6 ( 2) 7 ( 5) 2,277 ( 4) 5-12 101 ( 1) 230 ( 1) 127 ( 1) 6 ( 2) - - 466 ( 1) 13-19 113 ( 1) 358 ( 1) 91 ( 1) 1 ( 0) 1 ( 1) 565 ( 1) 20-24 802 ( 6) 1,737 ( 6) 751 ( 7) 15 ( 5) 16 (11) 3,325 ( 6) 25-29 2,316 (18) 4,786 (16) 2,053 (18) 27 (10) 29 (20) 9,222 (17) 30-34 2,970 (23) 6,975 (24) 2,746 (25) 56 (20) 38 (26) 12,806 (24) 35-39 2,381 (18) 6,377 (22) 2,150 (19) 45 (16) 21 (14) 10,995 (20) 40-44 1,403 (11) 3,804 (13) 1,289 (12) 42 (15) 14 (10) 6,561 (12) 45-49 765 ( 6) 1,614 ( 6) 627 ( 6) 25 ( 9) 8 ( 6) 3,044 ( 6) 50-54 444 ( 3) 878 ( 3) 362 ( 3) 15 ( 5) 3 ( 2) 1,705 ( 3) 55-59 380 ( 3) 504 ( 2) 219 ( 2) 10 ( 4) 4 ( 3) 1,119 ( 2) 60-64 295 ( 2) 320 ( 1) 112 ( 1) 13 ( 5) 3 ( 2) 743 ( 1) 65 or older 685 ( 5) 328 ( 1) 118 ( 1) 16 ( 6) 1 ( 1) 1,149 ( 2) Female subtotal 13,015 (100) 29,273 (100) 11,181 (100) 277 (100) 145 (100) 53,978 (100) Total (2) 198,130 130,384 68,903 2,706 944 401,749 (1) Includes 593 males, 87 females, and 2 persons of unknown sex whose race/ethnicity is unknown. (2) Includes 1 male and 1 female whose age at diagnosis is unknown, and 4 persons whose sex is unknown. Table 9. AIDS cases, case-fatality rates (1), and deaths, by half-year and age group, through June 1994, United States Adults/adolescents Children < 13 years old Cases diagnosed Case-fatality Deaths occurring Cases diagnosed Case-fatality Deaths occurring Half-year during interval rate during interval during interval rate during interval Before 1981 88 87.5 30 8 75.0 1 1981 Jan.-June 102 89.2 37 10 80.0 2 July-Dec. 199 92.0 83 5 100.0 6 1982 Jan.-June 417 93.5 151 13 84.6 9 July-Dec. 717 91.4 295 16 87.5 4 1983 Jan.-June 1,329 93.4 525 32 100.0 14 July-Dec. 1,689 93.8 945 43 90.7 16 1984 Jan.-June 2,644 93.2 1,419 51 86.3 26 July-Dec. 3,465 93.6 2,009 62 85.5 24 1985 Jan.-June 5,056 92.6 2,862 109 78.9 47 July-Dec. 6,499 92.4 3,954 135 83.0 70 1986 Jan.-June 8,591 91.7 5,178 139 84.9 67 July-Dec. 10,176 91.8 6,689 193 73.6 96 1987 Jan.-June 13,391 90.3 7,783 226 76.1 121 July-Dec. 14,806 88.1 8,215 265 71.3 171 1988 Jan.-June 17,183 86.0 9,639 263 65.8 136 July-Dec. 17,661 85.7 11,013 343 63.6 179 1989 Jan.-June 20,524 81.9 12,643 367 61.9 172 July-Dec. 20,886 79.9 14,519 342 63.7 193 1990 Jan.-June 23,369 76.2 14,889 376 57.2 192 July-Dec. 22,976 72.6 15,832 392 48.5 197 1991 Jan.-June 26,978 66.9 16,715 377 48.0 169 July-Dec. 28,933 59.7 18,593 365 43.3 213 1992 Jan.-June 34,269 48.3 18,548 445 37.1 185 July-Dec. 36,969 37.9 19,386 378 35.4 214 1993 Jan.-June 36,726 23.4 19,764 356 28.7 230 July-Dec. 27,169 14.9 19,527 311 23.2 228 1994 Jan.-June 13,203 7.0 8,773 112 14.3 114 Total (2) 396,015 60.7 240,323 5,734 54.1 3,100 (1) Case-fatality rates are calculated for each half-year by date of diagnosis. Each 6-month case-fatality rate is the number of deaths ever reported among cases diagnosed in that period (regardless of the year of death), divided by the number of total cases diagnosed in that period, multiplied by 100. For example, during the interval January through June 1982, AIDS was diagnosed in 417 adults/adolescents. Through June 1994, 390 of these 417 were reported as dead. Therefore, the case fatality rate is 93.5 (390 divided by 417, multiplied by 100). The case-fatality rates shown here may be underestimates because of incomplete reporting of deaths. Reported deaths are not necessarly caused by HIV-related disease. (2) Death totals include 307 adults/adolescents and 4 children known to have died, but whose dates of death are unknown. Table 10. AIDS cases by year of diagnosis and definition category, diagnosed through June 1994, United States Period of diagnosis Before July 1990- July 1991- July 1992- July 1993- Cumulative June 1990 June 1991 June 1992 June 1993 June 1994 total Definition category No. (%) No. (%) No. (%) No. (%) No. (%) No. (%) Pre-1987 definition 130,826 (76) 30,464 (60) 32,364 (51) 26,383 (35) 11,031 (27) 231,068 (58) 1987 definition 36,714 (21) 15,349 (30) 18,164 (28) 16,331 (22) 7,171 (18) 93,729 (23) 1993 definition (1) 4,086 ( 2) 4,881 (10) 13,438 (21) 31,803 (43) 22,744 (56) 76,952 (19) Pulmonary tuberculosis 756 710 1,289 1,966 876 5,597 Recurrent pneumonia 178 121 296 833 555 1,983 Invasive cervical cancer 34 23 43 82 