AIDS/HIV in Georgia 1981-1989 [1989]

Office of Infectious Disease Division of Public Health Department of Human Resources
Georgia

This is the first annual report on AlDS (acquired immunodeficiency syndrome) and HIV (human immunodeficiency virus type I) infection produced by the Office of Infectious Disease (OID), 2 Division of Public Health, Department of Human Resources, Georgia. An abbreviated report on
; AlDS statistics is produced in the quarterly newsletter from the OID.
The report is presented in two components, AIDS and HIV. All data presented within the AlDS component are those from reporting of cases of AIDS by physicians, infection control practitioners, clinics and other sites. Without the assistance of all these individuals, little would be known about the epidemic of AlDS in Georgia.
Data about HIV infection is presented from a number of sources. Demographic data from reports of infected persons tested since July 1988 are presented here. Since 1985, sites (CTS) have been established throughout the state to provide counselling for individuals about the risks of infection with HIV and have provided facilities for testing for evidence of infection, the antibody . test. Some data are collected on all persons tested at these sites and are also presented here.
The Centers for Disease Control initiated a collection of seroprevalence surveys (HFS) at selected sites nationally in 1988. Atlanta is one such site, the data from which are included in , this report.
i In addition, population based testing, the testing of all of particular populations rather than
selecting a sample of a population, is performed on blood donors and civilian recruits to the military. Data about these testing programs are presented for Georgia.
To all those persons responsible for providing services and collecting these data, we acknowledge and thank you for your efforts in assisting in managing this epidemic.

Joseph A. Wilber MD Medical Consultant

Jane C. Carr RN Director

Bruce M. Whyte MD Medical Epidemiologist

TABLE OF CONTENTS
CHARACTERISTICS OF ALL AlDS CASES
Cumulative cases of AIDS in Georgia and the United States. 1W1 .1989 . . . . . . . . . .
Cumulative cases of AIDS in Georgia and the United States. 1981 .1989. . . . . . . . . . . . . . . . 2
Incident cases d AIDS in Georgia and the United States. 1981 .1989. . . . . . . . . . . . . . . . . . . . . . . . 3 Incident cases of AIDS in Georgia and the United States. 1981.1989. . . . . . . . . . . . . . . . . . 4
The cumulative number d cases in Georgh and other major reporting states.
through1969. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Incident cases of AIDS in 1989 in Georgia and the other major reporting states. . . . . . . . . . . . . . . . . 6
lncident cases d AlDS in 1989 per 100.000 populationfor Georgia
and the other major reporting states. . . . . . . . . . . . . . . . . . . . . . . 6 Incident cases of AIDS by sex in Georgia. 1981 .1989. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Incident cases of AIDS by sex in Georgia. 1981.1989. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Ratio of cases of AIDS in males and females by year of incidence. Georgia. 1981 .1989. . . . 9 Incident cases in Macks and whites. Georgia. 1981 .1989. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1 Incident cases in blacks and whites. Georgia. 1981.1989. . . . . . . . . . . . . . . . . . . . . . . . . 12 Ratio of AIDS cases to blacks and whites. Georgia. 1981 .1989. . . . . . . . . . . . . . . . . . . . . 13 Cumulative age distribution of AIDS cases in Georgia and the US through 1989. . . . . . . . . . . . . . . . 15 Age distribution of AIDS cases in Georgia and the US through 1989. . . . . . . . . . . . . . . . . . . 16
ADULT AND ADOLESCENT CASES
Cumulative cases of AIDS by risk group and age. Georgia. through 1989. . . . . . . . . . . . . . . . . . . . . 17 Cumulative cases of AIDS by risk group. Georgia. through 1989. . . . . . . . . . . . . . . . . . . . . 18
Incident cases of AIDS in homosexual and bisexual men. Georgia. 1983 .1989. . . . . . . . . . . . . . . . 19 Incident cases of AIDS in homosexual and bisexual men. Georgia. 1983- 1989. . . . . . . . . . 20
Incident cases of AIDS in IV drug users and heterosexuals. Georgia. 1983 .1989. . . . . . . . . . . . . . . 21
Incident cases of AIDS in IV drug users and heterosexuals. Georgia. 1983 .1989. . . . . . . . . 22

lncident cases of AlDS in transfusion recipients and persons with hemophilia.
Georgia. 1983 .1989. . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
lncident cases of AlDS in transfusion recipients and persons with hemophilia,
Georgia. 1983 .1989. . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
lncident cases of AlDS in homosexual/bisexual IV drug users.
and cases with no identified risk. Georgia. 1983 .1989. . . . . . . . . . . . . . . . 25
lncident cases of AlDS in homosexual/bisexual IV drug users.
and cases with no identified risk. Georgia. 1983 .1989. . . . . . . . . . . . . . . 26
PEDIATRIC CASES
Cumulative cases by risk group. Georgia. through 1989. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Cumulative cases by risk group. Georgia. through 1989. . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Yearly incidence of cases by risk group. Georgia. 1981 .1989. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Yearly incidence of cases by risk group. Georgia. 1981 .1989. . . . . . . . . . . . . . . . . . . . . . . 30
Maternal risk for perinatally infected children. Georgia. through 1989. . . . . . . . . . . . . . . . . . . . . . . . 31 Maternalrisk for perinatally infected children. Georgia. through 1989. . . . . . . . . . . . . . . . . . 32
CHARACTERISTICS OF ALL CASES
Frequency of diseases in all reported cases. Georgia. through 1989. . . . . . . . . . . . Case fatality rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
HIV IN GEORGIA THROUGH 1989
Introductionto HIV reports. . . . . . . . . . . . . . . . . . . . Health districts and health units in Georgia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
HIV REPORTING IN GEORGIA
HIV reporting requirements in Georgia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Reports of HIV infection by health districts and unit. Georgia. July 1988 .December 1989. . . . . . . . . 40 Cumulative reports of HIV infection by age groups. Georgia. July 1988 .December 1989. . . . . . . . . 41
Cumulative reports of HIVinfection by age groups. Georgia. July 1988 .December 1989. . . 42

