1998 - 1999 Georgia HIV/STD report

AIDS Cases by Year of Diagnosis Georgia, 1981-1999
Number of cases 2500

2000

1500

1000

500

0 Cases

1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 11 15 47 112 244 431 731 999 1205 1593 1871 2084 2158 2233 2155 1993 1495 1385 1037

Blinded HIV Seroprevalence Survey: DeKalb County STD Clinic HIV positivity by sex and year

Percent HIV positive 6
# Males $ Females
5

Total

4# 3

2

1
0
Males Females
Total

$
1992 3.9 0.5 2.2

#
$
1993 3.8 1.5 2.7

#
$ 1994
3.2 0.7 2.1

#
$
1995 2.3 0.9 1.7

#
$ 1996
5.4 0.7 3.2

#
$ 1997
4.9 0.6 2.9

#
$ 1998
5.2 0.5
3

#
$ 1999
5 1 3.3

Blinded HIV Seroprevalence Survey: Fulton County Drug
Treatment Clinic HIV positivity by sex and year

Percent HIV positive 20

# Males $ Females Total 15

#

#

$

#

#

10 #

#

#

#

#

$

$

$

$

$

$

$

$

5

0
Males Females
Total

1990 10 7
9

1991 10 7.7
9.2

1992 11 8.3
10

1993 10 8.1
9.7

1994 11 7.2
9.9

1995 13 7.4
11

1996 17 9.6
14

1997 15 7.2
12

1998 18 17
18

SHAS Project: Persons with AIDS at Grady Health System Is your most recent steady sex partner infected with the AIDS virus?

Percent 60

50

$

40 #
30

20

,

10

0
Yes No Don't know

1995 33 50 17

$#

$

$

$#

#

#

# Yes $ No , Don't know

,

,

,

,

1996 43 42 13

1997 35 43 20
Year of Interview

1998 37 44 17

1999 41 42 16

Georgia Behavioral Risk Factor Surveillance System Have you ever had your blood tested for HIV/AIDS?

Percent answering yes 60

50

40

#

#

30 #

20

10

0 Total #

1993 26

1994 35

1995 34

#
1996 33

#
1997 39

#
1998 52

#
1999 56

Note: Data for 1998 and 1999 exclude any tests related to blood donation. Data for prior years may include tests related to blood donation.

Georgia HIV/STD Report
1998 - 1999

Early Syphilis by Year of Diagnosis Georgia, 1945 - 1999
Number of cases (Thousands) 20 15 10
5 0
45 50 55 60 65 70 75 80 85 90 95 Year
Gonorrhea Cases by Public Health District Georgia, 1999
Metropolitan Atlanta

N = 22,033 reported cases

Georgia Chlamydia Project
Chlamydia positivity by age group, 1998

Age Group 10 - 19 20 - 29 30 - 39 40 - 49

Percent Positive

12%

(2,226/18,448)

6%

(1,814/28,761)

2%

(145/7,251)

1%

(16/1,529)

Total

8% (4,201/55,989)

Georgia Department of Human Resources | Division of Public Health |

1998-1999 GEORGIA HIV/STD REPORT

Georgia Department of Human Resources

Department of Human Resources Gary B. Redding -- Acting Commissioner

Division of Public Health

Kathleen E. Toomey, M.D., M.P.H.-- Director

Prevention Services Branch, STD/HIV Section

Teresa Edwards -- Chlamydia Project Coordinator

Epidemiology Branch

Paul A. Blake, M.D., M.P.H.-- Director

Chronic Disease, Injury, and Environmental Health Epidemiology Section

Linda M. Martin, M.S.-- BRFSS Coordinator

HIV/STD Epidemiology Section John F. Beltrami, M.D., M.P.H. & T.M.-- Chief Lyle W. McCormick, M.P.H.-- Data Manager

Acknowledgments
State AIDS and STD surveillance staff, District AIDS liaisons, District STD coordinators, Alan Fann, M.Sc. and Jeffrey Lennox, M.D. (Grady Health System and Emory University), Stuart Brown, M.D. (DeKalb County Board of Health), Pradnya Tambe, M.D. (Fulton County Department of Health and Wellness), staff at the Fulton County Alcohol and Drug Treatment Center, and Jimmy Clanton (Visual Information Specialist, Division of Public Health)
2 | 1998 - 1999 GEORGIA HIV/STD REPORT

TABLE OF CONTENTS
I. Introduction ............................................................................................4. II. AIDS Surveillance...................................................................................5. III. HIV Seroprevalence Surveys..................................................................25
A. DeKalb County STD clinic..............................................................25 B. Fulton County drug treatment clinic................................................2.9 IV. Supplement to HIV/AIDS Surveillance (SHAS) Project.......................32 V. Behavioral Risk Factor Surveillance System (BRFSS).........................3. 7 VI. STD Surveillance.....................................................................................41 A. Syphilis...........................................................................................4. 2 B. Gonorrhea.......................................................................................5. 6 C. Chlamydia.......................................................................................70 VII. Chlamydia Project...................................................................................84 VIII. Gonococcal Isolate Surveillance Project (GISP)...................................8. 9 IX. Appendix: Technical Notes ....................................................................9. 1
3 | 1998 - 1999 GEORGIA HIV/STD REPORT

INTRODUCTION
Purpose of Report The purpose of this report is to: a) provide information on the human immunodeficiency virus (HIV), the acquired immunodeficiency syndrome (AIDS), and sexually transmitted diseases (STDs); b) show the interrelatedness of HIV/AIDS with STDs and drug use; c) inform persons who are infected and affected by these conditions; and d) inform health care providers, public health workers, and policy makers who are responsible for the control, prevention, and reporting of these diseases. Because Ryan White funding, Housing Opportunities for Persons with AIDS (HOPWA) funding, the HIV Prevention Community Planning process, public health policy, and various grant proposals are all based on data, the information in this report is extremely important. The data contained in this report are useful to help: a) acquire and distribute federal Ryan White and HOPWA funds to persons infected and affected by HIV/AIDS; b) acquire and distribute federal funds to sponsor HIV prevention activities conducted by community-based organizations; c) make public health policy at the national, state, and local levels; d) support grant proposals from several organizations; and e) complete hundreds of data requests each year.
4 | 1998 - 1999 GEORGIA HIV/STD REPORT

AIDS Surveillance
AIDS is caused by an infection with HIV. HIV affects the immune system and may cause many different diseases and conditions. HIV is acquired primarily through sexual activity and injection drug use and can be asymptomatic for many years. Although adherence to prescribed medications can be difficult, effective treatments are now available.
Since the earliest days of the HIV/AIDS epidemic, Georgia has continually had a substantial number of reported cases of AIDS. In 1999, Georgia had the eighth highest rate of AIDS among all states. Other parameters help put this finding into a better perspective. As of December 1999, Georgia had the eighth highest cumulative number of AIDS cases reported among the 50 states and the seventh highest number of persons living with AIDS. The characteristics of the AIDS epidemic in Georgia have gradually shifted since the 1980s from an epidemic mostly represented by urban white men who have sex with men (MSM), to an epidemic with increasing proportions of minorities, women, persons infected through heterosexual contact, and persons residing in rural areas. In this report, charts and tables are used to describe persons who are infected with HIV or STDs primarily by year of diagnosis, demographic information (i.e., age group, sex, race/ethnicity), geographic location, and sexual and drug use behaviors that put persons at risk for acquiring or transmitting HIV or STDs.
In Georgia, health care providers are required by law to report cases of HIV and AIDS to the appropriate local or state health department. Although Georgia has HIV reporting, the statewide AIDS database is more useful for statistical purposes. When interpreting AIDS surveillance data, it is important to note that the database, as with most surveillance databases, does not represent 100% complete reporting. Therefore, the numbers presented in this document reflect an underestimate of the true number of cases in the state. AIDS information should be further interpreted with caution because of the recent advances in HIV/AIDS medications. Given the success of these medications, AIDS trends are now more likely to reflect persons who take the medications or have access to treatment, as opposed to representing the course of the epidemic.
Through December 1999, 21,799 cumulative persons with AIDS have been reported in Georgia, of which 11,947 (55%) have died. The number of persons living with AIDS has increased each year since 1981, whereas the number of AIDS deaths has been decreasing in recent years. The recent decrease in reported cases and deaths has been attributed to the new antiretroviral medications which delay the progression of an HIV-infected person to AIDS. Based on year of diagnosis, the epidemic in Georgia peaked in the mid-1990s, and since 1995, the number of new cases has declined each year. Although AIDS cases have been declining, it cannot be said that the HIV/AIDS epidemic is waning. Evidence from some states which conduct standardized HIV reporting suggests that the number of new cases of HIV are stable or possibly increasing for some segments of the population.
5 | 1998 - 1999 GEORGIA HIV/STD REPORT

For cases diagnosed in 1999, AIDS rates per 100,000 population are shown in Table 1 by age group, sex, and race/ethnicity.