52 234 Severe HIV-related immunosuppression (2) 3,132 4,035 11,830 28,953 21,278 69,228 Total 171,626 (100) 50,694 (100) 63,966 (100) 74,517 (100) 40,946 (100) 401,749 (100) (1) Persons who meet only the 1993 AIDS surveillance case definition and whose date of diagnosis is before January 1993 were diagnosed retrospectively. The sum of diagnoses listed for the four conditions under the 1993 definition do not equal the 1993 definition total because some persons have more than one diagnosis from the added conditions of pulmonary tuberculosis, recurrent pneumonia, and invasive cervical cancer. (2) Defined as CD4+ T-lymphocyte count of less than 200 cells/uL or a CD4+ percentage less than 14 in persons with laboratory confirmation of HIV infection. Table 11. Health-care workers with documented and possible occupationally acquired AIDS/HIV infection, by occupation, reported through June 1994, United States (1) Documented Possible occupational occupational transmission (2) transmission (3) Occupation No. No. Dental worker, including dentist - 7 Embalmer/morgue technician - 3 Emergency medical technician/paramedic - 9 Health aide/attendant 1 9 Housekeeper/maintenance worker 1 6 Laboratory technician, clinical 15 14 Laboratory technician, nonclinical 2 1 Nurse 13 19 Physician, nonsurgical 6 9 Physician, surgical - 1 Respiratory therapist 1 2 Technician, dialysis 1 1 Technician, surgical 2 1 Technician/therapist, other than those listed above - 4 Other health-care occupations - 2 Total 42 88 (1) Health-care workers are defined as those persons, including students and trainees, who have worked in a health-care, clinical, or HIV laboratory setting at any time since 1978. See MMWR 1992;41:823-5. (2) Health-care workers who had documented HIV seroconversion after occupational exposure or had other laboratory evidence of occupational infection: 36 had percutaneous exposure, 4 had mucocutaneous exposure, 1 had both percutaneous and mucocutaneous exposures, and 1 had an unknown route of exposure. Thirty-eight exposures were to blood from an HIV-infected person, 1 to visibly bloody fluid, 1 to an unspecified fluid, and 2 to concentrated virus in a laboratory. Fifteen of these health-care workers developed AIDS. (3) These health-care workers have been investigated and are without identifiable behavioral or transfusion risks; each reported percutaneous or mucocutaneous occupational exposures to blood or body fluids, or laboratory solutions containing HIV, but HIV seroconversion specifically resulting from an occupational exposure was not documented. Table 12. Adult/adolescent AIDS cases by single and multiple exposure categories, reported through June 1994, United States AIDS cases Exposure category No. (%) Single mode of exposure Men who have sex with men 204,140 (52) Injecting drug use 82,127 (21) Hemophilia/coagulation disorder 2,584 ( 1) Heterosexual contact 26,408 ( 7) Receipt of transfusion (1) 6,540 ( 2) Receipt of transplant of tissues/organs or artificial insemination (2) 8 ( 0) Other (3) 27 ( 0) Single mode of exposure subtotal 321,807 (81) Multiple modes of exposure Men who have sex with men; injecting drug use 22,501 ( 6) Men who have sex with men; hemophilia/coagulation disorder 103 ( 0) Men who have sex with men; heterosexual contact 4,478 ( 1) Men who have sex with men; receipt of transfusion/transplant 2,830 ( 1) Injecting drug use; hemophilia/coagulation disorder 127 ( 0) Injecting drug use; heterosexual contact 14,280 ( 4) Injecting drug use; receipt of transfusion/transplant 1,244 ( 0) Hemophilia/coagulation disorder; heterosexual contact 45 ( 0) Hemophilia/coagulation disorder; receipt of transfusion/transplant 749 ( 0) Heterosexual contact; receipt of transfusion/transplant 873 ( 0) Men who have sex with men; injecting drug use; hemophilia/coagulation disorder 28 ( 0) Men who have sex with men; injecting drug use; heterosexual contact 2,364 ( 1) Men who have sex with men; injecting drug use; receipt of transfusion/transplant 445 ( 0) Men who have sex with men; hemophilia/coagulation disorder; heterosexual contact 8 ( 0) Men who have sex with men; hemophilia/coagulation disorder; receipt of transfusion/transplant 28 ( 0) Men who have