Reporting of HIV infection by race. Georgia. July 1988 .December 1989. . . . . . . . . . . . . . . . . . . . . 43
Reports of HIV infection by race and health district and unit. Georgia. July 1988 . December
1989. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
COUNSELLING AND TESTING SITES
Testing at HIV counselling and testing sites in Georgia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Testing at HIV counselling and testing sites. Georgia. through 1989. . . . . . . . . . . . . . . . . . . . . . . . . 46
HIV FAMILY OF SURVEYS
Background. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Summary of HIV seroprevalence surveys. Atlanta. Georgia. July 1988 .September 1989. . . . . . . . . . 48 Seroprevalence in STD clinics. Atlanta. Georgia. July 1988 .February 1989. . . . . . . . . . . . . . . . . . . 49 Seroprevalence in STD clinics. Atlanta. Georgia. July 1988 .September 1989. . . . . . . . . . . . . . . . . . 50 Seroprevalence in drug treatment clinics. Atlanta. Georgia. July 1988 .June 1989. . . . . . . . . . . . . . 51 Seroprevalence in drug treatment clinics. Atlanta. Georgia. July 1988 .June 1989. . . . . . . . . . . . . . 52 Seroprevalence in women of reproductive age. Atlanta. Georgia. July 1988 .September 1989. . . . . . 54 Seroprevalence in child bearing women. Georgia. September 1988 .February 1989. . . . . . . . . . . . . 55 Seroprevalence in child bearing women. Georgia. September 1988 .February 1989. . . . . . . . . . . . . 56 Seroprevalence in child bearing women. Georgia. September 1988 .February 1989. . . . . . . . . . . . . 57
POPULATION BASED TESTING
Seroprevalence in blood donors attending the American Red Cross. Georgia. 1985 .1989. . . . . . . . 59
Seroprevalence in blood donors attending the American Red Cross. Georgia. 1985 .
1989. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Seroprevalence in male and female civilian applicants to the military.
Georgia. 1985- 1989. . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Seroprevalence in male and female civilian applicants to the military.
Georgia. 1985 .1989. . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Seroprevalence in black and white civilian applicants to the military.
Georgia. 1985 .1989. . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Seroprevalence in black and white civilian applicants to the military.
Georgia. 1985 .1989. . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

Page 1

I
AIDS IN GEORGIA 191

- Cumulative cases of AIDS in Georgia and the United States, 1981 1989

Number of cases Number of cases

cumulatively

cumulatively

reported in

reported in the

Georgia.

United States.

, AIDS IN GEORGIA 1989

Page 2

- Cumulative cases of AlDS in Georgia and the United States, 1981 1989

US cases (Thousands) 120
I

GA cases 3500
I

1982 1083 1084 1086 1986 1987 1988 I080

Half year of report

I

1

- Cumulative cases of AlDS reported in Georgia and the US by half year of report, 1982 1989.

The epidemic curve for total cumulative reported cases of AlDS in Georgia is steeper than that of the US as a whole. This may be due to more timely reporting in Georgia (briefer lag time) or a longer lag time in the US as a whole. This is evident in the graph which charts the cumulative number of reported cases in Georgia and the US according to half year of report of those cases. The average lag time of reporting of adult cases in Georgia was 142 days, with a median of 56 days.

Page 3

AIDS IN GEORGIA I S

- Incident cases of AIDS in Georgia and the United States, 1981 1989

Number of cases

Number of cases

reported for

reported for each

each year in

year in the

Georgia.

United States.

. AIDS IN GEORGIA 1989
i
P

Page 4

- lncident cases of AIDS in Georgia and the United States, 1981 1989

) US cases (Thousands)

20

7'00

Reported GA

Reported US

I

1982

1983

1984 1 9 8 6 , 1986 1987
Half year of report

1988

1989

I

L

I

- lncident cases of AlDS reported in Georgia and
the US by half year of report, 1982 1989.

A similar epidemic curve to that of cumulative cases is seen in the number of cases reported in each half year,

: the incident number of cases. Those in Georgia appear to have 'caught up' with those in the rest of the US. In

: ,

fact, the epidemic in Georgia can be seen to have progressed at a faster rate than in the US as a whole over

'< recent years. The number of cases in Georgia as a proportion of all cases in the US has increased from 2.2% in

"

1987 to 3.6% in 1989 adding further support to the notion that the epidemic in Georgia is progressing at a faster rate at the present time than in the country as a whole.

Page 5

AIDS IN GEORGIA 198

The cumulative number of cases in Georgia and other major reporting states, through 1989

New Jersey

QS

Georgia

3,1 18

- The top eight states for cumulative numbers
of reported cases of AIDS, 1981 1989.

Since the commencement of the epidemic of AlDS and reporting of persons with AIDS, Georgia has consistently remained one of the top reporting states in the US. Currently, and for the last several years, Georgia has been the eighth highest reporting state for the cumulative number of reported cases. This excludes Territories and the District of Columbia. Although Georgia ranks eighth in the cumulative number of reported cases of AlDS in the country since the commencement of the epidemic, this ranking alters when considering only those reported during the year of 1989, incident cases. Then, Georgia ranks seventh in the number of cases reported. Of those states reporting the highest numbers of cases in 1989, Georgia ranks sixth in the number of reported cases as a proportion of the total population, i.e. cases per 100,000.

&IDS IN GEORGIA 1989

Page 6

Incident cases of AlDS in 1989 in Georgia and the other major reporting states

Georgia

1,106

The top seven states for reported incident cases of AlDS in 1989.

lncident cases of AlDS in 1989 per 100,000 population for Georgia and the other major reporting states.