Table 1

AIDS rates by age group, sex, and race/ethnicity: Georgia, 1999

Rate per 100,000

Cases diagnosed Population

Age group

0-12

0.4

13-19

0.6

20-29

13

30-39

33

40-49

26

>= 50

7.9

6

1,498,287

5

792,556

141

1,119,574

429

1,316,512

308

1,197,557

148

1,863,754

Total

13

1,037

7,788,240

Sex Male Female
Total

20

757

3,791,130

7.0

280

3,997,110

13

1,037

7,788,240

Race/ethnicity

White

3.4

African American 38

Hispanic

8.3

Asian/PI

1.9

Am. Ind./AN

6.3

Total

13

175 838
20 3 1
1,037

5,162,469 2,215,435
239,566 154,903 15,867
7,788,240

6 | 1998 - 1999 GEORGIA HIV/STD REPORT

AIDS Cases by Year of Diagnosis Georgia, 1981-1999
Number of cases 2500

2000

1500

1000

500

0
Cases

1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 11 15 47 112 244 431 731 999 1205 1593 1871 2084 2158 2233 2155 1993 1495 1385 1037

AIDS Cases and Rates by Year of Diagnosis Georgia, 1987-1999

Number of cases 2500

Number of cases # Rate* #

#

#

#

2000

#

#

#

1500
#
#
1000
#

# #

500

Rate 35
30
25
20
15
#
10
5

0

0

1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Number of cases 731 999 1205 1593 1871 2084 2158 2233 2155 1993 1495 1385 1037

Rate* 12 16

19 25 28 31 32 32 30 28 20 18 13

* Rate = cases/100,000 population

7 | 1998 - 1999 GEORGIA HIV/STD REPORT

AIDS Deaths by Year Georgia, 1981 - 1999

Number of deaths* 1600

1400

1200

1000

800

600

400

200

0
Deaths

1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999
1 7 17 56 131 226 355 524 710 884 103111551095 991 14921183 709 644 570

* Does not include cases with unknown dates of death

Persons Living with AIDS by Year Georgia, 1984 - 1999
Number of cases (Thousands) 12

10

8

6

4

2

0
Cases

1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999
0.104 0.216 0.415 0.786 1.252 1.745 2.442 3.268 4.18 5.239 6.474 7.131 7.938 8.723 9.461 9.925

8 | 1998 - 1999 GEORGIA HIV/STD REPORT

AIDS Cases by Age Group at Diagnosis and Year of Diagnosis Georgia, 1990-1999

Percent of cases

50 $

$

$

$

$

$

$

$

$

)

40 30 )

)

)

)

)

)

)

)

)

$
& 13-19 # 20-29

20 #

#

#

#

#

#

#

#

#

#

$ 30-39 ) >= 40

10

0& 1990
13-19 0.4
20-29 22
30-39 48
>= 40 29

& 1991
0.3 23 48 29

& 1992
0.7 23 46 30

& 1993
0.9 22 45 31

& 1994
0.7 19 48 31

& 1995
0.6 18 47 34

& 1996
0.9 16 48 35

& 1997
0.5 14 48 37

& 1998
0.4 17 44 39

& 1999
0.5 14 41 44

Pediatric AIDS Cases by Year of Diagnosis Georgia, 1982-1999
Number of cases 35 30 25 20 15 10
5 0
198219831984198519861987198819891990199119921993199419951996199719981999 Cases 1 1 1 2 6 11 8 12 15 19 21 19 32 19 9 5 12 6
Note: Of these 199 pediatric cases (i.e., <13 years old at diagnosis), 187 are perinatal.
9 | 1998 - 1999 GEORGIA HIV/STD REPORT

AIDS Cases in Women by Year of Diagnosis Georgia, 1984-1999

Number of cases 500

Percent of all cases 30

#

400 Number of cases
# Percent of all cases
300

25

##

# ##

20

###

15

200

#

#

10

100

####

#

5

0

0

1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Number of cases 4 14 24 44 70 112 189 256 318 334 411 400 415 344 322 280

Percent of all cases 4

6667

9 12 14 15 16 18 19 21 23 23 27

AIDS Cases by Race/Ethnicity and Year of Diagnosis Georgia, 1987-1999
Percent of all cases 100

! White , Black # Hispanic ' Other
80

,,,

60 !

!

!

,

,

,

,

,

,

,

40 ,

,

,

!

!

!

!

!

!

!

20

!!!

0 #' #' #' #' #' #' #' #' #' #' #' #' #'

White Black Hispanic Other

1987
61 37 2.2 0.1

1988
56 43
1 0.1

1989
52 47 1.4 0.2

1990
46 53 1.1
0

1991
40 58 1.6 0.1

1992
36 62 1.7 0.1

1993
34 65 1.6 0.2

1994
34 64 1.5 0.3

1995
34 64 2.6 0.1

1996
28 69 2.6 0.2

1997
21 76 2.3 0.4

1998
20 78 2.5 0.3

1999
17 81 1.9 0.4

10 | 1998 - 1999 GEORGIA HIV/STD REPORT

AIDS Cases in Males by Race/Ethnicity and Year of Diagnosis Georgia, 1987-1999
Percent of all cases 100

80

! White , Black # Hispanic ' Other

,

,

,

60 !
40
,

! ,

! ,

,!

, !

, !

, !

, !

, !

, !

20

!

!

!

0 #' #' #' #' #' #' #' #' #' #' #' #' #'

White Black Hispanic Other

1987
62 35 2.3 0.1

1988
58 41
1 0

1989
55 44 1.6 0.2

1990
50 49 1.1
0

1991
45 54 1.7 0.1

1992
40 58 1.7 0.2

1993
37 61 1.8 0.3

1994
38 60 1.4 0.3

1995
37 60 2.8 0.3

1996
32 66 2.6 0.2

1997
25 72 2.6 0.4

1998
23 74 2.7 0.3

1999
20 78 2.2 0.3

AIDS Cases in Females by Race/Ethnicity and Year of Diagnosis Georgia, 1987-1999

Percent of all cases 100

,,,

80

,

,

,

,

,

,

,

,

,

60 ,

! White , Black # Hispanic ' Other

40 !

20

!

!

!

!

!

!

!

!

!

!

!

!

0 #' #' #' #' #' #' #' #' #' #' #' #' #'

White Black Hispanic Other

1987
36 64
0 0

1988
21 76 1.4 1.4

1989
21 79
0 0

1990
22 76 1.6
0

1991
15 84 1.2
0

1992
15 83 1.9 0.3

1993
15 84 0.9 0.3

1994
17 82 1.7 0.2

1995
18 80 1.8 0.3

1996
14 84 2.4 0.2

1997
8 91 1.2
0

1998
10 89 1.6 0.3

1999
9 89 1.1
1

11 | 1998 - 1999 GEORGIA HIV/STD REPORT

AIDS Cases by Mode and Year of Diagnosis Adults/Adolescents in Georgia, 1990-1999

Percent of all cases

60 # 50

#

#

40

30

20 10 0
MSM IDU
MSM&IDU Heterosexual
Other*

) $'
1990
58 18
7 9 8

)
$'
1991
54 22
7 10
7

) $ '
1992
49 22
7 12 10

#
) $ '
1993
47 22
6 14 12

#
) $ '
1994
47 21 6 13 13

#
$) ' 1995
47 20 5 18 11

#
$)
' 1996
42 19 5 20 15

#
$)
' 1997
38 20 4 20 18

#
$)
' 1998
37 18 4 17 25

#
$)
' 1999
28 14 2.7 16 39

# MSM ) IDU ' MSM&IDU $ Heterosexual Other*

*Other includes primarily "No identified risk" category

AIDS Cases by Mode and Year of Diagnosis Male Adults/Adolescents in Georgia, 1990-1999

Percent of all cases

70 60

#

#

#

50

40

30

20 )

)

)

10 0

$'

$'

$'

1990 1991 1992

MSM 65

63

58

IDU 16

18

19

MSM&IDU 8

8

8

Heterosexual 4

5

6

Other* 7

6

9

#
) $' 1993
55 20 7 8 11

#
) $' 1994
57 18 7 7 12

#
) $' 1995
57 18 6 9 9

#
) $' 1996
52 17 6 11 13

#
) $ ' 1997
50 19 5 11 16

#
$') 1998
48 14
6 10 22

#
$)' 1999
39 14
4 9 36

# MSM ) IDU ' MSM&IDU $ Heterosexual Other*

*Other includes primarily "No identified risk" category

12 | 1998 - 1999 GEORGIA HIV/STD REPORT

AIDS Cases by Mode and Year of Diagnosis Female Adults/Adolescents in Georgia, 1990-1999

Percent of all cases 60

50 $ 40

) $

$ )

$

$

$

$

$

$

) 30 20

)

)

$

)

)

)

)

) 10

0
IDU Heterosexual
Other*

1990
34 50 16

1991
46 41 13

1992
39 46 15

1993
34 48 18

1994
33 45 23

1995
26 54 20

1996
25 53 22

1997
23 52 25

1998
20 42 38

1999
14 34 53

) IDU $ Heterosexual Other*

*Other includes primarily "No identified risk" category

Cumulative Pediatric AIDS Cases by Risk Category Georgia, Reported 1982 - 1999
44 21 13 13 2.5 1 0.5 3.5 0.5 2
Percent of all 199 pediatric cases
13 | 1998 - 1999 GEORGIA HIV/STD REPORT

AIDS Cases by Public Health District (HD) Groupings Georgia, 1990-1999

Percent of all cases 80

Atlanta HDs Small MSA HDs Rural HDs

60

40

20

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Atlanta HDs 73 71 66 67 69 65 63 64 66 62

Small MSA HDs 19 19 25 22 21 22 24 24 21 28

Rural HDs 8 10

9 12 10 13 12 12 13 10

Note: 8-county metro Atlanta includes the Marietta, Fulton, Clayton, Gwinnett, and DeKalb districts. Districts that include a small metropolitan statistical area (MSA) are Albany, Athens, Augusta, Columbus, Macon, and Savannah.

Cumulative AIDS Cases by Public Health District Georgia, 1981 - 1999
Metropolitan Atlanta

14 | 1998 - 1999 GEORGIA HIV/STD REPORT

AIDS Cases by Year of Diagnosis Rome (1-1) Health District, 1990-1999

Number of cases 100

80

60

40

20

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases

16

21

25

25

30

21

26

22

13

14

AIDS Cases by Year of Diagnosis Dalton (1-2) Health District, 1990 -1999

Number of cases 100

80

60

40

20

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases

13

12

11

19

20

15

15

13

7

4

15 | 1998 - 1999 GEORGIA HIV/STD REPORT

AIDS Cases by Year of Diagnosis Gainesville (2-0) Health District, 1990 -1999

Number of cases 100

80

60

40

20

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases

11

25

20

14

15

21

19

13

13

6

AIDS Cases by Year of Diagnosis Marietta (3-1) Health District, 1990 -1999
Number of cases 200

150

100

50

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases

70

66

77

67

87

107

62

39

42

31

16 | 1998 - 1999 GEORGIA HIV/STD REPORT

AIDS Cases by Year of Diagnosis Fulton (3-2) Health District, 1990 -1999

Number of cases 1400

1200

1000

800

600

400

200

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases

768

924 901

960 1004 888

841

652 587

442

AIDS Cases by Year of Diagnosis Clayton (3-3) Health District, 1990 -1999

Number of cases 100

80

60

40

20

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases

28

23

24

35

43

44

51

33

38

23

17 | 1998 - 1999 GEORGIA HIV/STD REPORT

AIDS Cases by Year of Diagnosis Gwinnett (3-4) Health District, 1990 -1999
Number of cases 200