sex with men; heterosexual contact; receipt of transfusion/transplant 188 ( 0) Injecting drug use; hemophilia/coagulation disorder; heterosexual contact 28 ( 0) Injecting drug use; hemophilia/coagulation disorder; receipt of transfusion/transplant 28 ( 0) Injecting drug use; heterosexual contact; receipt of transfusion/transplant 521 ( 0) Hemophilia/coagulation disorder; heterosexual contact; receipt of transfusion/transplant 26 ( 0) Men who have sex with men; injecting drug use; hemophilia/coagulation disorder; heterosexual contact; 6 ( 0) Men who have sex with men; injecting drug use; hemophilia/coagulation disorder; receipt of transfusion/transplant 14 ( 0) Men who have sex with men; injecting drug use; heterosexual contact; receipt of transfusion/transplant 87 ( 0) Men who have sex with men; hemophilia/coagulation disorder; heterosexual contact; receipt of transfusion/transplant 4 ( 0) Injecting drug use; hemophilia/coagulation disorder; heterosexual contact; receipt of transfusion/transplant 12 ( 0) Men who have sex with men; injecting drug use; hemophilia/coagulation disorder; heterosexual contact; receipt of transfusion/transplant 2 ( 0) Multiple modes of exposure subtotal 51,019 (13) Risk not reported or identified (4) 23,162 ( 6) Total 396,015 (100) (1) Includes 27 adult/adolescents who developed AIDS after receiving blood screened negative for HIV antibody. (2) Eight adults developed AIDS after receiving tissue, organs, or artificial insemination from HIV-infected donors. Three of the 8 received tissue or organs from a donor who was negative for HIV antibody at the time of donation. See N Engl J Med 1992;326:726-32. (3) "Other" refers to 15 health-care workers who developed AIDS after occupational exposure to HIV-infected blood, as documented by evidence of seroconversion; to 4 patients who developed AIDS after exposure to HIV within the health-care setting, as documented by laboratory studies; to 7 persons who acquired HIV infection perinatally and were diagnosed with AIDS after age 13; and to 1 person with intentional self-inoculation of blood from an HIV-infected person. (4) See Figure 6. Table 13. HIV infection cases (not AIDS) by state, reported July 1993 through June 1994, and cumulative totals by state and age group, through June 1994, from states with confidential HIV infection reporting July 1993- Cumulative totals State of residence June 1994 Adults/ Children (Date HIV reporting initiated) No. adolescents < 13 years old Total Alabama (Jan. 1988) 564 3,434 27 3,461 Arizona (Jan. 1987) 395 2,921 24 2,945 Arkansas (July 1989) 266 1,115 12 1,127 Colorado (Nov. 1985) 529 5,050 27 5,077 Connecticut (July 1992) (1) 50 - 74 74 Idaho (June 1986) 53 311 2 313 Indiana (July 1988) 609 2,390 16 2,406 Louisiana (Feb. 1993) 1,468 2,744 12 2,756 Michigan (April 1992) 727 1,510 67 1,577 Minnesota (Oct. 1985) 291 1,992 21 2,013 Mississippi (Aug. 1988) 503 2,536 31 2,567 Missouri (Oct. 1987) 635 2,974 29 3,003 Nevada (Feb. 1992) 376 1,697 21 1,718 New Jersey (Jan. 1992) 3,287 7,222 271 7,493 North Carolina (Feb. 1990) 1,031 4,437 45 4,482 North Dakota (Jan. 1988) 29 56 - 56 Ohio (June 1990) 681 2,728 25 2,753 Oklahoma (June 1988) 211 1,460 7 1,467 South Carolina (May 1985) 907 5,238 65 5,303 South Dakota (Jan. 1988) 16 136 5 141 Tennessee (Jan. 1992) 799 2,130 25 2,155 Texas (Feb. 1994) (1) 54 - 54 54 Utah (April 1989) 121 775 5 780 Virginia (July 1989) 1,369 5,055 50 5,105 West Virginia (Jan. 1989) 98 290 2 292 Wisconsin (Nov. 1985) 288 1,807 19 1,826 Wyoming (June 1989) 12 67 - 67 Subtotal 15,369 60,075 936 61,011 Persons reported from states with confidential HIV reporting who were residents of other states (2) 504 1,420 12 1,432 Total 15,873 61,495 948 62,443 (1) Connecticut and Texas have confidential HIV infection reporting for pediatric cases only. (2) Includes 244 persons reported from states with confidential HIV infection reporting, but whose state of residence is unknown. See Technical Notes. Table 14. Male adult/adolescent HIV infection cases (not AIDS) by exposure category and race/ethnicity, reported July 1993 through June 1994, and cumulative totals through June 1994, from states with confidential HIV infection reporting (1) White, not Hispanic Black, not Hispanic Hispanic July 1993- Cumulative July 1993- Cumulative July 1993- Cumulative June 1994 total June 1994 total June 1994 total Exposure category No. (%) No. (%) No. (%) No. (%) No. (%) No. (%) Men who have sex with men 2,839 (58) 13,594 (60) 1,572 (29) 6,549 (31) 211 (29) 944 (37) Injecting drug use 506 (10) 1,948 ( 9) 1,304 (24) 4,584 (22) 269 (37) 759 (30) Men who have sex with men and inject drugs 348 ( 7) 1,888 ( 8) 254 ( 5) 1,078 ( 5) 32 ( 4) 179 ( 7) Hemophilia/coagulation disorder 79 ( 2) 290 ( 1) 19 ( 0) 59 ( 0) 1 ( 0) 8 ( 0) Heterosexual contact: 134 ( 3) 534 ( 2) 432 ( 8) 1,743 ( 8) 50 ( 7) 133 ( 5) Sex with an injecting drug user 46 157 126 465 17 52 Sex with person with hemophilia - 5 2 2 - 1 Sex with transfusion recipient with HIV infection 4 18 6 25 2 2 Sex with HIV-infected person, risk not specified 84 354 298 1,251 31 78 Receipt of blood tranfusion, blood components, or tissue 30 ( 1) 174 ( 1) 30 ( 1) 117 ( 1) 5 ( 1) 17 ( 1) Risk not reported or identified (2) 983 (20) 4,311 (19) 1,890 (34) 7,016 (33) 150 (21) 525 (20) Total 4,919 (100) 22,739 (100) 5,501 (100) 21,146 (100) 718 (100) 2,565 (100) Asian/Pacific Islander American Indian/Alaska Native Cumulative totals (3) July 1993- Cumulative July 1993- Cumulative July 1993- Cumulative June 1994 total June 1994 total June 1994 total Exposure category No. (%) No. (%) No. (%) No. (%) No. (%) No. (%) Men who have sex with men 13 (39) 59 (50) 26 (48) 142 (50) 4,723 (41) 21,522 (45) Injecting drug use 4 (12) 11 ( 9) 11 (20) 40 (14) 2,111 (18) 7,423 (15) Men who have sex with men and inject drugs - - 2 ( 2) 8 (15) 44 (16) 648 ( 6) 3,222 ( 7) Hemophilia/coagulation disorder 3 ( 9) 3 ( 3) 1 ( 2) 5 ( 2) 103 ( 1) 370 ( 1) Heterosexual contact: 3 ( 9) 5 ( 4) 3 ( 6) 10 ( 4) 638 ( 6) 2,461 ( 5) Sex with an injecting drug user 2 2 - 2 198 689 Sex with person with hemophilia - - - - 2 8 Sex with transfusion recipient with HIV infection - - - - 12 45 Sex with HIV-infected person, risk not specified 1 3 3 8 426 1,719 Receipt of blood tranfusion, blood components, or tissue - - 2 ( 2) - - 3 ( 1) 66 ( 1) 322 ( 1) Risk not reported or identified 10 (30) 35 (30) 5 ( 9) 39 (14) 3,257 (28) 13,004 (27) Total 33 (100) 117 (100) 54 (100) 283 (100) 11,546 (100) 48,324 (100) (1) See Table 13 for states with confidential HIV infection reporting. (2) For HIV infection cases (not AIDS), "Risk not reported or identified" refers primarily to persons whose mode of exposure was not reported and who have not been followed up to determine their mode of exposure, and to a smaller number of persons who are not reported with one of the exposures listed above after follow-up. See Technical Notes. (3) Includes 1,474 men whose race/ethnicity is unknown. Table 15. Female adult/adolescent HIV infection cases (not AIDS) by exposure category and race/ethnicity, reported July 1993 through June 1994, and cumulative totals through June 1994, from states with confidential HIV infection reporting (1) White, not Hispanic Black, not Hispanic Hispanic July 1993- Cumulative July 1993- Cumulative July 1993- Cumulative June 1994 total June 1994 total June 1994 total Exposure category No. (%) No. (%) No. (%) No. (%) No. (%) No. (%) Injecting drug use 284 (29) 1,063 (30) 643 (25) 2,125 (25) 73 (29) 207 (29) Hemophilia/coagulation disorder - - 9 ( 0) 2 ( 0) 7 ( 0) - - - - Heterosexual contact: 373 (39) 1,310 (37) 792 (30) 2,878 (34) 102 (40) 299 (42) Sex with an injecting drug user 144 517 290 953 47 148 Sex with a bisexual male 48 179 64 216 4 11 Sex with person with hemophilia 10 45 5 21 - 5 Sex with transfusion recipient with HIV infection 9 20 5 24 1 4 Sex with HIV-infected person, risk not specified 162 549 428 1,664 50 131 Receipt of blood tranfusion, blood components, or tissue 23 ( 2) 105 ( 3) 44 ( 2) 144 ( 2) 5 ( 2) 16 ( 2) Risk not reported or identified (2) 287 (30) 1,012 (29) 1,133 (43) 3,357 (39) 76 (30) 189 (27) Total 967 (100) 3,499 (100) 2,614 (100) 8,511 (100) 256 (100) 711 (100) Asian/Pacific Islander American Indian/Alaska Native Cumulative totals (3) July 1993- Cumulative July 1993- Cumulative July 1993- Cumulative June 1994 total June 1994 total June 1994 total Exposure