New Vork

33-5

New Jersey 28.9

FUorida

273

GaUiffomia 22.7

Nevad~

170E3

Georgia

17.2

Rates of AlDS per 100,000 population of the top six states for reported cases of AIDS.

k

Page 7

AIDS IN GEORGIA I9
I
- Incident cases of AIDS by sex in Georgia, 1981 1989

Men

Women

Total

41DS IN GEORGIA 1989
I
- lncident cases of AlDS by sex in Georgia, 1981 1989.

Male cases 1200

Female cases

1000

800

600

400

200

n -

-

1981 1982 1983 1984 1985 1986 1987 1988 1989

Year of report

- lncident cases of AlDS by sex and
year of report, Georgia, 1981 1989.

Page 8

The number of males has consistently been markedly greater than the number of females. Since the first female was reported with AlDS in 1983, the number of females reported has increased at a greater rate than males. The . graph highlights this using different scales for males and females so that the slope of the incident number of cases can be compared. The slope of the curve for females is steeper than that for males representing a more rapid increase in the number of reported female cases. The number of male cases reported in 1983 represented an increase of 225% over the number in 1982, the greatest increase in any year. In contrast, the greatest increase in female cases occurred in 1985 with an increase of 600% over 1984.

Page 9

AIDS IN GEORGIA 191

- ~ Ratio of cases of AIDS in males and females by year of incidence, Georgia, 1981 1989.

M:F ratio 80

70 -

65

1981 1982 1983 1984 1985 1986 1987 1988 1989 Year of report
Ratio of males to females for each year of reporting.
The highest male to female ratio occurred in 1984, the second year in which women were reported with AIDS. This ratio of 65:1 has steadily fallen to the current ratio of 12:l. In contrast, the male to female ratio for reported cases in the US for 1989 was 8.5:1.

, AIDS IN GEORGIA 1989
1

Page 10

: Page 11

AIDS IN GEORGIA 198<
1
- Incident cases in blacks and whites, Georgia, 1981 1989

Black

White

Black:white ratio Other race/ not known

AIDS IN GEORGIA 1989
I
- lncident cases in blacks and whites, Georgia, 1981 1989

Page 12

White cases 700 i

600

lack case6

White caaas

Black cases r 700

- lncident cases of AIDS in blacks and whites by year of report, Georgia, 1981 1989.

The rate at which cases have been reported in blacks in one year compared to the previous year has remained

consistently higher than the equivalent comparison of cases among whites. The rate of incident cases in blacks

reported in 1989 compared to 1988 was the same rate as in whites reported in 1987 compared to 1986. This

can be seen as a steeper slope for the blacks suggesting a greater increase than in whites. It is also apparent

i

that the number of cases reported in blacks will shortly exceed that in whites if present trends continue.

Page 13
I

AIDS IN GEORGIA 198
- Ratio of AlDS cases in blacks to whites, Georgia, 1981 1989

Black:white ratio

I

1

01 1981

I
1982

I
1983

I

I

I

1984 1985 1986

Year of report

I
1987

I
1988

I
1989

- Ratio of black to white AlDS cases by year of report, Georgia, 1981 1989.

The ratio of blacks to whites has rapidly risen since 1986, having been relatively stationary prior to that time. As i evident above, the ratio will be 1:1 sometime during the next two years at current trends.

AIDS IN GEORGIA 1989
1

Page 14

Page 15

AIDS IN GEORGIA 1986

Cumulative age distribution of AIDS cases in Georgia and the US through 1989

Age grouping

Georgia United States

Less than 13 years
-13 19 years -20 29 years -30 39 years -40 49 years
Greater than 49 years

36 14 734 1,518 586 220

1,995 461 24,056 54,334 24,951 1 1,984

, AIDS IN GEORGIA 1989

Page 16

Age distribution of AIDS cases in Georgia and the US through 1989

Age in yeare
Age distribution of all cases in Georgia as a proportion of all cumulatively reported cases compared with those of the US.
The age distribution of all cases in Georgia shows that a greater proportion of cases were reported in persons between 20 and 40 years of age than in the US. Although representing only a very small proportion (0.4%), adolescents (persons befween 13 and 19 years of age) in Georgia represent a similar proportion as in the US.

Page 17

AIDS IN GEORGIA 1986

ADULT AND ADOLESCENT CASES Cumulative cases of AIDS by risk group and sex, Georgia, through 1989

Homosexual or bisexual men
Intravenous (IV)drug user
Homo/Bi IV drug user Person with hemophilia Heterosexual contact Transfusion with blood/products None of the abovelother

Male (%)
2,126 (73.6) 328 (11.4) 206 (7.1) 18 ( 0.6) 51 ( 1.8) 53 ( 1.8) 105 ( 3.6)

Female (%)

Total (%)

. AIDS IN GEORGIA 1989
f
ADULT AND ADOLESCENT CASES Cumulative cases of AlDS by risk group, Georgia, through 1989

Page 18

% of all cases
1 a09b

% of all cases
r

Homo

IVDU Homo/lVDU Blood

Hetero

NIR

Cumulative cases of AlDS for each risk group as a proportion of all cases reported in Georgia compared to those for the US through 1989.

- Homo - Homosexual and bisexual men IVDU Intravenous drug user
Homo/lVDU - Homosexual and bisexual intravenous drug users
- Blood - Recipients of blood or blood products Hetero Heterosexual sexual contact NIR - No identified risk identified

.j The only major differences between the distribution of the cumulative number of persons with AlDS by risk activities in Georgia and the rest of the USA is the greater proportion of homosexual and bisexual men and the lesser proportion of heterosexual intravenous drug users in Georgia.

Page 19

AIDS IN GEORGIA 198

ADULTANDADOLESCENTCASES
- lncident cases of AIDS in homosexual and bisexual men, Georgia, 1983 1989

Year of report

Incident cases in homo/bisexual men

Percent of all incident cases

AIDS IN GEORGIA 1989

Page 20

1

ADULT AND ADOLESCENT CASES
- lncident cases of AlDS in homosexual and bisexual men, Georgia, 1983 1989

Georgia cases

1000

aHomolBlrexual

Qeorgia

Homo/bisexual cases r 1200

1983

1984

1985 1986 1987 Year of report

1988

1989

- Incident cases of AlDS in homosexual and bisexual men, and all incident cases in Georgia, 1983 1989.