150

100

50

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases

46

58

52

53

75

62

43

38

29

18

AIDS Cases by Year of Diagnosis DeKalb (3-5) Health District, 1990 -1999

Number of cases 500

400

300

200

100

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases

244 252 318 326 327 299 265 188 214 100

18 | 1998 - 1999 GEORGIA HIV/STD REPORT

AIDS Cases by Year of Diagnosis LaGrange (4-0) Health District, 1990 -1999
Number of cases 200

150

100

50

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases

26

42

47

69

44

88

68

50

51

17

AIDS Cases by Year of Diagnosis Dublin (5-1) Health District, 1990 -1999

Number of cases 100

80

60

40

20

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases

5

10

6

14

7

15

11

10

13

4

19 | 1998 - 1999 GEORGIA HIV/STD REPORT

AIDS Cases by Year of Diagnosis Macon (5-2) Health District, 1990 -1999
Number of cases 200

150

100

50

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases

50

53

77

67

94

74

82

84

78

77

AIDS Cases by Year of Diagnosis Augusta (6-0) Health District, 1990 -1999
Number of cases 200

150

100

50

0

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases

92

86

126 105 105 115

98

74

74

70

20 | 1998 - 1999 GEORGIA HIV/STD REPORT

AIDS Cases by Year of Diagnosis Columbus (7-0) Health District, 1990 -1999
Number of cases 200

150

100

50

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases

38

42

79

73

91

75

79

66

44

44

AIDS Cases by Year of Diagnosis Valdosta (8-1) Health District, 1990 -1999

Number of cases 100

80

60

40

20

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases

8

13

9

25

22

41

45

25

34

22

21 | 1998 - 1999 GEORGIA HIV/STD REPORT

AIDS Cases by Year of Diagnosis Albany (8-2) Health District, 1990 -1999
Number of cases 200

150

100

50

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases

39

59

85

81

78

73

100

69

55

59

AIDS Cases by Year of Diagnosis Savannah (9-1) Health District, 1990 -1999
Number of cases 200

150

100

50

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases

68

92

133 119

70

91

104

49

31

24

22 | 1998 - 1999 GEORGIA HIV/STD REPORT

AIDS Cases by Year of Diagnosis Waycross (9-2) Health District, 1990 -1999

Number of cases 100

80

60

40

20

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases

24

43

45

40

58

53

34

30

24

30

AIDS Cases by Year of Diagnosis Brunswick (9-3) Health District, 1990 -1999

Number of cases 100

80

60

40

20

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases

26

23

32

44

33

26

29

20

19

6

23 | 1998 - 1999 GEORGIA HIV/STD REPORT

AIDS Cases by Year of Diagnosis Athens (10-0) Health District, 1990 -1999

Number of cases 100

80 60

40

20

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases

21

27

17

22

30

47

21

20

18

16

24 | 1998 - 1999 GEORGIA HIV/STD REPORT

HIV Seroprevalence Surveys
Through the years that DHR and local sites have conducted anonymous HIV surveys, the results have been and remain very useful. The methodology for these surveys consisted of abstracting information from medical records and anonymous HIV testing that was done on all left-over blood collected for routine diagnostic purposes. Before HIV testing, demographic and risk information was abstracted from clinic records and documented on a study form that had a study number which could not be linked to the client. No client-identifying information such as name, address, phone number, or medical record number was abstracted for this survey.
The primary advantages of these surveys are that there is no concern about underreporting as seen with surveillance databases and there is no selection bias regarding the intent of persons to participate or not. However, as with most studies, there are limitations to the data. It should be kept in mind that these results are applicable primarily to the participating site and the persons who are likely to attend that particular site. Because of the protocols used for the seroprevalence surveys mentioned in this report, some of the data from these studies represent persons who have visited the same facility in different years.
HIV Seroprevalence Survey: DeKalb County STD Clinic
From 1992 to 1999, the overall HIV infection rate at the DeKalb County Board of Health, Vinson Health Center, STD clinic was 2.7% (326/11,911). The highest yearly HIV infection rates occurred in the most recent years. For each year, males had higher rates than females, and in recent years, African Americans and Whites have had somewhat similar rates. Men who have sex with men have had much higher rates than heterosexual males and females, and clients who had an STD or were a sexual contact to someone with an STD had higher rates compared to clients with no STD.

Blinded HIV Seroprevalence Survey: DeKalb County STD Clinic HIV positivity by sex and year

Percent HIV positive 6

# Males $ Females Total

#

5

#

#

#

4# 3

2

1
0
Males Females
Total

$
1992
3.9 0.5 2.2

#
$
1993
3.8 1.5 2.7

#
$ 1994
3.2 0.7 2.1

#
$
1995
2.3 0.9 1.7

$
1996
5.4 0.7 3.2

$
1997
4.9 0.6 2.9

$
1998
5.2 0.5
3

$
1999
5 1 3.3

25 | 1998 - 1999 GEORGIA HIV/STD REPORT

Blinded HIV Seroprevalence Survey: DeKalb County STD Clinic HIV positivity by sex and year for persons 15-44 years old

Percent HIV positive 6

5

# Males $ Females

4

#

#

#

3

2

1
0
Males Females

$
1992
4.2 0.5

$
1993
3.4 1.4

$
1994
3.3 0.7

#
$
1995
2.1 1

#
$ 1996
5.7 0.8

#
$ 1997
5 0.5

#
$ 1998
5.2 0.5

#
$ 1999
5 0.9

Blinded HIV Seroprevalence Survey: DeKalb County STD Clinic HIV positivity by race and year

Percent HIV positive 5

) Black $ White

$

4

)

3

$

)

$

)

$)

$

)

2

)

$)

)

$

1

$

0
Black White

1992
2.2 2.9

1993
2.5 4.3

1994
1.8 1.6

1995
1.8 0.9

1996
3.5 1.7

1997
3 3.4

1998
3.1 3

1999
4 3.1

26 | 1998 - 1999 GEORGIA HIV/STD REPORT

Blinded HIV Seroprevalence Survey: DeKalb County STD Clinic HIV positivity by sexual orientation, sex, and year

Percent HIV positive

60

)

) MSM

50

$ Heterosexual males

40

)

)

Heterosexual females ) )

)

) 30

20

)

10

0
MSM Heterosexual males Heterosexual females

$ 1992
54 1.4 0.5

$ 1993
40 1.7 1.3

$ 1994
39 1.5 0.7

$ 1995
22 1.5 0.9

$
1996
37 3
0.7

$ 1997
33 1.7 0.7

$
1998
42 2.1 0.5

$ 1999
43 1.5 1.1

Blinded HIV Seroprevalence Survey: DeKalb County STD Clinic
Did the client receive confidential HIV counseling and testing at this visit? Did the client ever previously receive HIV counseling and testing?
Percent "yes" 100

80

60 This visit Previously
40

20

0
This visit Previously

1997
53 80

1998
48 81

1999
51 80

27 | 1998 - 1999 GEORGIA HIV/STD REPORT

Blinded HIV Seroprevalence Survey: DeKalb County STD Clinic HIV positivity by STD diagnosis* at this visit

Percent HIV positive 5

4

3 No STD STD
2

1

0
No STD STD

1997
1.2 3.9

1998
0.8 4.4

1999
2 3.9

* Patient had no STD vs patient had STD or was a sexual contact to someone with an STD

28 | 1998 - 1999 GEORGIA HIV/STD REPORT

HIV Seroprevalence Survey: Fulton County Drug Treatment Clinic
When interpreting the results of this anonymous HIV survey, it should be noted that clients represented in this study are primarily being treated for cocaine use and that clients attending the clinic for "alcohol only" are not included in this study. From 1990 to 1998, the overall HIV infection rate at the Fulton County Alcohol and Drug Treatment Center (FCADTC) was 11% (1,356/12,633). The yearly HIV infection rates have generally increased over time with the highest rate in 1998 (18%). The rates in males have been consistently higher than in females (although the difference was smallest in 1998); African Americans have had a higher rate each year compared to Whites; and MSM have had much higher rates than heterosexual persons. Although persons over 24 years old had higher rates each year compared to younger persons, the rates were similar in 1998.

Blinded HIV Seroprevalence Survey:
Fulton County Drug Treatment Clinic HIV positivity by sex and year

Percent HIV positive 20

# Males $ Females Total 15

#

$#

#

#

#

#

10 #

#

#

$

$

$

$

$

$

$

$

5

0
Males Females
Total

1990
10 7 9

1991
10 7.7 9.2

1992
11 8.3 10

1993
10 8.1 9.7

1994
11 7.2 9.9

1995
13 7.4 11

1996
17 9.6 14

1997
15 7.2 12

1998
18 17 18

29 | 1998 - 1999 GEORGIA HIV/STD REPORT

Blinded HIV Seroprevalence Survey: Fulton County Drug Treatment Clinic
HIV positivity by race and year

Percent HIV positive 20

) Black $ White

)

15

)

$

)

)

)

10

)

)

$

$

)

)

$

$

$

5

$

$

$

0
Black White

1990
9.1 6.8

1991
9.3 7.6

1992
11 2.7

1993
9.9 5.1

1994
10 7.5

1995
11 8.3

1996
15 5.5

1997
12 9.7

1998
18 13

Blinded HIV Seroprevalence Survey: Fulton County Drug Treatment Clinic HIV positivity by sexual orientation and year

Percent HIV positive

50

)

) MSM $ Heterosexual

40

)

30

)

)

)

)

)

20

$

10 $

$

$

$

$

) $

$

) $

0
MSM Heterosexual

1990
36 8.4

1991
26 8.6

1992
48 9

1993
33 8.6

1994
26 9

1995
14 11

1996
32 13

1997
14 11

1998
32 17

30 | 1998 - 1999 GEORGIA HIV/STD REPORT

Blinded HIV Seroprevalance Survey: Fulton County Drug Treatment Clinic Persons aged 15-44: HIV positivity by age group and year

Percent HIV positive 20
# 15-24 $ 25-34 ) 35-44

15

)

) 10
$

$ )

$

$)

