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% 89 | 1998 - 1999 GEORGIA HIV/STD REPORT 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. 90 | 1998 - 1999 GEORGIA HIV/STD REPORT 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 91 | 1998 - 1999 GEORGIA HIV/STD REPORT 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