- Horno/Bisexual homosexual and bisexual men

Although the number of reports of AlDS in homosexual and bisexual men have continued to rise, the proportion

:

of cases represented by this risk group has diminished since 1983. This can be seen in the widening gap

*A between the number of cases in homosexual and bisexual men and the total incident numbers in Georgia. This

does not represent a levelling of the epidemic in this subpopulation, rather a slower increase than is evident in

all cases in Georgia.

Page 21

AIDS IN GEORGIA 1989

ADULT AND ADOLESCENT CASES
- Incident cases of AIDS in IV drug users and heterosexuals, Georgia, 1983 1989

Year of report

Heterosexual cases

Percent all

IVDU

incident cases

i
Percent all incident cases

- Heterotexual cases persons infected solely from heterosexual sexual activities
IVDU - intravenous drug users who are not also homosexual or bisexual men

. AIDS !N GEORGIA 7989
1
9

Page 22

ADULT AND ADOLESCENT CASES

- lncident cases of AlDS in IV drug users and heterosexuals, Georgia, 1983 1989

Georgia cases
-7

IVDU, Hetero cases
r

1983

1984

1985 1986 1987 Year of report

1988

1989

- lncident cases of AlDS in heterosexual IVDU, heterosexuals and all incident cases in Georgia, 1983 1989.

- Hetero IVDU heterosexual IV drug users
Hetero - heterosexualsex partners

-
b

The number of cases attributed to intravenous drug use initially increased at a slower rate than all cases in

; .

Georgia until 1988, after which the rate of reporting of cases in this subpopulation increased to a greater extent

'

than any other group. Cases atkibuted solely to heterosexual activities have also increased but at a slower rate

than in IV drug users.

Page 23

I
AIDS 1N GEORGIA 1984
I

ADULTANDADOLESCENTCASES

- Incident cases of AIDS in transfusion recipients and persons with hemophilia, Georgia, 1983 1989

I I
I

Year of report Transfusion cases

Percent of all Persons with incident cases hemophilia

I
Percent of all incident cass

AIDS IN GEORGIA 1989
1!

Page 24

ADULTANDADOLESCENTCASES
- lncident cases of AlDS in transfusion recipients and persons with hemophilia, Georgia, 1983 1989

Georgia cases 1200 1
Hemophilia

Cases related to blood/products r 30

1983

1984

1986 1986 1987 Year of report

1988

1989

- lncident cases of AlDS in transfusion recipients, persons with hemophilia,
and all incident cases in Georgia, 1983 1989.

Page 25

3
AIDS rrJ GEORGIA 1989
ADULTANDADOLESCENTCASES
- Incident cases of AIDS in homosexual/bisexual IV drug users, and cases with no identified risk, Georgia, 1983 1989

Year of report

Homosexual bisexual IVDU

Percent of all NIR cases incident cases

Pinecricdeenntt Ocfas

ADULTANDADOLESCENTCASES
- lncident cases of AlDS in homosexual/bisexual IV drug users, and cases with no identified risk, Georgia, 1983 1989

Georgia cases

12001 I

I

Homo/lVDU and NIR cases
rc r 8 0

1983

1984

1985 1986 1987 Year of report

1988

1989

- lncident cases of AlDS in homosexual and bisexual IV drug users,
cases with no identified risk, and all incident cases in Georgia, 1983 1989.

Page 27

AIDS IN GEORGIA 1986
I
PEDIATRIC CASES Cumulative cases by risk group, Georgia, through 1989

Child with hemophilia

Male (%) 1 ( 5.6)

Female ( %)

Total ( %)

1

I

0 ( 0.0)

I
1 ( 2-81

Mother at risk/has AIDS/HIV

15 (83.3)

16 (88.9)

31 (86.1)

I

.?
;:

Transfusion with blood/products 2 (11.l) 2 (11.1)

4 (11.1)

~ ~

Total

18 (100)

18 (100)

36 ( 100)

AIDS IN GEORGIA 1989
.j
d 4

PEDIATRIC CASES

Cumulative cases by risk group, Georgia, through 1989

Page 28

Transfusion 11% Mother at risk 86% Hemophilia 3%
Georgia

Transfusion 11%

Mother at risk 81%

USA

Hemophilia 5%

Page 29

AIDS rrJ GEORGIA 1985
PEDIATRIC CASES
- Yearly incidence of cases by risk group, Georgia, 1981 1989

Pediatric

All Georgia

Ratio all cases to pediatric

AIDS IN GEORGIA 1989
1
PEDIATRIC CASES
- Yearly incidence of cases by risk group, Georgia, 1981 1989

Page 30

Georgia cases 1200r r
Pediatric Georgia, all

Pediatric cases
1l2

1983

1984

1985 1986 1987 Year of report

1988

1989

- Incident pediatric cases and the incidence of all cases in Georgia, 1983 1989.

The epidemic in children, although of smaller numbers, is following the same epidemic curve as that for all

cases in Georgia. The risk group with the largest number of children is that of mothers at risk of infection with

HIV who have AIDS or who are already known to be infected with HIV. Children infected secondary to

contaminated blood comprised the second largest risk group. The proportions of children in each risk group in

r :

Georgia are virtually the same as those for the US as a whole.