#

#

5

#

#

0
15-24 25-34 35-44

1990
4 8.8 12

1991
6.5 11 9.2

1992
3.8 10 13

1993
6.3 10 9.8

) $
# 1994
1.8 10 12

$) #
1995
7.7 11 12

) $
#
1996
5.2 14 17

) $
#
1997
4.2 11 13

$#)
1998
17 18 18

31 | 1998 - 1999 GEORGIA HIV/STD REPORT

Supplement to HIV/AIDS Surveillance (SHAS) Project
The SHAS Project is an interview study which takes about 50-60 minutes for each confidential interview and includes information about socioeconomics, alcohol and drug use, sexual behavior, history of STDs and other diseases, maternal and child health, and access to social services. All interviews at the Grady Infectious Disease Clinic were conducted with persons with AIDS. One caveat to keep in mind with SHAS data is that persons are asked to recall events or conditions that may have occurred many years prior to the interview; hence, the accuracy of the recalled information may not be precise. A second caveat is with the trend charts. The trends are representative of the persons interviewed and are not necessarily representative of the spread of the HIV epidemic itself. For example, the data presented in this report do not distinguish when these persons were diagnosed with HIV or AIDS. A third caveat is that for many of the behaviors, it is not always known whether they occurred before or after HIV infection.
SHAS Project: Persons with AIDS at Grady Health System
2,298 completed interviews,1990 - 1999
) Gender: 5 83% (n=1,900) male 5 17% (n= 398) female
) Race: 5 66% (n=1,517) African-American 5 29% (n= 672) White 5 3% (n= 73) Hispanic 5 2% (n= 36) Other
32 | 1998 - 1999 GEORGIA HIV/STD REPORT

SHAS Project: Persons with AIDS at Grady Health System
2,298 completed interviews,1990 - 1999
) Highest grade completed: 5 25% (n= 570) < high school 5 75% (n=1,728) >= high school
) Current employment: 5 79% (n=1,817) no 5 21% (n= 481) yes
) Household income in last year: 5 50% (n=1,121) < $10,000 5 50% (n=1,100) >= $10,000
) Current health insurance: 5 35% (n= 800) no 5 65% (n=1,475) yes

SHAS Project: Persons with AIDS at Grady Health System
Is your most recent steady sex partner infected with the AIDS virus?

Percent 60

50

$

40

30

#

20

,

10

0
Yes No Don't know

1995
33 50 17

$#

$

$

$#

#

#

# Yes $ No , Don't know

,

,

,

,

1996
43 42 13

1997
35 43 20
Year of Interview

1998
37 44 17

1999
41 42 16

33 | 1998 - 1999 GEORGIA HIV/STD REPORT

SHAS Project: Persons with AIDS at Grady Health System
When you had sex with casual partners, how often were condoms used in the year before knowing of your HIV infection and since knowing of your HIV infection?

Percent* answering always 70

60

50

40

30

20

10

0
Year before Since

1995
30 63

1996
23 58

1997
24 60

1998
28 61

1999
24 64

*Of those sexually active with casual partners during specified time period

SHAS Project: Persons with AIDS at Grady Health System
Number of visits to a doctor or clinic for an STD in the last 10 years

Percent answering 0, 1, or >= 2 60

50

40

#)

)

#

#

#

#

#

#

#

#

30 20

# $

) $

) $

) $

) $

$)

$)

$)

) $

10 $

# 0 $ 1 ) >= 2

0 1990
0 46
1 11
>= 2 43

1991
34 20 46

1992
41 23 36

1993
42 20 36

1994
49 20 30

1995
44 23 33

1996
47 28 26

Year of Interview

1997
47 26 26

1998
49 24 27

1999
47 22 31

34 | 1998 - 1999 GEORGIA HIV/STD REPORT

SHAS Project: Persons with AIDS at Grady Health System
In the past 5 years, has anyone ever given you money to have sex with them? In the past 5 years, has anyone ever given you drugs to have sex with them? Have you ever paid money or given drugs to anyone to have sex with you?

Percent answering yes 30

)

25

)

)

)

)

)

20

)

15

)

) # Received $ $ Received drugs ) Paid $/drugs

#

#

#

#

# $

#

10 ) 5#

# $

$

# $

$#

$

$

$

$

0
Received $ Received drugs
Paid $/drugs

$ 1990
6
0
9

1991
7 5 15

1992
12 8
16

1993
7 4 23

1994
7 6 19

1995
13 9
22

1996
13 9
25

1997
12 10 24

1998
14 12 27

1999
13 10 23

Year of Interview

SHAS Project: Persons with AIDS at Grady Health System
Have you ever used mind-altering substances other than alcohol? Have you ever used crack cocaine?
Have you ever injected drugs with a needle?

Percent answering yes 100

80

60

Non-alcohol drug # Crack $ IDU

40 20 $#

$#

$#

# $

#$

# $

# $

# $

# $

# $

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Non-alcohol drug 77

84

86

78

82

79

79

77

80

78

Crack 14

32

35

41

36

44

42

43

45

49

IDU 20

28

31

31

31

25

28

29

20

23

Year of Interview

35 | 1998 - 1999 GEORGIA HIV/STD REPORT

SHAS Project: Persons with AIDS at Grady Health System

During the past 5 years, have you been enrolled in a drug/alcohol treatment program? During the past 5 years, did you try to enter a program but were unable to enroll?

Percent answering yes 35

30

25

#

#

#

20

15

#

#

#

#

#

#

# Enrolled $ Couldn't enroll

10 #

$

$

$

$

$

5

$

$

$

$

0
Enrolled Couldn't enroll

$ 1990
9
0

1991
26 10

1992
23 5

1993
25 5

1994
26 6

1995
29 6

1996
30 8

1997
29 8

1998
32 8

1999
27 9

Year of Interview

36 | 1998 - 1999 GEORGIA HIV/STD REPORT

Behavioral Risk Factor Surveillance System (BRFSS)
The Behavioral Risk Factor Surveillance System (BRFSS) is a yearly random telephone survey of about 2,000 persons in Georgia aged 18 years and older who are asked a standardized set of health-related questions. Adults 18 to 64 years old are also asked the questions specific to HIV/AIDS. Two caveats to the interpretation of this data are that BRFSS does not represent households without telephones and that persons could potentially be interviewed, by chance, more than once from year to year or even within the same year.
From 1993 to 1999, the proportion of persons who have been tested for HIV has generally increased from 26% to 56%, with similar proportions among men and women. When asked about their selfperceived risk for becoming HIV-infected, the proportion of persons thinking that they were at medium or high risk has fluctuated from 11% in 1993 to 3.9% in 1996 to 6.8% in 1999. The results further show that about 85% of tested persons are receiving their HIV results, and among those receiving results, less than one-third are receiving counseling.

Georgia Behavioral Risk Factor Surveillance System
Have you ever had your blood tested for HIV/AIDS?

Percent answering yes 60

50

40

#

#

30 #

20

10

0 Total #

1993
26

1994
35

1995
34

#
1996
33

#
1997
39

#
1998
52

#
1999
56

Note: Data for 1998 and 1999 exclude any tests related to blood donation. Data for prior years may include tests related to blood donation.

37 | 1998 - 1999 GEORGIA HIV/STD REPORT

Georgia Behavioral Risk Factor Surveillance System
Self-perception of chances for becoming HIV-infected

Percent answering none, low, medium, or high 80

#

60

#

$

#

40

$

#

$

20

# None $ Low ) Medium , High

$

0
None Low
Medium High

,) 1995
52 42 4.2 2.1

,) 1996
45 51 3.2 0.7

,) 1997
55 41 3.7 1.2

,) 1998
69 25 3.4 2.3

#
$ ,) 1999
72 21 4.2 2.5

Georgia Behavioral Risk Factor Surveillance System
If tested for HIV within the last 12 months, did you receive the results? If tested and received the results, did you receive counseling for the results?

Percent "yes" 100
80 60

Results Counseling

40

20

0
Results Counseling

1998
86 26

1999
85 30

38 | 1998 - 1999 GEORGIA HIV/STD REPORT

Self-perception of HIV risk is shown in Table 2; the frequency distribution and corresponding percentages for several variables are in the third column, marked "Total." Three points should be kept in mind when viewing the table. They are that: the An=s@ are based on sample size, percentages are weighted to age-, race-, and sex- distributions of the 1999 Georgia population aged 18 years and older, and each column adds to 100% for every variable. The first two columns allow comparisons to be made for these variables between persons perceiving themselves at risk for HIV and persons with no self-perceived risk.

Table 2 Self-Perceived HIV Risk of Persons Aged 18 to 64 Years Interviewed for the 1999 Georgia BRFSS Study

Low/Medium/High

None

Total

Age group 18-29 30-39 40-49 50-64

n (weighted percent)
140 (34%) 180 (30%) 137 (22%)
81 (14%)

n (weighted percent)
226 (24%) 357 (25%) 379 (25%) 379 (26%)

n (weighted percent)
366 (27%) 537 (26%) 516 (24%) 460 (23%)

Sex Female Male

288 (45%) 253 (55%)

837 (53%) 511 (47%)

1,125 (51%) 764 (49%)

Race White Black Other

366 (64%) 156 (31%)
16 ( 5%)

992 (72%) 324 (26%)
28 ( 2%)

1,358 (70%) 480 (27%) 44 ( 3%)

County of residence 20-county Atlanta Rural

262 (49%) 264 (51%)

622 (47%) 706 (53%)

884 (48%) 970 (53%)

Highest level of education < high school >= high school/GED

42 ( 8%) 499 (92%)

148 (11%) 1,196 (89%)

190 (10%) 1,695 (90%)

Annual household income <$15,000 >=$15,000

37 ( 8%) 457 (92%)

105 ( 8%) 1,094 (92%)

142 ( 8%) 1,551 (92%)

39 | 1998 - 1999 GEORGIA HIV/STD REPORT

Table 2 continued Self-Perceived HIV Risk of Persons Aged 18 to 64 Years Interviewed for the 1999 Georgia BRFSS Study

Low/Medium/High

None

Total

n (weighted percent)

n (weighted percent)

n (weighted percent)

Have you ever been tested for HIV, excluding blood donations?

Yes

314 (62%)

657 (53%)

No

201 (38%)

617 (47%)

971 (56%) 818 (44%)

Have you been tested for HIV within the last 12 months, excluding blood donations?