category No. (%) No. (%) No. (%) No. (%) No. (%) No. (%) Injecting drug use 1 ( 9) 4 (12) 9 (36) 35 (43) 1,019 (26) 3,464 (26) Hemophilia/coagulation disorder - - - - - - - - 2 ( 0) 16 ( 0) Heterosexual contact: 6 (55) 12 (36) 7 (28) 28 (34) 1,301 (33) 4,571 (35) Sex with an injecting drug user 3 5 5 18 494 1,655 Sex with a bisexual male - - 1 5 117 412 Sex with person with hemophilia - - - - 15 71 Sex with transfusion recipient with HIV infection - - - - 15 48 Sex with HIV-infected person, risk not specified 3 7 1 5 660 2,385 Receipt of blood tranfusion, blood components, or tissue - - 2 ( 6) - - 1 ( 1) 72 ( 2) 275 ( 2) Risk not reported or identified 4 (36) 15 (45) 9 (36) 18 (22) 1,577 (40) 4,828 (37) Total 11 (100) 33 (100) 25 (100) 82 (100) 3,971 (100) 13,154 (100) (1) See Table 13 for states with confidential HIV infection reporting. (2) For HIV infection cases (not AIDS), "Risk not reported or identified" refers primarily to persons whose mode of exposure was not reported and who have not been followed up to determine their mode of exposure, and to a smaller number of persons who are not reported with one of the exposures listed above after follow-up. See Technical Notes. (3) Includes 318 women whose race/ethnicity is unknown. Table 16. HIV infection cases (not AIDS) by sex, age at diagnosis, and race/ethnicity, reported through June 1994, from states with confidential HIV infection reporting (1) White, not Black, not Asian/Pacific American Indian/ Male Hispanic Hispanic Hispanic Islander Alaska Native Total (2) Age at diagnosis (years) No. (%) No. (%) No. (%) No. (%) No. (%) No. (%) Under 5 84 ( 0) 225 ( 1) 47 ( 2) 2 ( 2) 2 ( 1) 367 ( 1) 5-12 76 ( 0) 50 ( 0) 14 ( 1) - - 2 ( 1) 148 ( 0) 13-19 509 ( 2) 593 ( 3) 48 ( 2) 4 ( 3) 8 ( 3) 1,190 ( 2) 20-24 3,445 (15) 3,034 (14) 358 (14) 22 (18) 55 (19) 7,110 (15) 25-29 6,029 (26) 4,797 (22) 667 (25) 36 (30) 86 (30) 11,964 (24) 30-34 5,410 (24) 4,770 (22) 657 (25) 20 (17) 65 (23) 11,262 (23) 35-39 3,493 (15) 3,876 (18) 429 (16) 17 (14) 36 (13) 8,111 (17) 40-44 1,970 ( 9) 2,270 (11) 238 ( 9) 10 ( 8) 20 ( 7) 4,659 (10) 45-49 986 ( 4) 936 ( 4) 93 ( 4) 4 ( 3) 6 ( 2) 2,109 ( 4) 50-54 468 ( 2) 460 ( 2) 37 ( 1) 3 ( 3) 4 ( 1) 1,004 ( 2) 55-59 201 ( 1) 214 ( 1) 14 ( 1) - - 2 ( 1) 441 ( 1) 60-64 122 ( 1) 105 ( 0) 15 ( 1) - - 1 ( 0) 249 ( 1) 65 or older 106 ( 0) 91 ( 0) 9 ( 0) 1 ( 1) - - 225 ( 0) Male subtotal 22,899 (100) 21,421 (100) 2,626 (100) 119 (100) 287 (100) 48,839 (100) Female Age at diagnosis (years) Under 5 76 ( 2) 218 ( 2) 41 ( 5) 2 ( 6) 5 ( 6) 358 ( 3) 5-12 16 ( 0) 42 ( 0) 10 ( 1) 1 ( 3) 1 ( 1) 74 ( 1) 13-19 203 ( 6) 735 ( 8) 42 ( 6) - - 6 ( 7) 1,001 ( 7) 20-24 690 (19) 1,528 (17) 112 (15) 8 (22) 15 (17) 2,401 (18) 25-29 912 (25) 1,949 (22) 196 (26) 12 (33) 17 (19) 3,160 (23) 30-34 761 (21) 1,855 (21) 189 (25) 5 (14) 15 (17) 2,893 (21) 35-39 463 (13) 1,304 (15) 75 (10) 1 ( 3) 17 (19) 1,908 (14) 40-44 199 ( 6) 658 ( 8) 53 ( 7) 2 ( 6) 10 (11) 949 ( 7) 45-49 124 ( 3) 229 ( 3) 22 ( 3) 2 ( 6) 2 ( 2) 397 ( 3) 50-54 42 ( 1) 89 ( 1) 13 ( 2) 2 ( 6) - - 158 ( 1) 55-59 39 ( 1) 77 ( 1) 6 ( 1) - - - - 125 ( 1) 60-64 20 ( 1) 37 ( 0) 3 ( 0) - - - - 61 ( 0) 65 or older 46 ( 1) 50 ( 1) - - 1 ( 3) - - 101 ( 1) Female subtotal 3,591 (100) 8,771 (100) 762 (100) 36 (100) 88 (100) 13,586 (100) Total (3) 26,491 30,194 3,388 155 375 62,443 (1) See Table 13 for states with confidential HIV infection reporting. (2) Includes 1,487 males and 338 females whose race/ethnicity is unknown. (3) Includes 18 persons whose sex is unknown. Technical notes Surveillance of AIDS All 50 states, the District of Columbia, U.S. dependencies and possessions, and independent nations in free association with the U.S. report AIDS cases to CDC using a uniform surveillance case definition and case report form. The original definition was modified in 1985 (MMWR 1985;34:373-5), in 1987 (MMWR 1987;36[suppl no. 1S]:1S-15S), and again in 1993 (MMWR 1992;41[no. RR-17]:1-19 and MMWR 1994;43:160-1,167-70). The revisions incorporated a broader range of AIDS-indicator diseases and conditions and used HIV diagnostic tests to improve the sensitivity and specificity of the definition. For persons with laboratory-confirmed HIV infection, the 1987 revision