HIV and AIDS Trends


Nationwide, to determine where HIV is having the greatest public health impact, where its toll is increasing, and where it is stabilizing or decreasing, it is important to look at HIV as not one, but several epidemics. The dynamics of the HIV epidemic are different in various populations. Looking only at the big picture -- either the total number of AIDS cases or the total number of people estimated to be infected -- may mask the true impact of HIV disease on certain groups of individuals. In this document, CDC presents current data on the magnitude and direction of the epidemic nationally and identifies regional trends. CDC collects these data to help communities target and evaluate prevention efforts. State health departments can provide more detailed information about HIV and AIDS in local areas.

To develop the most complete analysis, CDC examines several data sources. This fact sheet uses three: (1) annual AIDS cases are used to analyze changes in the characteristics of people reported to CDC with AIDS over time; (2) estimated AIDS incidence (the number of people diagnosed with AIDS each year) is used to analyze trends over time*; and (3) statistical estimates and surveys of HIV prevalence (the total number of people infected with HIV) are used to provide an indication of who has become infected with HIV more recently and to predict future trends in HIV-related illness and death.

AIDS

Since the epidemic began, over 500,000 Americans have been reported with AIDS. At least 300,000 of them have died. In 1995, 74,180 people were reported with AIDS. Estimated AIDS incidence has increased at a rate of less than 5% each year since 1992. This percentage increase is much lower than earlier years in the epidemic. In the mid-'80s, AIDS incidence increased by 65 to 96% each year.

HIV

Overall Trends

Trends Among Young and Middle-Aged Adults and Among Adolescents

Implications for Prevention

These trends provide evidence that HIV prevention works. Efforts to date have resulted in behavior change among some groups, and the HIV epidemic has slowed overall. But a great deal more must be done. The number of new infections each year - at least 40,000 - is unacceptable. CDC provides these and other data to communities as a starting point to help evaluate and address their unique prevention needs. Because of multiple subepidemics of HIV, prevention programs are most effective when designed and implemented at a local level.

It is critical that effective prevention programs be sustained and that lessons learned in one area be applied to designing programs for groups and communities that have not yet been effectively reached. It is also clear that for prevention efforts to succeed, HIV prevention programs must continue to work with substance abuse prevention and treatment programs. Combating the duel epidemics of drug use and HIV will continue to present complex challenges. But many communities are seeing signs of success. And as long as we continue to see preventable infections occurring each year, we must work to do things better.

The Changing Landscape of the Epidemic: A Closer Look

Cumulatively, the largest proportion of AIDS cases has been reported among men who have sex with men (MSM). But an analysis of AIDS reporting over time reveals several shifts in the epidemic. Comparing the epidemic in 1985 to 1995, we can see the following trends.

By Exposure Category

The proportion of newly reported AIDS cases attributed to MSM decreased from 66% of the annual total in 1985 to 42% in 1995.

The proportion of newly reported AIDS cases among adults and adolescents attributed to injecting drug use increased from 17% in 1985 to 26% in 1995.

The proportion of newly reported AIDS cases among adults and adolescents infected heterosexually increased from 2% in 1985 to 11% in 1995.

By Gender

Women account for an increasing proportion of newly reported AIDS cases. The proportion of female adult and adolescent AIDS cases increased from 7% of the annual total in 1985 to 19% in 1995.

In contrast, the proportion of male adult and adolescent AIDS cases decreased from 93% of the annual total in 1985 to 81% in 1995.

By Region

Although the rate of AIDS cases reported per 100,000 people remains highest in the Northeast, the epidemic is spreading to other regions, with an increasing proportion of cases reported in the South.

Cases in the Northeast represent a decreasing proportion of the annual total, declining from 42% in 1985 to 31% in 1995.

The proportion of newly reported AIDS cases in the South increased from 24% in 1985 to 36% in 1995.

The proportion of cases in the West decreased from 28% in 1985 to 20% in 1995.

The proportion of newly reported AIDS cases in the North Central region increased from 6% in 1985 to 10% in 1995.

By Risk Category

By Race or Ethnicity

African Americans account for an increasing proportion of yearly reported cases -- from 25% in 1985 to 40% in 1995.

Similarly, the proportion of newly reported cases among Hispanics has steadily increased from 15% of the annual total in 1985 to 19% in 1995.

In contrast, the proportion of cases among whites has decreased from 60% in 1985 to 40% in 1995.

Note: The proportion of cases among Asians and American Indians has remained at less than 1%.

Men Who Have Sex With Men (MSM)

To date, HIV-related illness and death have had the greatest impact on MSM. And MSM continue to account for the largest number of AIDS cases reported annually. But the rate of increase in AIDS incidence in MSM has slowed overall. The overall stabilization among MSM reflects declines in some groups of MSM -- most notably older white men -- but increases in others. Data suggest that the highest rate of new infection is among minority MSM. These findings emphasize that prevention is not a "one-shot deal." Sustained, targeted prevention efforts will be needed to reduce the stable -- but still high -- rate of AIDS cases among MSM.

Injecting Drug Use

AIDS cases diagnosed among injecting drug users (IDUs) increased rapidly during the early 1990s, but annual increases have slowed since 1993. HIV prevalence data suggest that the rate of infection among IDUs has stabilized at a high rate -- with the highest concentration of infections remaining in the Northeast. AIDS cases and new infections related to injecting drug use appear to be increasingly concentrated in minorities, particularly African Americans.

Heterosexual Contact

Estimated AIDS incidence is increasing more rapidly among heterosexuals than among MSM and IDUs. Consequently, the proportion of yearly reported AIDS cases related to heterosexual sex has increased steadily over time, from 2% in 1985 to 11% in 1995.





*AIDS incidence is the best indication of trends in the epidemic and must be estimated from AIDS cases reported each year. Researchers estimate AIDS incidence by using consistent formulas over time to adjust for changes in the AIDS surveillance case definition (or criteria used to report AIDS) and delays in AIDS case reporting. Adult and adolescent AIDS incidence figures provided in this document represent estimates of the number of AIDS opportunistic infections that occur annually. Estimated AIDS incidence among children is based on cases diagnosed, adjusted for reporting delays.

+The seroprevalence data cited in this document are from data from seroprevalence surveys in a number of settings, including sexually transmitted disease clinics and drug treatment centers. These surveys are not conducted in all states and may not be representative of the entire population, nor do they represent all people in the subgroups surveyed. For example, surveys of STD clinics may represent individuals at higher risk than the population in general.

++An increasing number of Americans have been tested for HIV and know their serostatus. Consequently, an increasing percentage of people reported to CDC with AIDS also knew their partner's status at the time of their own diagnosis. These people are classified in the exposure category called sex with HIV-infected person whose risk was not specified.