Yes

118 (27%)

234 (21%)

352 (23%)

No

394 (73%)

1,032 (79%)

1,426 (77%)

If tested for HIV within the last 12 months, did you receive the results?

Yes

104 (87%)

199 (84%)

No

14 (13%)

34 (16%)

303 (85%) 48 (15%)

If tested within the last 12 months and received results, did you receive counseling about the results?

Yes

31 (29%)

62 (31%)

93 (30%)

No

73 (71%)

137 (69%)

210 (70%)

40 | 1998 - 1999 GEORGIA HIV/STD REPORT

STD Surveillance
STDs cause a tremendous health and economic burden and are the most commonly reported diseases in the United States. Each year, more than 12 million Americans, 3 million of whom are teenagers, are infected with STDs, resulting in a cost of approximately $10 billion for STDs and their complications. STDs are primarily associated with unprotected sexual activity and drug use, but other behavioral, biological, and social factors are also known to contribute to STD transmission. In Georgia, health care providers and laboratories are required by law to report cases of syphilis, gonorrhea, and chlamydia to the appropriate local or state health department. The number of reported syphilis cases in 1999 is the lowest in several decades. Because the majority of syphilis cases are concentrated in a small number of geographic areas, there is now a national plan to eliminate syphilis. From the mid1970s to the mid-1990s, the rate of gonorrhea cases in the United States has steadily decreased; however, a reversal of this trend occurred in 1998 and continued through 1999. In the last several years, the reporting of chlamydia has improved and become more standardized across the United States. Chlamydial genital infection is now the most common STD in the United States, and 4 million cases are estimated to occur annually. In recent years, Georgia has ranked in the top ten among all states for reported cases of STDs. Of all reportable diseases in the state, gonorrhea and chlamydia are the two most frequently reported; in 1999, there were 22,033 cases of gonorrhea and 31,498 cases of chlamydia. These two STDs cause pelvic inflammatory disease (PID), infertility, ectopic pregnancy, chronic pelvic pain, epididymitis, and an increased risk of HIV transmission.
41 | 1998 - 1999 GEORGIA HIV/STD REPORT

STD Surveillance: Syphilis
Syphilis is an STD that is caused by a bacterium which is primarily acquired from person to person through direct contact with a syphilis lesion. The first stage of infection, known as primary syphilis, results in a single painless sore, and the second stage, known as secondary syphilis, is usually manifested by a rash. Early syphilis includes primary syphilis, secondary syphilis, and a time period, generally less than one year, during which the patient has no symptoms. Although not as common as the sore and rash, other more serious complications include the heart and nervous system. Diagnosed syphilis is generally easy to treat and cure. Congenital syphilis may occur when a pregnant mother passes the infection on to her newborn. Since 1990, the number of reported cases of syphilis has steadily declined. In 1999, there were 439 reported cases of primary and secondary syphilis for a rate of 6 cases per 100,000 population. Of these 439 reported persons, 273 (62%) were male, and 313 (71%) were at least 30 years old. The five districts with the highest number of cases were Fulton (221), Augusta (55), DeKalb (45), Columbus (21), and Macon (17).
Early Syphilis by Year of Diagnosis Georgia, 1945 - 1999
Number of cases (Thousands) 20
15
10
5
0 45 50 55 60 65 70 75 80 85 90 95 Year
42 | 1998 - 1999 GEORGIA HIV/STD REPORT

Early Syphilis by Year of Diagnosis Georgia, 1987 - 1999
Number of cases (Thousands) 10

8

6

4

2

0
Cases

1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999
3.07 4.849 7.605 8.359 6.999 5.265 3.919 2.703 2.612 1.998 1.556 1.184 1.183

Note: Early syphilis includes primary, secondary, and early latent syphilis

Congenital Syphilis Cases and Female Early Syphilis Rates Georgia, 1986 - 1999

Number of cases 250
&

Rate 120

200

&

150
& 100
&
50 &

& &

Cong. syphilis cases
& Early syphilis rate*

100 80 60

&

40

&

&

&

&

&

&

20

0

0

1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cong. syphilis cases 4 7 8 14 107 136 148 79 58 57 35 22 16 21

Early syphilis rate* 27 40 59 102 116 96 70 43 33 31 25 18 13 13

* Rate = cases/100,000 population

43 | 1998 - 1999 GEORGIA HIV/STD REPORT

Primary and Secondary Syphilis Cases and Rates Georgia, 1990 - 1999

Number of cases (Thousands) 4&

3

&

Cases & Rate*

Rate 60 50 40

2

&

30

&

20

1

&

&

&

&

&

10 &

0

0

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases 3.86 2.905 1.843 1.24 0.89 0.934 0.691 0.506 0.363 0.439

Rate* 60

44

27

18

13

13

10

7

5

6

* Rate = cases/100,000 population

Primary and Secondary Syphilis Cases and Rates Males in Georgia, 1990 - 1999

Number of cases 3000 &

Rate

2500

2000

&

60 Cases & Rate*

1500

40

&

1000 500

&

20

&

&

&

&

0

&

& 0

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases 2210 1590 1016 711

496

553

406

311

222

273

Rate* 72

50

31

21

15

16

12

9

3

4

* Rate = cases/100,000 population

44 | 1998 - 1999 GEORGIA HIV/STD REPORT

Primary and Secondary Syphilis Cases and Rates Females in Georgia, 1990 - 1999

Number of cases 2500
&
2000 &
1500

1000

&

500

0 1990
Cases 1650
Rate* 50

1991
1315 39

1992
827 24

&
1993
529 15

&
1994
394 11

Cases & Rate*

&

&

&

&

1995 1996 1997 1998

381 285 195 141

10

8

5

2

Rate 50
40
30
20
10 &0 1999
165 2

* Rate = cases/100,000 population

Primary and Secondary Syphilis by Age Group Georgia, 1990 - 1999

Number of Cases 1,800

1,600

)

1,400

1,200

$

1,000

'

) $

800

$

600

'

)

400 200
0
10-19

#
1990
103

#
1991
125

' #
1992
181

20-29 1,249 1,007

754

30-39 1,549 1,116

608

40+ 938

635

296

$) ' #
1993
86 488 437 231

Agegroup # 10-19 $ 20-29 ) 30-39 ' 40+

$) ' #
1994
76 339 335 187

$)' #
1995
57 302 351 215

$)' #
1996
54 203 259 175

$') # 1997
28 141 182 154

$#') 1998
21 99 142 101

$#)' 1999
23 102 159 154

45 | 1998 - 1999 GEORGIA HIV/STD REPORT

Primary and Secondary Syphilis Cases by Public Health District Georgia, 1999

Metropolitan Atlanta

Dalton 0 Gainesville

Rome

7

2

Athens

Atlanta

1

LaGrange 4

Macon 17

Augusta 55

Columbus 21
Albany 14

Dublin 1
Waycross 4
16 Valdosta

Marietta 9

Gwinnett 8
DeKalb 45

Fulton Clayton

221

5

Savannah 4
Brunswick 0

Primary and Secondary Syphilis Cases by Year of Diagnosis Rome (1-1) Health District, 1990-1999

Number of cases 200

150

100

50

0
Cases

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

40

115 145 107

23

23

17

10

4

2

46 | 1998 - 1999 GEORGIA HIV/STD REPORT

Primary and Secondary Syphilis Cases by Year of Diagnosis Dalton (1-2) District, 1990-1999

Number of cases 100

80

60

40

20

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases

8

11

9

6

0

9

0

2

0

0

Primary and Secondary Syphilis Cases by Year of Diagnosis Gainesville (2-0) District, 1990-1999

Number of cases 100

80

60

40

20

0

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases

40

24

14

7

10

5

4

2

5

7

47 | 1998 - 1999 GEORGIA HIV/STD REPORT

Primary and Secondary Syphilis Cases by Year of Diagnosis Marietta (3-1) District, 1990-1999
Number of cases 200

150

100

50

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases

86

79

57

63

26

30

51

24

12

9

Primary and Secondary Syphilis Cases by Year of Diagnosis Fulton (3-2) District, 1990-1999

Number of csaes

1400

1200

1000

800

600

400

200

0
Cases

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999
1409 968 624 395 312 366 268 201 168 221

48 | 1998 - 1999 GEORGIA HIV/STD REPORT

Primary and Secondary Syphilis Cases by Year of Diagnosis Clayton (3-3) District, 1990-1999

Number of cases 100

80

60

40

20

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases

40

36

21

8

10

8

5

5

7

5

Primary and Secondary Syphilis Cases by Year of Diagnosis Gwinnett (3-4) District, 1990-1999
Number of cases 200

150

100

50

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases

79

58

45

33

17

18

14

26

15

8

49 | 1998 - 1999 GEORGIA HIV/STD REPORT

Primary and Secondary Syphilis Cases by Year of Diagnosis DeKalb (3-5) District, 1990-1999
Number of cases 400

300

200

100

0
Cases

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

328 214 147 115

79

76

71

52

47

45

Primary and Secondary Syphilis Cases by Year of Diagnosis LaGrange (4-0) District, 1990-1999

Number of cases 200

150

100

50

0
Cases

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

132 172 118

70

62

84

40

28

7

4

50 | 1998 - 1999 GEORGIA HIV/STD REPORT

Primary and Secondary Syphilis Cases by Year of Diagnosis Dublin (5-1) District, 1990-1999

Number of cases 100

80

60

40

20

0

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases

76

63

45

19

6

6

8

7

2

1

Primary and Secondary Syphilis Cases by Year of Diagnosis Macon (5-2) District, 1990-1999

Number of cases 300

250

200

150

100

50

0
Cases

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

213 156 101

56

88

32

15

14

10

17

51 | 1998 - 1999 GEORGIA HIV/STD REPORT

Primary and Secondary Syphilis Cases by Year of Diagnosis Augusta (6-0) District, 1990-1999

Number of cases 500

400

300

200

100

0
Cases

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

479 249 113

66

86

46

41

23

19

55

Primary and Secondary Syphilis Cases by Year of Diagnosis Columbus (7-0) District, 1990-1999
Number of cases 200