incorporated HIV encephalopathy, wasting syndrome, and other indicator diseases that are diagnosed presumptively (i.e., without confirmatory laboratory evidence of the opportunistic disease). In addition to the 23 clinical conditions in the 1987 definition, the 1993 case definition for adults and adolescents includes HIV-infected persons with CD4+ T-lymphocyte counts of less than 200 cells/uL or a CD4+ percentage of less than 14, and persons diagnosed with pulmonary tuberculosis, recurrent pneumonia, and invasive cervical cancer. All conditions added to the 1993 definition require laboratory confirmation of HIV infection. Persons who meet the criteria for more than one definition category are classified hierarchically in the following order: pre-1987, 1987, and 1993. Persons in the 1993 definition category meet only the 1993 definition. Although completeness of reporting of diagnosed AIDS cases to state and local health departments varies by geographic region and patient population, studies conducted by state and local health departments indicate that reporting of AIDS cases in most areas of the United States is more than 85 percent complete (J Acquir Immune Def Syndr, 1992;5:257-64 and Am J Public Health 1992;82:1495-9). In addition, multiple routes of exposure, opportunistic diseases diagnosed after the initial AIDS case report was submitted to CDC, and vital status may not be determined or reported for all cases. Surveillance of HIV infection (not AIDS) Through December 31, 1993, 25 states had laws or regulations requiring confidential reporting by name of all persons with confirmed HIV infection, in addition to reporting of persons with AIDS. Another state, Connecticut, required reporting by name of HIV infection only for children less than 13 years of age. These states initiated reporting at various times after the development of serum HIV-antibody tests in 1985. Before 1991, surveillance of HIV infection was not standardized and reporting of HIV infections was based primarily on passive surveillance. Consequently, many cases reported before 1991 do not have complete information. Since then, CDC has assisted states in conducting active surveillance of HIV infection using standardized report forms and software. However, collection of demographic and risk information still varies greatly among states. HIV infection data should be interpreted with caution. HIV surveillance reports are not representative of all persons with HIV infection. Because many HIV-reporting states also offer anonymous HIV testing, confidential HIV infection reports are not representative of all persons being tested in these areas. Furthermore, many factors may influence testing patterns, including the extent that testing is targeted or routinely offered to specific groups and the availability and access to medical care and testing services. These data provide a minimum estimate of the number of persons known to be HIV infected in states with confidential HIV infection reporting. For this report, persons greater than 15 months of age were considered HIV infected if they had at least one positive Western blot or positive detection test (culture, antigen, or other detection test) or had a diagnosis of HIV infection documented by a physician. Children less than 15 months of age born to an HIV-infected mother were considered HIV infected if they met the definition stated in the pediatric classification system for HIV infection (see MMWR 1987;36:225-30,235) or were diagnosed as HIV infected by a physician. Although many states monitor reports of children born to infected mothers, among children less than 15 months, only those with documented diagnosis of HIV infection are included in this report. Because states initiated reporting on different dates, the length of time reporting has been in place will influence the number of HIV infection cases reported. For example, data presented for a given annual period may include cases reported during only a portion of the year. Prior to statewide HIV reporting, some states collected reports of HIV infection in selected populations. Therefore, these states have reports prior to initiation of statewide confidential reporting. Over