Page 31

AIDS IN GEORGIA 1989
I
PEDIATRIC CASES Maternal risk for perinatally infected children, Georgia, through 1989

Cases

Percent

Mother an IV drug user

15

42%

Sex partner a male IV drug user

7

19%

Sex partner a bisexual male

4

10%

Sex partner known HIV infected

4

10%

Sex partner infected through blood transfusion 1

3%

Mother from Pattern II country

1

3%

Mother's risk not known

3

8%

-N intravenousdrug user - Pattern II country country where predominant mode of spread of HN is helercaexual c4otact

AIDS IN GEORGIA 1989
.J
PEDIATRIC CASES Maternal risk for perinatally infected children, Georgia, through 1989

Page '32

IVDU Sex/lVDU Sex/bi

I I

Sex/TA Sex/HIV

Mother's risk for infection with HIV

- .-
?

Proportion of all pediatric cases infected perinatally according to the mother's risk of infection, Georgia, through 1989.

iVDU - intravenous drug user
- Sex/NDU sex partner of male I M U - Sex/bi 8ex partner of bisexual man -II woman from Pattern IIcountry - Sex/TA sex partner of male transfusion recipient - Sex/HN sex partner of H N infected man -? mother infected but source of infection unclear

A

. .

Within the group of children who were infected perinatally, most mothers were infected directly or

indirectly through intravenous (IV) drug use. In Georgia, about 62% of children who had a mother who

was at risk for infection were infected through IV drug use. As with the risks for all children, the

proportion of mothers in each of the risk groups was similar in Georgia and the US as a whole.

Page 33

AIDS IN GEORGIA 198

Frequency of diseases in all reported cases, Georgia, through 1989

Bacterial infections Candidiasis (bronchi or lungs) Candidiasis (esophagus) Coccidiodmycosis Cryptococcus Cryptosporidiosis Cytomegalovirus disease Cytomegalovirus (retinitis) HIV encephalopathy Herpes simplex Histoplasmosis lsosporiasis Lymphoid interstitial pneumonitis Kaposi's sarcoma Lymphoma (Burkitt) Lymphoma (irnmunoblastic) Lymphoma (primary brain) Mycobacterium aviurn Mycobacterium tuberculosis Mycobacterium other Pneumocystis carinii pneumonia Progressive multifocal leukoencephalopathy Salmonella septicemia Toxoplasmosis (brain) Wasting syndrome

Number of ptrsons Percent of pysons

with disease.

with disease.

0.16

2.15

15.55

0.13

9.17

1.48

4.01

1.83

4.36

3.88

0.42

0.06

0.35

11.64

0.45

1.57

0.71

3.91

2.69

1.38

62.38

0.32

0.22

3.91

9.94

the number of diseases Is greater than the number of persons with AIDS as some had more than one disease diagnosed.

AIDS IN GEORGIA 1989
!
1

Page 34

Case fatality rates

I

Case fatality rate by half year of diagnosis of all cases, adult, adolescent and pediatric, reported through 1989

Half-Year of Diagnosis
Before 1980
1980 Jan June July-Dec
1981 Jan June July-Dec
1982 Jan June July-Dec
1983 Jan June July-Dec
1984 Jan June July-Dec
1985 Jan June July-Dec
1986 Jan June July-Dec
1987 Jan June July-Dec
1988 Jan June July-Dec
1989 Jan June July-Dec
Totals

Number of Cases

Number of Deaths

CaseFatality Rate

0
0 0
3 4
5 7
17 2 1
42 61
95 131
190 215
332 341
425 440
459 330
31 18

0

-----

0

-----

0

-----

0

0.0%

3

75.0%

16 2 1
41 53
84 119
146 174
254 227
248 208
133 76
1814

94.1 % 100%
97.6% 86.9%
88.4% 90.8%
76.8% 80.9%
76.5% 66.6%
58.4% 47.3%
29.0% 23.0%
58.2%

* US adun and addescent uw fatality Rltw only

US cas~fatality rate

-.<: AIDS IN GEORGIA 1989
i'

Page 36

Page 37

I
HIV IN GEORGIA THROUGH 1989
I

HIV IN GEORGIA THROUGH 1989.
Introduction to HIV reports
Data presented in this report to this point have been those about AlDS in Georgia. It is known that AlDS is only one manifestation, although the most severe, of infection with the human immunodeficiency virus type I (HIV). Studies have determined that it usually takes many years from the time of initial infection with HIV before a person develops AIDS. This interval, the incubation interval or period, may be as long as 11 years, or as short as several months. Data concerning persons with AlDS and trends in these persons thus describes infection and trends in infection
that occurred many years ago, perhaps as long as 11 years. Useful as these may be, it would be more meaningful
to present efforts to understand more about trends in infection that are current.
Many other conditions result from infection with HIV and attempts have been made to classify these. A number of studies are attemptingto more clearly define these other manifestations. However, there are data currently collected that assist in understanding spread of HIV infection in our community. These data for Georgia are presented in the remainder of the report.

HIV IN GEORGIA THROUGH 7989
!!
Health districts and health units in Georgia

Page 38

Georgia is divided into 10 health districts (1 - 10). Five of these are further divided into health units. On the left

..:

are the health districts and units, excluding the health units in health district 3, Atlanta, which are detailed to the

right. Much of the following data are presented according to health districts/units as detailed above.

Page 39
4 '

HI!! REPORTING IN GEORGIA THROUGH 198
HIV REPORTING IN GEORGIA. HIV reporting requirements in Georgia

Infection with HIV became a reportable condition in Georgia on July 1, 1988, under provisions within Act No. 1440 (House Bill No. 1281). The relevant section of the Act states: Each health care provider, health care facility, or any other person or legal entity which orders an HIV test for any person shall report each confirmed positive HIV test to the department along with age, sex, race , and county of residence of the person having the confirmed positive HIV test but shall include in that report no other identifying characteristics regarding the HIV
infected person.... These strict requirements were instituted to protect the privacy and confidentiality of infected
persons.
As a result of this Act, many reports of infected individuals have been received by the Sun/eillance Unit of the Office of Infectious Disease within DHR. However, due to the anonymous nature of these reports, as required under the Act, it is not possible to detect multiple reports on any one individual. Hence, analysis of those reports received of infected individuals must be viewed with extreme caution as the analyses are merely of reports received and not necessarily of individuals.
The following tables include only those reports received from July 1, 1988 to December 31, 1989 in which at least three of the four required data variables were provided on the report form. Hence, in some, one variable may be missing.