150

100

50

0
Cases

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

186 159 135

91

94

90

38

21

12

21

52 | 1998 - 1999 GEORGIA HIV/STD REPORT

Primary and Secondary Syphilis Cases by Year of Diagnosis Valdosta (8-1) District, 1990-1999

Number of cases 100

80

60

40

20

0

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases

62

79

31

25

16

15

4

17

19

16

Primary and Secondary Syphilis Cases by Year of Diagnosis Albany (8-2) District, 1990-1999

Number of cases 300

250

200

150

100

50

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases 220 166

88

79

60

74

64

22

20

14

53 | 1998 - 1999 GEORGIA HIV/STD REPORT

Primary and Secondary Syphilis Cases by Year of Diagnosis Savannah (9-1) District, 1990-1999

Number of cases 300

250

200

150

100

50

0
Cases

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

209 171

65

50

13

16

25

22

4

4

Primary and Secondary Syphilis Cases by Year of Diagnosis Waycross (9-2) District, 1990-1999

Number of cases 200

150

100

50

0
Cases

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

131

73

33

31

23

10

9

19

6

4

54 | 1998 - 1999 GEORGIA HIV/STD REPORT

Primary and Secondary Syphilis Cases by Year of Diagnosis Brunswick (9-3) District, 1990-1999

Number of cases 100

80

60

40

20

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases

78

88

39

14

3

3

2

0

0

0

Primary and Secondary Syphilis Cases by Year of Diagnosis Athens (10-0) District, 1990-1999

Number of cases 100

80

60

40

20

0

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Cases

40

18

6

3

7

15

17

11

1

1

55 | 1998 - 1999 GEORGIA HIV/STD REPORT

STD Surveillance: Gonorrhea
Gonorrhea is an STD that is caused by a bacterium which primarily affects the reproductive tract of women and men. Infections in women, compared to men, are more likely to be asymptomatic or mild. Gonorrhea infections have become increasingly resistant to routine antibiotics, resulting in more expensive treatment options. Untreated infection can cause infertility, pelvic inflammatory disease, ectopic pregnancy, and chronic pelvic pain.
After a gradual decline in the rate and number of reported cases of gonorrhea in recent years, a reversal of this trend began in 1998. In 1999, there were 22,033 reported cases for a rate of 283 cases per 100,000 population. Of these 22,033 reported persons, 10,460 (47%) were female, 6,544 (30%) were 10 to 19 years old, and 9,694 (44%) were 20 to 29 years old. The five districts with the highest number of cases were Fulton (5,872), DeKalb (2,113), Macon (1,751) Columbus (1,514), and Albany (1,335).

Gonorrhea Cases and Rates by Year of Diagnosis Georgia, 1995-1999

Number of cases (Thousands) 25
&

20

&

&

&

Rate 300
&
250

15

200

Cases

150 & Rate* 10

100

5

50

0
Cases Rate*

1995
21.446 302

1996
19.94 277

1997
18.525 253

* Rate = cases/100,000 population

1998
20.669 270

0 1999
22.033 283

56 | 1998 - 1999 GEORGIA HIV/STD REPORT

Gonorrhea Cases by Sex and Year of Diagnosis Georgia, 1995-1999

Number of cases 14,000

12,000 #

#

10,000

$

$#

$

$#

$

#

8,000

6,000 4,000

# Male $ Female

2,000

0
Male Female

1995
11,158 10,149

1996
10,005 9,817

1997
8,897 9,577

1998
10,525 10,056

1999
11,447 10,460

Gonorrhea Cases and Rates by Sex
Georgia, 1999

Number of cases (Thousands)

12

,

10

8 Cases , Rate*
6

4

2

0
Cases Rate*

Males
11.447 302

* Rate = cases/100,000 population

,
Females
10.46 262

Rate 300 250 200 150 100 50 0

57 | 1998 - 1999 GEORGIA HIV/STD REPORT

Gonorrhea by Age Group and Year of Diagnosis Georgia, 1995-1999

12,000 10,000
8,000 6,000

Number of cases
$ #

Age group # 10-19 $ 20-29 ) 30-39 ' 40+

$ $

#

#

4,000

)

)

)

2,000

'

'

'

0
10-19 20-29 30-39
40+

1995
6,798 9,077 3,427 2,127

1996
6,415 8,406 3,214 1,890

1997
5,889 7,744 3,017 1,856

$
#
) '
1998
6,095 9,149 3,347 1,621

$
#
) '
1999
6,544 9,694 3,464 1,797

Gonorrhea Cases by Age Group and Gender Georgia, 1999

Age Group 10 - 19 20 - 29 30 - 39 >= 40

Males 2115 5244 2368 1492

Females 4406 4415 1080 300

58 | 1998 - 1999 GEORGIA HIV/STD REPORT

Gonorrhea Cases by Public Health District (HD) Groupings
Georgia, 1995-1999

Percent of all cases 60
Atlanta HDs 50

Small MSA HDs

Rural HDs

40

30

20

10

0
Atlanta HDs Small MSA HDs
Rural HDs

1995
50 35 15

1996
48 33 19

1997
49 34 17

1998
45 36 19

1999
46 35 19

Note: 8-county metropolitan Atlanta includes the Marietta, Fulton, Clayton, Gwinett, and DeKalb districts. Districts with a small metropolitan statistical area (MSA) are Albany, Athens, Augusta, Columbus, Macon, and Savannah.

Gonorrhea Cases by Public Health District Georgia, 1999
Metropolitan Atlanta

59 | 1998 - 1999 GEORGIA HIV/STD REPORT

Gonorrhea Cases by Year of Diagnosis Rome (1-1) District, 1995 - 1999

Number of cases 1000

800

600

400

200

0
Cases

1995
249

1996
254

1997
209

1998
390

1999
491

Gonorrhea Cases by Year of Diagnosis Dalton (1-2) District, 1995 - 1999

Number of cases 1000

800

600

400

200

0
Cases

1995
105

1996
106

1997
99

1998
119

1999
243

60 | 1998 - 1999 GEORGIA HIV/STD REPORT

Gonorrhea Cases by Year of Diagnosis Gainesville (2-0) District, 1995 - 1999

Number of cases 1000

800

600

400

200

0
Cases

1995
290

1996
367

1997
344

1998
346

1999
339

Gonorrhea Cases by Year of Diagnosis Marietta (3-1) District, 1995 - 1999

Number of cases 1400

1200

1000

800

600

400

200

0
Cases

1995
794

1996
1092

1997
613

1998
546

1999
721

61 | 1998 - 1999 GEORGIA HIV/STD REPORT

Gonorrhea Cases by Year of Diagnosis Fulton (3-2) District, 1995 - 1999
Number of cases (Thousands) 8

6

4

2

0
Cases

1995
7.412

1996
5.68

1997
5.437

1998
5.599

1999
5.872

Gonorrhea Cases by Year of Diagnosis Clayton (3-3) District, 1995 - 1999

Number of cases 1400

1200

1000

800

600

400

200

0
Cases

1995
264

1996
330

1997
454

1998
608

1999
592

62 | 1998 - 1999 GEORGIA HIV/STD REPORT

Gonorrhea Cases by Year of Diagnosis Gwinnett (3-4) District, 1995 - 1999

Number of cases 1000

800

600

400

200

0
Cases

1995
254

1996
388

1997
322

1998
323

1999
461

Gonorrhea Cases by Year of Diagnosis DeKalb (3-5) District, 1995 - 1999

Number of cases 3000

2500

2000

1500

1000

500

0
Cases

1995
1943

1996
2108

1997
2224

1998
2314

1999
2113

63 | 1998 - 1999 GEORGIA HIV/STD REPORT

Gonorrhea Cases by Year of Diagnosis LaGrange (4-0) District, 1995 - 1999
Number of cases 2000

1500

1000

500

0
Cases

1995
950

1996
921

1997
823

1998
959

1999
1044

Gonorrhea Cases by Year of Diagnosis Dublin (5-1) District, 1995 - 1999

Number of cases 1000

800

600

400

200

0
Cases

1995
279

1996
263

1997
297

1998
340

1999
338

64 | 1998 - 1999 GEORGIA HIV/STD REPORT

Gonorrhea Cases by Year of Diagnosis Macon (5-2) District, 1995 - 1999

Number of cases 2500

2000

1500

1000

500

0
Cases

1995
1778

1996
1493

1997
1088

1998
1293

1999
1751

Gonorrhea Cases by Year of Diagnosis Augusta (6-0) District, 1995 - 1999
Number of cases 2000

1500

1000

500

0
Cases

1995
1153

1996
1028

1997
914

1998
983

1999
1195

65 | 1998 - 1999 GEORGIA HIV/STD REPORT

Gonorrhea Cases by Year of Diagnosis Columbus (7-0) District, 1995 - 1999

Number of cases 2500

2000

1500

1000

500

0
Cases

1995
1357

1996
1063

1997
1212

1998
1625

1999
1514

Gonorrhea Cases by Year of Diagnosis Valdosta (8-1) District, 1995 - 1999

Number of cases 1400

1200

1000

800

600

400

200

0
Cases

1995
624

1996
846

1997
723

1998
658

1999
705

66 | 1998 - 1999 GEORGIA HIV/STD REPORT

Gonorrhea Cases by Year of Diagnosis Albany (8-2) District, 1995 - 1999

Number of cases 2500

2000

1500

1000

500

0
Cases

1995
1733

1996
1371

1997
1401

1998
1620

1999
1335

Gonorrhea Cases by Year of Diagnosis Savannah (9-1) District, 1995 - 1999

Number of cases 1400

1200

1000

800

600

400

200

0
Cases

1995
679

1996
875

1997
676

1998
970

1999
882

67 | 1998 - 1999 GEORGIA HIV/STD REPORT

Gonorrhea Cases by Year of Diagnosis Waycross (9-2) District, 1995 - 1999

Number of cases 1400

1200

1000

800

600

400

200

0
Cases

1995
593

1996
653

1997
548

1998
784

1999
686

Gonorrhea Cases by Year of Diagnosis Brunswick (9-3) District, 1995 - 1999

Number of cases 1000

800

600

400

200

0
Cases

1995
241

1996
266

1997
216

1998
260

1999
251

68 | 1998 - 1999 GEORGIA HIV/STD REPORT

Gonorrhea Cases by Year of Diagnosis Athens (10-0) District, 1995 - 1999

Number of cases 1400

1200

1000

800

600

400

200

0
Cases

1995
689

1996
756

1997
915

1998
932

1999
686

69 | 1998 - 1999 GEORGIA HIV/STD REPORT

STD Surveillance: Chlamydia
Chlamydia is an STD that is caused by a bacterium which primarily affects the reproductive tract of women and men. As many as 85% of infections in women and 40% of infections in men may be asymptomatic and will not be identified without screening. Diagnosed chlamydia is easily treated and cured, but untreated infection can cause complications, particularly in women, such as infertility, pelvic inflammatory disease, ectopic pregnancy, and chronic pelvic pain.
Since 1995, the rate and number of cases of chlamydia in the state has increased each year. This trend is partly due to the implementation and expansion of the Chlamydia Project which is described in the next section. In 1999, there were 31,498 reported cases for a rate of 404 cases per 100,000 population. Of these 31,498 reported persons, 25,568 (81%) were female, 13,158 (42%) were 10 to 19 years old, and 14,689 (47%) were 20 to 29 years old. The five districts with the highest number of cases were Fulton (5,797), DeKalb (3,205), Augusta (2,411), Macon (2,195), and Columbus (2,106).