time, persons with HIV infection will be diagnosed and reported with AIDS. HIV infection cases later reported with AIDS are deleted from the HIV infection tables and added to the AIDS tables. Persons with HIV infection may be tested at any point in the clinical spectrum of disease, therefore the time between diagnosis of HIV infection and AIDS will vary. In addition, because surveillance practices differ, reporting and updating of clinical and vital status of cases vary among states. Tabulation and presentation of HIV infection and AIDS data Data in this report are provisional. Each issue of this report includes information received by CDC through the last day of the previous quarter. AIDS data are tabulated by date of report to CDC unless otherwise noted. For HIV infection (not AIDS) cases reported through December 31, 1993, the date HIV cases were entered at the state or local health department was used to determine the date reported to CDC. Data for U.S dependencies and possessions and for associated independent nations are included in the totals. Age group tabulations are based on the person's age at first documented positive HIV-antibody test result for HIV infection cases, and age at diagnosis of AIDS for AIDS cases; adult/adolescent cases include persons 13 years of age and older; pediatric cases include children under 13 years of age. Age group tabulations for AIDS cases in Table 14 (year-end edition only) are based on age at death. Tabulations of persons living with HIV and AIDS (Table 23, year-end edition only), include persons whose vital status was "alive" as of the last update. Table 2 lists AIDS case counts for each metropolitan areas with 500,000 or more population. AIDS case counts for metropolitan areas with 50,000 to 500,000 are reported as a combined subtotal. On December 31, 1992, the Office of Management and Budget announced new Metropolitan Statistical Area (MSA) definitions, which reflect changes in the U.S. population as determined by the 1990 census. These definitions were updated most recently on July 1, 1994. The cities and counties which compose each metropolitan area listed in Table 2 are provided in the publication "Revised Statistical Definitions for Metropolitan Areas" (available from the National Technical Information Service, telephone 1-7030487-4650, and ordering accession no. PB94-165-628). Standards for defining central and outlying counties of metropolitan areas were published in the "Federal Register" (see FR 1990;55;12154-60). The metropolitan areas definitions are the MSAs for all areas except the 6 New England states. For these states, the New England County Metropolitan Areas (NECMA) are used. Metropolitan areas are named for a central city in the MSA or NECMA, may include several cities and counties, and may cross state boundaries. For example, AIDS cases and annual rates presented for the District of Columbia in Table 1 include only persons residing within the geographic boundaries of the District. AIDS cases and annual rates for Washington, D.C., in Table 2 include persons residing within the several counties in the metropolitan area, including counties in Maryland, Virginia, and West Virginia. State or metropolitan area data tabulations are based on the person's residence at first positive HIV-antibody test result for HIV infection cases and residence at diagnosis of the first AIDS-indicator condition(s) for AIDS cases. Exposure categories For surveillance purposes, HIV infection cases and AIDS cases are counted only once in a hierarchy of exposure categories. Persons with more than one reported mode of exposure to HIV are classified in the exposure category listed first in the hierarchy, except for men with both a history of sexual contact with other men and injecting drug use. They make up a separate exposure category. ~Men who have sex with men~ cases include men who report sexual contact with other men (i.e., homosexual contact) and men who report sexual contact with both men and women (i.e., bisexual contact). "Heterosexual contact" cases are in persons who report specific heterosexual contact with a person with, or at increased risk for, HIV infection (e.g., an injecting drug