HI!! REPORTING IN GEORGIA THROUGH 1989
i

Page 40

- Reports of HIV infection by health districts and unit, Georgia, July 1988 December 1989

Health Unit Number of reports
Not stated Rome Dalton Gainesville Cobb Fulton Clayton Gwinnett DeKalb LaGrange Dublin Macon Augusta Columbus Valdosta Albany Savannah Waycross Brunswick Athens

Total

6,587

Percent of total
100.0

AlDS cases as percent of total'
100.0

-1 Cases of AIDS ~neach health umt as a percent of all c d M y mpcnted caws m -ia
1
The number of reports from health district 3, approximately metropolitan Atlanta, represented 53.2% of all reports. This same health district has reported 74% of all cases of AlDS since 1981.As qualified on the previous page, these reports are not necessarily representative of HIV infection in Georgia and may merely represent availability of testing facilities.

Page 41
lJi' :

HIV REPORTING IN GEORGIA THROUGH 1989
I

- Cumulative reports of HIV infection by age groups, Georgia, July 1988 December 1989

Age group Number of Percent of ( ~ r s ) reports reports

Total

6587

93.3

Many reports were received that did not specify the age of the individual being reported and were included with those aged less than 10 years. Due to the inabilily to differentiate those missing an age from those less than 10 years of age, these reports are not listed in the table. The average age of all remaining reported individuals was 29.6 years, several years younger than the average of 33 years for persons with AIDS. The average age of females, 28.5 years, was less than in males, 30.1 years.

,; HIV REPORTING IN GEORGIA THROUGH 1989
8 I

Page 42

- Cumulative reports of HIV infection by age groups, Georgia, July 1988 December 1989

Percent of all cases

AIDS

HIV

- 20 - 29 30 39
Age group in years
Cumulative number of reported cases of AlDS and HIV infection by age groups through December 1989.
- AlDS cumuiati proportionof reported cases of AlDS
HIV - curnulati proportionof reported cases of HN infection

- Reporting of HIV infection by race, Georgia, July 1988 December 1989
The number of individuals who were reported infected with HIV and who were black exceeded the number who were white by a large margin. In health district 3, approximating metropolitan Atlanta, the ratio of blacks to whites was 1.4 to 1. For all other health districts combined in Georgia, the ratio was 2 to 1. Statewide, reports of blacks represented 56% of all reports. In comparison, blacks represent 27% of the total population in Georgia. This disproportion in reports of infected blacks compared to whites is similar to that for reported cases of AIDS, although to a greater degree (page 11).
Despite the cautions that apply to these data on reported infections with HIV, they are not inconsistent
with that expected - that individuals infected with Hnl who have not progressed to AIDS, are likely to be
younger than those with AlDS and that the trend towards a greater proportion of black cases of AlDS is reflected with a proportion of blacks that is already greater in those infected and reported.

- 3eports of HIV infection by race and health district and unit, Georgia, July 1988 December 1989

Health Unit

White

Not stated Rome Dalton Gainesville Cobb Fulton Clayton Gwinnett DeKalb LaGrange Dublin Macon Augusta Columbus Valdosta Albany Savannah Waycross Brunswick Athens

Total

Black

Total

Page 45

HIV IN CTS IN GEORGIA THROUGH 198

COUNSELLING AND TESTING SITES
Testing at HIV counselling and testing sites in Georgia
Testing for antibodies to HIV, with accompanying counselling before and after the test, is available at all 159 county health departments in Georgia. This commenced in 1985. These testing sites are also located in some publicly funded drug treatment centers in the counties. Testing is performed in all these sites in an anonymous (no personal identifiers collected or recorded) or confidential (records with identifiers kept under tight securityl manner. The cost for the test is minimal and may not be charged if the person cannot afford the cost. Counselling before and after the test follows the guidelines produced by the Centers for Disease Control. Appropriate referrals are made for further medical evaluation, psychological support and social services.
Some information is collected on all individuals who seek to be tested at these alternate test sites. This includes their age, sex, race, county of residence and probable mode of infection with HIV. As this is not required or mandated within the state, these data are generally incomplete and are not, therefore, presented here. Rather, summary testing data only are provided.
It is difficult to interpret these data due to the inability to generalize from this population to that of the total population in Georgia. This population, that tested at these sites, is likely to be those persons at high risk for infection with HIV who are motivated to be tested. This same motivation, that leads them to seek to be tested and take steps to limit further spread, may be a marker that suggests that these persons are more aware of the risks of infection and are therefore less likely to undertake activities that place them at risk of infection. If that were to be the case, there would be many more persons at risk who have not been tested and who are likely to be infected. It is the inability to interpret these data that leaves them open to discussion.
However, testing at these sites has allowed at least 69,670 individuals to be counselled about activities likely to place them at risk of infection. At least, because many partners and friends of these individuals have also benefited from this counselling. It is realistic to expect that some proportion of these individuals have subsequently modified their behavior to reduce the risk of being infected or to limit further spread if already infected. Many of these individuals would otherwise not have any contact with health care facilities that provide counselling, so this method of testing has allowed a large, otherwise unreached population to be counselled and referred for further care where appropriate.