Chlamydia Cases and Rates by Year of Diagnosis Georgia, 1995-1999

Number of cases (Thousands) 35

30

25

20 &

15

&

&

10

5

0
Cases Rate*

1995
11.45 161

1996
13.596 189

1997
16.164 220

* Rate = cases/100,000 population

&
1998
25.248 330

Rate

&

400

300 Cases
200 & Rate*
100

0 1999
31.498
404

70 | 1998 - 1999 GEORGIA HIV/STD REPORT

Chlamydia Cases by Sex and Year of Diagnosis Georgia, 1995-1999

Number of cases 30,000

25,000

20,000

15,000

10,000

$

5,000
0
Male Female

#
1995
983 10,417

$
# 1996
1,811 11,757

$
# 1997
1,978 14,150

$ $

# Male $ Female

#
1998
3,931 21,155

#
1999
5,699 25,568

Chlamydia Cases and Rates by Sex
Georgia, 1999

Number of cases (Thousands) 30

25

20 Cases , Rate*
15

10 ,
5

0
Cases Rate*

Males
5.699 150

* Rate = cases/100,000 population

,
Females
25.568 640

Rate 700 600 500 400 300 200 100 0

71 | 1998 - 1999 GEORGIA HIV/STD REPORT

Chlamydia by Age Group and Year of Diagnosis Georgia, 1995 - 1999

Number of cases 16,000

14,000

12,000 10,000

Age group # 10-19 $ 20-29 ) 30-39 ' 40+

8,000

$#

6,000 $#

$#

4,000

2,000
0
10-19 20-29 30-39
40+

)'
1995
5,103 4,790
850 693

)'
1996
6,061 5,784 1,021
724

)'
1997
7,119 6,971 1,070
979

$ #
) ' 1998
10,412 11,565
1,896 446

$ #
) ' 1999
13,158 14,689
2,238 562

Chlamydia Cases by Age Group and Sex Georgia, 1999

Age Group 10 - 19 20 - 29 30 - 39 >= 40

Males 1533 3010 735 256

Females 11562 11621 1494 304

72 | 1998 - 1999 GEORGIA HIV/STD REPORT

Chlamydia Cases by Public Health District (HD) Groupings
Georgia, 1996-1999

Percent of all cases 60 50

Atlanta HDs Small MSA HDs Rural HDs

40

30

20

10

0
Atlanta HDs Small MSA HDs
Rural HDs

1996
56 26 18

1997
47 34 19

1998
43 36 21

1999
40 36 24

Note: 8-county metropolitan Atlanta includes the Marietta, Fulton, Clayton, Gwinnett, and DeKalb districts. Districts with a small metropolitan statistical area (MSA) are Albany, Athens, Augusta, Columbus, Macon, and Savannah.

Chlamydia Cases by Public Health District Georgia, 1999
Metropolitan Atlanta

73 | 1998 - 1999 GEORGIA HIV/STD REPORT

Chlamydia Cases by Year of Diagnosis Rome (1-1) District, 1995 - 1999

Number of cases 1400

1200

1000

800

600

400

200

0
Cases

1995
245

1996
386

1997
448

1998
767

1999
888

Chlamydia Cases by Year of Diagnosis Dalton (1-2) District, 1995 - 1999

Number of cases 1000

800

600

400

200

0
Cases

1995
119

1996
141

1997
198

1998
338

1999
466

74 | 1998 - 1999 GEORGIA HIV/STD REPORT

Chlamydia Cases by Year of Diagnosis Gainesville (2-0) District, 1995 - 1999

Number of cases 1400

1200

1000

800

600

400

200

0
Cases

1995
164

1996
182

1997
227

1998
351

1999
613

Chlamydia Cases by Year of Diagnosis Marietta (3-1) District, 1995 - 1999

Number of cases 2000

1500

1000

500

0
Cases

1995
395

1996
792

1997
581

1998
1023

1999
1339

75 | 1998 - 1999 GEORGIA HIV/STD REPORT

Chlamydia Cases by Year of Diagnosis Fulton (3-2) District, 1995 - 1999

Number of cases (Thousands) 6

5

4

3

2

1

0
Cases

1995
4.545

1996
4.724

1997
4.351

1998
5.276

1999
5.797

Chlamydia Cases by Year of Diagnosis Clayton (3-3) District, 1995 - 1999

Number of cases 1400

1200

1000

800

600

400

200

0
Cases

1995
251

1996
332

1997
472

1998
1009

1999
881

76 | 1998 - 1999 GEORGIA HIV/STD REPORT

Chlamydia Cases by Year of Diagnosis Gwinnett (3-4) District, 1995 - 1999

Number of cases 1400

1200

1000

800

600

400

200

0
Cases

1995
264

1996
495

1997
617

1998
757

1999
1056

Chlamydia Cases by Year of Diagnosis DeKalb (3-5) District, 1995 - 1999

Number of cases (Thousands) 4

3

2

1

0
Cases

1995
0.825

1996
1.288

1997
1.655

1998
2.894

1999
3.205

77 | 1998 - 1999 GEORGIA HIV/STD REPORT

Chlamydia Cases by Year of Diagnosis LaGrange (4-0) District, 1995 - 1999

Number of cases 2500

2000

1500

1000

500

0
Cases

1995
479

1996
688

1997
716

1998
1362

1999
1786

Chlamydia Cases by Year of Diagnosis Dublin (5-1) District, 1995 - 1999

Number of cases 1000

800

600

400

200

0
Cases

1995
177

1996
128

1997
144

1998
288

1999
548

78 | 1998 - 1999 GEORGIA HIV/STD REPORT

Chlamydia Cases by Year of Diagnosis Macon (5-2) District, 1995 - 1999

Number of cases 3000

2500

2000

1500

1000

500

0
Cases

1995
757

1996
920

1997
1280

1998
1884

1999
2195

Chlamydia Cases by Year of Diagnosis Augusta (6-0) District, 1995 - 1999

Number of cases 3000

2500

2000

1500

1000

500

0
Cases

1995
583

1996
539

1997
903

1998
1907

1999
2411

79 | 1998 - 1999 GEORGIA HIV/STD REPORT

Chlamydia Cases by Year of Diagnosis Columbus (7-0) District, 1995 - 1999

Number of cases 3000

2500

2000

1500

1000

500

0
Cases

1995
1117

1996
1117

1997
1343

1998
2123

1999
2106

Chlamydia Cases by Year of Diagnosis Valdosta (8-1) District, 1995 - 1999

Number of cases 1400

1200

1000

800

600

400

200

0
Cases

1995
258

1996
331

1997
475

1998
700

1999
928

80 | 1998 - 1999 GEORGIA HIV/STD REPORT

Chlamydia Cases by Year of Diagnosis Albany (8-2) District, 1995 - 1999

Number of cases 2500

2000

1500

1000

500

0
Cases

1995
427

1996
328

1997
775

1998
1308

1999
1656

Chlamydia Cases by Year of Diagnosis Savannah (9-1) District, 1995 - 1999

Number of cases 2500

2000

1500

1000

500

0
Cases

1995
347

1996
451

1997
807

1998
1330

1999
1463

81 | 1998 - 1999 GEORGIA HIV/STD REPORT

Chlamydia Cases by Year of Diagnosis Waycross (9-2) District, 1995 - 1999

Number of cases 2000

1500

1000

500

0
Cases

1995
172

1996
402

1997
677

1998
1068

1999
1272

Chlamydia Cases by Year of Diagnosis Brunswick (9-3) District, 1995 - 1999

Number of cases 1000

800

600

400

200

0
Cases

1995
95

1996
122

1997
146

1998
354

1999
493

82 | 1998 - 1999 GEORGIA HIV/STD REPORT

Chlamydia Cases by Year of Diagnosis Athens (10-0) District, 1995 - 1999

Number of cases 2000

1500

1000

500

0
Cases

1995
174

1996
222

1997
345

1998
509

1999
1221

83 | 1998 - 1999 GEORGIA HIV/STD REPORT

Chlamydia Project
Since 1994, Georgia has participated in the federal Region IV Chlamydia Project, whose main goals include determining the prevalence of chlamydia and preventing and controlling chlamydia and its complications, particularly in women. Since the implementation of the project, the number of sites in Georgia which are screening and treating for chlamydia has expanded. In 1998, the project expanded to 446 sites, most of which were family planning clinics. In general, women who had a pelvic exam during their clinic visit were screened for chlamydia and gonorrhea, and symptoms were defined as vaginal discharge or bleeding, abdominal pain, and pain with urination or intercourse. The data presented in this text includes information from the 265 sites which sent data to the state office at DHR in 1998.
Georgia Chlamydia Project
265 sites, 1998
Of women with positive or negative chlamydia (CT) results, 7.6% (4,466/59,106) were positive
Of women with CT, 96% (4,287/4,466) were known to be treated Of women with positive or negative gonorrhea (GC) results,
2.9% (1,666/57,316) were positive Of women with positive or negative CT and GC results,
1.0% (543/56,824) were positive for both
84 | 1998 - 1999 GEORGIA HIV/STD REPORT