user). Adults/adolescents born, or who had sex with someone born, in a country where heterosexual transmission was believed to be the predominant mode of HIV transmission (formerly classified as Pattern-II countries by the World Health Organization) are no longer classified as having heterosexually acquired AIDS. Similar to case reports for other persons who are reported without behavioral or transfusion risks for HIV, these reports are now classified (in the absence of other risk information which would classify them into another exposure category) as "no risk reported or identified" (see MMWR 1994;43:155-60). Children whose mother was born, or whose mother had sex with someone born, in a Pattern-II country are now classified (in the absence of other risk information which would classify them into another exposure category) as "Mother with/at risk for HIV infection: has HIV infection, risk not specified." "Risk not reported or identified" cases are in persons with no reported history of exposure to HIV through any of the routes listed in the hierarchy of exposure categories. Risk not reported or identified cases include persons who are currently under investigation by local health department officials; persons whose exposure history is incomplete because they died, declined to be interviewed, or were lost to follow-up; and persons who were interviewed or for whom other follow-up information was available and no exposure mode was identified. Persons who have an exposure mode identified at the time of follow-up are reclassified into the appropriate exposure category. In general, investigations and follow up for modes of exposure by state health departments are conducted routinely for persons reported with AIDS and, as resources allow, for those reported with HIV infection. Therefore, the percentage of HIV-infected persons with risk not reported or identified is substantially higher than for those reported with AIDS. Rates Rates are calculated on an annual basis per 100,000 population for AIDS cases only. Rates are not calculated for HIV infection reports because case counts for HIV infection are believed to be less complete than AIDS case counts. Population denominators for computing AIDS rates for the 50 states and the District of Columbia are based on official post-census estimates from the U.S. Bureau of Census. Denominators for U.S. dependencies and possessions are linear extrapolations of official 1980 and 1990 census counts. Each 12-month rate is the number of cases reported during the 12-month period, divided by the 1992 or 1993 population, multiplied by 100,000. The denominators for computing race-specific rates (Table 10, year-end edition only) are based on 1990 census projections published in U.S. Bureau of Census publication P25-1092, "Population Projections of the United States, by Age, Sex, Race, and Hispanic Origin: 1992 to 2050." Race-specific rates are the number of cases reported for a particular racial/ethnic group during the preceding 12-month period divided by the projected population for that race/ethnicity, multiplied by 100,000. Case-fatality rates are calculated for each half-year by date of diagnosis of AIDS. Each 6-month case-fatality rate is the number of deaths ever reported among cases diagnosed in that period (regardless of the year of death), divided by the number of total cases diagnosed in that period, multiplied by 100. Reported deaths are not necessarily caused by HIV-related disease. Caution should be used in interpreting case-fatality rates because reporting of deaths is incomplete (see Am J Public Health 1992;82:1500-5 and Am J Public Health 1990;80:1080-6). Reporting delays Reporting delays (time between diagnosis of HIV infection or AIDS and report to CDC) vary widely among exposure, geographic, racial/ethnic, age and sex categories, and have been as long as several years for some AIDS cases. About 50 percent of all AIDS cases were reported to CDC within 3 months of diagnosis, with about 20 percent being reported more than one year after diagnosis. Reporting delay for HIV infection cases is being evaluated. ***** To realign the margins, download into WordPerfect and set the margins0 on left and right.