HI!! IN CTS IN GEORGIA THROUGH 1989
.'
Testing at HIV counselling and testing sites, Georgia, through 1989

Page 46

Health Unit

Number tested Number positive

1-1 Rome 1-2 Dalton 2 Gainesville 3-1 Cobb 3-2 Fulton 3-3 Clayton 3-4 Gwinnett 3-5 DeKalb 4 LaGrange 5-1 Dublin 5-2 Macon 6 Augusta 7 Columbus 8-1 Valdosta 8-2 Albany 9-1 Savannah 9-2 Waycross 9-3 Brunswick 10 Athens Drug treatment centers

Total

69,670

Seropositivity rate (%)

Page 47

HFS SURVEYS IN GEORGIA THROUGH 79l

HIV FAMILY OF SURVEYS.
Background
Although there are reliable data concerning the prevalence of AIDS in the community, comparable data about the number and characteristics of individuals infected with HIV are not as readily available. The only method of obtaining a reliable population based estimate of the prevalence of HN in the community is the selection of a random sample of the total population and testing all that sample for the presence of antibodies to HIV. That concept is not practical due to both difficulties in interpretation of a single HN test result in many individuals and the lack of safeguards to protect the anonymity of individuals being tested.
In 1988, the Centers for Disease Control introduced the HIV Family of Surveys Study (HFS). This is a group of surveys in selected populations whose purpose is to establish a baseline of HN seroprevalence and monitor trends over time through repeated surveys. States and Territories were invited to submit proposals to initiate surveys of HIV prevalence in five separate subpopulations: sexually transmitted disease clinics (STD clinics), drug treatment clinics, clinics caring for women of reproductive age (women's health clinics, abortion clinics), tuberculosis clinics and newborn infants. Atlanta is one of 39 sites participating nationally.
The HFS commenced in Atlanta in August 1988 in three counties (Cobb, DeKalb, Fulton). All sites commenced with the exception of tuberculosis clinics which was delayed until the second sampling period. The first component of these surveys was completed in September 1989. The period covered in this interval was the first period of the HFS and it is these data that are reported here. The second sampling period commenced in October 1989 and will not be completed until mid- 1990.
At all sites participating in the first component of the HFS, testing of samples of blood was performed in a blinded manner. In so doing, all identifiers of the individual from whom the sample had been collected were removed before the sample was tested. These identifiers included names, addresses, coded methods of identification and any other information that could possibly lead to identification of that individual. Hence, no person found to be infected could be informed of their infection. Rather than causing an ethical dilemma, these surveys allow public health efforts to limit further spread of the virus to be more effectively targeted. In each of the sites at which these blinded surveys have been conducted, confidential and/or anonymous testing for HIV antibodies with counselling both before and after the test are available by trained counsellors. Thus, no person would be denied the opportunity to be tested in an informed manner and be made aware of their infective status.

- Summary of HIV seroprevalence surveys, Atlanta, Georgia, July 1988 September 1989

STD clinics

Number tested 3,584

Seroprevalence ("A)
8.3

Drug treatment clinics

746

2:'

Women of reproductive age 1,117

13.0 0.4

Child bearing women

45,278

0.17

Time interval
July 88 - Feb 89 July 88 - June 89
July 88 - Sept 89 Sept 88 - Feb 89

Page 49

HFS SURVEYS IN GEORGIA THROUGH 198

- Seroprevalence in STD clinics, Atlanta, Georgia, July 1988 February 1989

During the first period, homosexual and bisexual males and females were oversampled in Georgia in order to obtain a better estimate of seropositivity in these two subgroups. This sampling bias artificially inflated the overall rate of HIV positivity reported for Georgia STD clinics. When adjusted for sampling bias the actual overall seroprevalence for STD clinics included in the Georgia HFS during the first sampling period was 4.2%.
The seropositivity in Georgia STD clinic sites of 4.2% was considerably higher than the 2.5% found across all sites nationally. Georgia has remained one of the highest reporting states in the US for cases of AIDS since 1982. This suggests that infection with HIV was also high when compared to other states over the same time period. It is not surprising therefore to find a seroprevalence higher than the national figure.

C! HFS SURVEYS IN GEORGIA THROUGH 1989
I

Page SO

- Seroprevalence in STD clinics, Atlanta, Georgia, July 1988 September 1989

No. tested

By risk group: Homo/Bi

406

No. seropositive Seropositive rate (%)

21 9

53.9

Hetero/lVDU

1 58

19

Other

2,987

39

By sex:

Males Females

2,027 1,557

By county:

Cobb

1,124

27

DeKalb

1,251

Fulton

1,209

139

Total:

3,584

296

2.4 '* 11.5 ** 8.3 **'

HomolBi - homosexual and bisexual men
- Homo/Bi/iVDU intravenous drug users who are also homosexual or bisexual - Hetero/iVDU intrawnous drug users who are heterosexuals - Other other risk for infection or risk not stated
* When adjusted for oversampling of homosexual/bisexual males, the seropositivity rate in male STD clinic clients was 6.6%
- - ** When adjusted for oversampling of homosexual/bisexual males, overall seropositivity rates were:
Cobb - 2.4% DeKalb 4.4% Fulton 6.1% *** When adjusted for oversampling of homosexual/bisexual males, the overall seroprevalence rate was 4.2%

Page 51

HFS SURVEYS IN GEORGIA THROUGH 798

- Seroprevalence in drug treatment clinics, Atlanta, Georgia, July 1988 June 1989
Persons tested for antibodies to HIV in this component of the HFS were tested in a blinded manner. In this form of testing, samples of blood withdrawn for testing for other procedures or for HIV testing, had all identiqing information about the client removed before the sample left the drug treatment site. Thus, no individual could possibly be identified from this procedure. All clients were intravenous drug users, although other methods of administering drugs may also have been used. Data about alternative routes of administration were not sought within this survey. These data suggest that 1 in 7 intravenous drug users is infected with HIV at these sites. The seroprevalence in these centers was two and a half times higher than the national average of 5.5%. As described for clients of STD clinics, this is not altogether surprising considering the early penetration of AIDS into Georgia compared to most other states.