Georgia Chlamydia Project
Chlamydia positivity by age group, 1998

Age Group 10 - 19 20 - 29 30 - 39 40 - 49

Percent Positive

12%

(2,226/18,448)

6% (1,814/28,761)

2%

(145/7,251)

1%

(16/1,529)

Total

8% (4,201/55,989)

Georgia Chlamydia Project
Chlamydia positivity by race/ethnicity, 1998

Race/ethnicity Black White
Hispanic Other

Percent Positive

11% (3,459/32,525)

4% (744/20,859)

3%

(127/3,895)

6%

(33/544)

Total

8% (4,363/57,823)

85 | 1998 - 1999 GEORGIA HIV/STD REPORT

Georgia Chlamydia Project
Chlamydia positivity by age group and race/ethnicity, 1998

Age Group

Black

White

Hispanic

10 - 19 17% (1,697/9,737) 5% (419/7,730)

7% (32/439)

20 - 29

9% (1,411/15,311) 3% (298/10,514)

3% (54/1,989)

30 - 39

3% (115/4,483) 1% (22/2,133) 1% (5/385)

40 - 49

1%

(12/999)

1%

(4/420)

0% (0/57)

Total

11% (3,235/30,530) 4% (743/20,797)

3% (91/2,870)

Georgia Chlamydia Project
Chlamydia positivity by age group and symptoms, 1998

Age Group 10 - 19 20 - 29 30 - 39 40 - 49 Total

Symptomatic 18% (728/3,997) 8% (620/7,609) 2% (73/2,997) 2% (12/722) 9% (1,433/15,325)

Asymptomatic

10% (1,470/14,228)

6% (1,157/20,655)

2%

(67/4,072)

0.5%

(4/757)

7% (2,698/39,712)

86 | 1998 - 1999 GEORGIA HIV/STD REPORT

Georgia Chlamydia Project
Chlamydia positivity by age group and pregnancy status, 1998

Age Group 10 - 19 20 - 29 30 - 39 40 - 49 Total

Pregnant 29% (67/230) 12% (40/346)
5% (3/66) 0% (0/3) 17% (110/645)

Not Pregnant

11% (1,985/17,414)

6% (1,661/27,083)

2% (125/6,621)

1%

(14/1,365)

7% (3,785/52,483)

Georgia Chlamydia Project
Chlamydia positivity by clinic type, 1998

Clinic type

Percent Positive

Family Planning

7% (3,158/45,881)

STD

10% (965/9,760)

Teen

11% (276/2,458)

College

7%

(49/743)

87 | 1998 - 1999 GEORGIA HIV/STD REPORT

Georgia Chlamydia Project
Chlamydia positivity by reason for visit, 1998

Reason for visit
STD problem or volunteer
Family planning
Referred by sex partner

Percent Positive

9% (1,441/15,506)

7% (2,867/42,073)

13%

(92/694)

Chlamydia Positivity by Location of Clinic Georgia, 1998
Metropolitan Atlanta

Dalton 4.6% Gainesville

Rome 5.1%

3.5%

Atlanta Athens 6.7%

LaGrange 8.8%

Macon 9.4%

Augusta 10%

Columbus 9.9%
Albany 11%

Dublin 8.4%
Waycross 6.6%
Valdosta 8.9%

Marietta 3.6%

Gwinnett 3.7%
DeKalb 7.3%

Fulton 8.3%

Clayton 6.8%

Savannah*

Brunswick 7.0%

* No sites submitted data in 1998.

88 | 1998 - 1999 GEORGIA HIV/STD REPORT

Gonococcal Isolate Surveillance Project (GISP)
Gonorrhea infections have become increasingly resistant to routine antibiotic treatment, resulting in more expensive treatment options. The main purpose of the Gonococcal Isolate Surveillance Project (GISP) is to monitor trends of antimicrobial susceptibilities in N. gonorrhoeae and to describe the diversity of antimicrobial resistance in N. gonorrhoeae by phenotypically characterizing antimicrobialresistant isolates. GISP data are useful for determining treatment recommendations. Each month, N. gonorrhoeae isolates from the first 20 men diagnosed with gonorrhea in STD clinics are collected. GISP has been conducted at the Fulton County STD clinic since 1988. Of the 265 males diagnosed with gonorrhea in 1999, there was no antimicrobial resistance to the antibiotics used for treatment.
Gonococcal Isolate Surveillance Project
Treatment for 265 males with gonorrhea at a Fulton County STD Clinic, 1999

Ceftriaxone 85.7%

None 1.1%
Missing 7.9%
Azithromycin 1.1% Spectinomycin 4.2%

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The percentage of gonococcal isolates resistant to antibiotics by year are shown in Table 3.

Table 3

Gonococcal Isolate Surveillance Project (GISP): Percentage of isolates resistant to specific antibiotics by year at a Fulton County STD clinic

Year Number PCN1 TET2 PCN Ciprofloxacin4 Cefixime5 Ceftriaxone Spectinomycin Azithromycin6

tested

& TET3

1988 236 3% 20% 4% ----

----

0%

0%

1989 240 18% 21% 5% ----

----

0%

0%

1990 236 36% 14% 3% ----

----

0%

0%

1991 240 29% 13% 6% 0%

----

0%

0%

1992 236 22% 19% 4% 0%

0%

0%

0%

1993 238 11% 17% 12% 0%

0%

0%

0%

1994 229 11% 25% 9% 0%

0%

0%

0%

1995 227 4% 35% 18% 0%

0%

0%

0%

1996 193 3% 30% 10% 0%

0%

0%

0%

1997 202 4% 20% 12% 1%

0%

0%

0%

1998 227 4% 27% 7% 0%

0%

0%

0%

1999 265 3% 22% 14% 0%

0%

0%

0%

---- ---- ---- ---- ---- ---- ---- ---- ---- 0% 0% 0%

1 PCN = Plasmid-mediated penicillinase-producing N. gonorrhoeae (PPNG) and chromosomallymediated resistance to penicillin (PenR) 2 TET = Plasmid-mediated tetracycline resistance (TRNG) and chromosomally-mediated resistance to tetracycline (TetR) 3 The APCN & TET@ category is exclusive of the APCN@ and ATET@ categories. 4 In 1997, there was one resistant isolate and one isolate with decreased susceptibility. In 1998 and 1999, there were no resistant isolates, but there were 11 and 14 isolates, respectively, with decreased susceptibility. 5 For cefixime, there has been no documented resistance for N. gonorrhoeae. In 1992, there was one isolate with decreased susceptibility at this clinic. 6 Definition of decreased susceptibility/resistance is the same as the one used in CDC=s September 22, 2000 MMWR.

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Appendix: Technical notes

1) Abbreviations and terminology used in this report include: a) AIDU@ for injection drug use; b) AMSM@ for men who have sex with men (bisexual and homosexual); c) ANIR@ for no identified risk; d) Apediatric@ for persons less than 13 years old; e) Aadolescents and adults@ for persons at least 13 years old; f) ASHAS@ for the Supplement to HIV/ AIDS Surveillance Project; g) ABRFSS@ for the Behavioral Risk Factor Surveillance System; and h) "GISP" for the Gonococcal Isolate Surveillance Project.

2) Data in this report may change over time due to reporting delays and quality assurance activities.

3) The populations used to calculate rates in this report are estimates from the U.S. Census Bureau.

4) Rates based on small numerators (e.g., number of cases) or denominators (e.g., population) may not be accurate.

5) As with most public health surveillance systems, the interpretation of data is limited by incomplete reporting.

6) For this report, "metropolitan Atlanta" is defined as the following 8 counties (Clayton, Cobb, DeKalb, Douglas, Fulton, Gwinnett, Newton, and Rockdale) unless otherwise specified.

7) In Georgia, there are 19 Public Health Districts which include the counties listed below.

Rome (1-1):

Bartow, Catoosa, Chattooga, Dade, Floyd, Gordon, Haralson, Paulding, Polk, and Walker

Dalton (1-2):

Cherokee, Fannin, Gilmer, Murray, Pickens, and Whitfield

Gainesville (2):

Banks, Dawson, Forsyth, Franklin, Habersham, Hall, Hart, Lumpkin, Rabun, Stephens, Towns, Union, and White

Marietta (3-1):

Cobb and Douglas

Fulton (3-2):

Fulton

Clayton (3-3):

Clayton

Gwinnett (3-4):

Gwinnett, Newton, and Rockdale

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DeKalb (3-5): LaGrange (4): Dublin (5-1): Macon (5-2): Augusta (6): Columbus (7):
Valdosta (8-1): Albany (8-2): Savannah (9-1): Waycross (9-2):
Brunswick (9-3): Athens (10):

DeKalb
Butts, Carroll, Coweta, Fayette, Heard, Henry, Lamar, Meriwether, Pike, Spalding, Troup, and Upson
Bleckley, Dodge, Johnson, Laurens, Montgomery, Pulaski, Telfair, Treutlen, Wheeler, and Wilcox
Baldwin, Bibb, Crawford, Hancock, Houston, Jasper, Jones, Monroe, Peach, Putnam, Twiggs, Washington, and Wilkinson
Burke, Columbia, Emanuel, Glascock, Jefferson, Jenkins, Lincoln, McDuffie, Richmond, Screven, Taliaferro, Warren, and Wilkes
Chattahoochee, Clay, Crisp, Dooly, Harris, Macon, Marion, Muscogee, Quitman, Randolph, Schley, Stewart, Sumter, Talbot, Taylor, and Webster
Ben Hill, Berrien, Brooks, Cook, Echols, Irwin, Lanier, Lowndes, Tift, and Turner
Baker, Calhoun, Colquitt, Decatur, Dougherty, Early, Grady, Lee, Miller, Mitchell, Seminole, Terrell, Thomas, and Worth
Chatham and Effingham
Appling, Atkinson, Bacon, Brantley, Bulloch, Candler, Charlton, Clinch, Coffee, Evans, Jeff Davis, Pierce, Tattnall, Toombs, Ware, and Wayne
Bryan, Camden, Glynn, Liberty, Long, and McIntosh
Barrow, Clarke, Elbert, Greene, Jackson, Madison, Morgan, Oconee, Oglethorpe, and Walton

92 | 1998 - 1999 GEORGIA HIV/STD REPORT