HFS SURVEYS IN GEORGIA THROUGH 1989

Page 52

- Seroprevalence in drug treatment clinics, Atlanta, Georgia, July 1988 June 1989

Sex:
!>.,
i.?,
Race:

Male Female
Black White

No. tested 31 1 62

Total:

No. positive
41 9

Seropositive rate (%) 13.2
14.5

Page 53

HFS SURVEYS IN GEORGIA THROUGH 15

- Seroprevalence in women of reproductive age, Atlanta, Georgia, July 1988 September 19I

Seroprevalence data were obtained on clients of women's health clinics at preselected locations. Results are not generalizable to the population of women attending family planning or abortion clinics elsewhere in Georgia. HIV tests were conducted on sera remaining from blood specimens routinely collected for a variety of other tests. All personal identifiers were removed from specimens prior to testing. Thus, tests were conducted in a double blind manner, i.e. clients were not aware that they were being tested for HIV and surveillance personnel were not aware of the identity of the clients. Seroprevalence rates in family planning and abortion clients at the sites selected were both higher than the rate of 0.17% found in Georgia childbearing women through testing of newborn infants. These data are presented later in the report (page 55).

- Seroprevalence in women of reproductive age, Atlanta, Georgia, July 1988 September 1989

Number tested Number positive Seropositive rate

Family planning clinics

325

Abortion clinics
I
L
Total

Page 55

HFS SURVEYS IN GEORGIA THROUGH 7989

- Seroprevalence in child bearing women, Georgia, September 1988 February 1989

This survey is not to be confused with the previous survey, both of which seek the seroprevalence in women of child bearing age. In Georgia, all newborn infants have several blood spots absorbed onto filter paper at birth. Some of the spots are used to test for a variety of abnormalities including thyroid disease and some metabolic disorders. After removal of identifying information about mother and infant, remaining blood spot samples were then tested for antibodies to HIV. Thus, all testing was performed in a blinded manner.
A sample that tested positive indicates that the newborn infant had antibodies to HIV in their blood. These may have been from the mother and crossed the placenta or they may be from the infant. If antibodies
mav are from the mother, the infant not be infected, but merely have the 'passive' transfer of maternal
antibodies. These passively transferred antibodies may last as long as 15 months before disappearing. Antibodies produced by the infant in response to an active infection in that infant will last for life. Hence, measurement of newborn infants' antibody status is one method of determining the HIV status of their mothers.
The health units that recorded the highest rates of seropositivity in child bearing women were Albany (82), Fulton (3-2), Savannah (9-I), DeKalb (3-5) and Macon (5-2). Three of these five health units are in the south of the state with major urban centers markedly smaller than Atlanta. The rates in these units were at least as high as the highest metropolitan Atlanta rate, found in Fulton (3-2). Only four units had no infected newborn infants during the period of the survey.

Y HFS SURVEYS IN GEORGIA THROUGH 1989
a

Page 56

- Seroprevalence in child bearing women, Georgia, September 1988 February 1989

Health Unit

No. tested

1-1 Rome 1-2 Dalton 2 Gainesville 3-1 Cobb 3-2 Fulton 3-3 Clayton 3-4 Gwinnett 3-5 DeKalb 4 LaGrange 5-1 Dublin 5-2 Macon 6 Augusta 7 Columbus 8-1 Valdosta 8-2 Albany 9-1 Savannah 9-2 Waycross 9-3 Brunswick 10 Athens Unknown

Total

No. positive

Seropositive rate (%)

Page 57

HFS SURVEYS IN GEORGIA THROUGH 1981

- Seroprevalence in child bearing women, Georgia, September 1988 February 1989.

Race

Number Number Positive

tested

positive rate (%)

White

27,445 20

Black

14,995 55

Other/unknown 2,838

4

0.07 0.37 0.14

Overall, black infants had a higher seroprevalence than white infants for the entire state. These data have not been analyzed for racial differences within health districts or health units.

Page 59

HIV SCREENING IN BTS IN GEORGIA THROUGH 196
I

POPULATION BASED TESTCNG.
- I Seroprevalence in blood donors attending the American Red Cross, Georgia, 1985 1989.

Since the testing procedures for antibodies to HIV became commercially available in 1985, all American Red Cross Blood Transfusion Services (ARCBTS) have required all potential blood donors to be serologically tested for HIV. All donors, irrespective of whether they are a new donor or a previous donor, are tested. In addition, all potential donors are advised that if they are involved in activities likely to place them at risk for infection with HIV, they should not donate. If, because of donating at a work site or for other reasons, persons are unable to state that they are involved in high risk activities they may advise the ARCBTS that their donation should be used for research purposes only. All donations found to be infected with HIV (positive antibody test, donated for research purposes) are discarded and not used in any manner.

No. donors

No.positives

Rate/ 100,000

testing wmmencsd on donatiom in March 1985

,4IV SCREENING IN BTS GEORGIA THROUGH 1989
4

Page 60

- Seroprevalence in blood donors attending the American Red Cross, Georgia, 1985 1989.

Thousands of donations
250 r

No. positives 1100

Year of donation

No. donations

No. positives

- Number of donations and number of infected donors detected by year of donation, Georgia, 1985 1989.

Page 61

I
HIV MILITARY SCREENING IN GEORGIA THROUGH 1 9 ~
I

- Seroprevalence in male and female civilian applicants to the military, Georgia, 1985 1989.

Tested

Men Positive

Pos rate Tested
(%I

Women Positive

Pos rate (%)

- Seroprevalence in male and female civilian applicants to the military, Georgia, 1985 1989.

1985

1986

1987

1988

b a r of testing

1989

Seropositivity rates of Georgia male and female applicants to the military by year of testing.

Page 63

HIV MILITARY SCREENING IN GEORGIA THROUGH 198

- Seroprevalence in black and white civilian applicants to the military, Georgia, 1985 1989.

Tested

Black Positive

Pos rate Tested
(%I

White Positive

Pos rate
("A)

;:HIV MILITARY SCREENING IN GEORGIA THROUGH 1989
d :

Page 64

- Seroprevalence in black and white civilian applicants to the military, Georgia, 1985 1989.

1985

1986

1987

1988

Year of testing

- .-
1989

Seropositivity rates in Georgia black and white civilian applicants to the military by year of testing.