EPIDEMIOLOGIC PROFILE For HIV Prevention Community Planning In Georgia 2002 Georgia Department of Human Resources Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia Prepared July 17, 2002 John Beltrami HIV/STD Epidemiology Section Epidemiology Branch, Division of Public Health Georgia Department of Human Resources Suzette Thedford Georgia Office of Minority Health Georgia Department of Community Health Linda Martin Chronic Disease, Injury, and Environmental Health Section Epidemiology Branch, Division of Public Health Georgia Department of Human Resources Judi Duffy STD/HIV Section Prevention Services Branch, Division of Public Health Georgia Department of Human Resources Alan Fann Grady Health System and Emory University Acknowledgement for graphics: Jimmy Clanton, Jr. Epidemiology Branch, Division of Public Health Georgia Department of Human Resources Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia 2 TABLE OF CONTENTS HIGHLIGHTS ...................................................................................................................................................... 4 INTRODUCTION ............................................................................................................................................... 5 DEMOGRAPHICS, SOCIOECONOMIC STATUS, AND VITAL STATISTICS ............................................... 6 AIDS SURVEILLANCE ...................................................................................................................................... 7 HIV ESTIMATES .............................................................................................................................................. 27 BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) .......................................................... 28 HIV COUNSELING AND TESTING PROGRAM ........................................................................................... 35 SUPPLEMENT TO HIV/AIDS SURVEILLANCE (SHAS) PROJECT ........................................................... 40 STD SURVEILLANCE ..................................................................................................................................... 44 HEPATITIS AAMONG MEN WHO HAVE SEX WITH MEN IN ATLANTA ................................................. 45 FOCUS ON MINORITIES ................................................................................................................................ 46 FOCUS ON HISPANIC/LATINO PERSONS ................................................................................................... 47 FOCUS ON ASIAN/PACIFIC ISLAND PERSONS ......................................................................................... 49 FOCUS ON AFRICAN AMERICAN WOMEN AGED >= 13 YEARS ............................................................ 50 FOCUS ON AFRICAN AMERICAN MEN WHO HAVE SEX WITH MEN ................................................... 52 FOCUS ON AFRICAN AMERICAN MEN WHO HAVE SEX WITH MEN AGED 13-29 YEARS ............... 53 FOCUS ON AFRICAN AMERICAN HETEROSEXUALS AGED 13-19 YEARS .......................................... 54 FOCUS ON AFRICAN AMERICAN HETEROSEXUALS AGED 20-29 YEARS .......................................... 55 FOCUS ON AFRICAN AMERICAN INJECTION DRUG USERS AGED 20-29 YEARS ............................. 56 FOCUS ON WHITE MEN WHO HAVE SEX WITH MEN AGED 13-29 YEARS ......................................... 57 FOCUS ON WHITE MEN WHO HAVE SEX WITH MEN AGED 13-19 YEARS ......................................... 58 FOCUS ON WHITE HETEROSEXUALS AGED 13-19 YEARS .................................................................... 58 3 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia HIGHLIGHTS -- As of December 2000, Georgia ranks 8th in the number of cumulative AIDS cases, 12th in the rate of AIDS, and 7th in the number of persons living with AIDS (CDC statistics). -- There are an estimated 8,200-15,300 adults/ adolescents diagnosed with HIV (non-AIDS) who are living in Georgia (CDC statistics). -- Since 1981, 24,406 cumulative AIDS cases have been reported in Georgia, and as of December 2001, 11,395 persons are living with AIDS. -- Men who have sex with men (MSM) represent the highest number of reported AIDS cases, but proportions of women, minorities, and heterosexuals are increasing. -- Of all reported AIDS cases, the proportion among African Americans has increased from 37% in 1987 to 77% in 2001. -- Although AIDS cases among Hispanics are relatively low, compared to African Americans and Whites, the number and proportion have been increasing in recent years. -- Among all pediatric AIDS cases (n=210), 46% of the mothers had an injection drug use (IDU) related mode of HIV transmission. Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia 4 INTRODUCTION Since the earliest days of the HIV/AIDS epidemic, Georgia has continually had a substantial number of reported cases of AIDS. In 2000, Georgia had the twelfth highest rate of AIDS among all states [CDC. HIV/AIDS Surveillance Report, 2000;12 (No. 2)]. Other parameters help put this finding into a better perspective. As of December 2000, 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. Additionally, Georgia has been among the top ten states for reported cases of syphilis, gonorrhea, and chlamydia in recent years. The characteristics of the AIDS epidemic in Georgia have gradually shifted since the 1980s from an epidemic mostly represented by whites, men who have sex with men (MSM), and persons residing in metropolitan Atlanta, to an epidemic in which African Americans are now the predominant race/ ethnicity affected. Increasing proportions of women, persons infected through heterosexual contact, and persons residing in rural areas are represented as well. In addition to AIDS surveillance, the Georgia Department of Human Resources (DHR), Division of Public Health has contracted with Emory University to conduct the Supplement to HIV/ AIDS Surveillance (SHAS) Project at the Grady Health System in Atlanta. The Division of Public Health also conducts the Behavioral Risk Factor Surveillance System (BRFSS), HIV Counseling and Testing Program, and STD surveillance. the statewide HIV Counseling and Testing Program. In addition to the presentation of data that is specific to HIV/AIDS, information from other databases, e.g., STDs, will be presented as important to understanding the HIV/AIDS epidemic, in part because STDs increase the risk of acquiring and spreading HIV and because STDrelated information is frequently a good marker for HIV-related risks and for identifying priority populations. All persons reported to the STD surveillance system are considered at risk for HIV. The AIDS and STD surveillance databases are based on case reports that are submitted by clinics, hospitals, and other providers. Although these surveillance systems are standardized, the reader is cautioned that the AIDS and STD surveillance databases, as with most surveillance databases, do not represent 100% complete reporting. Moreover, reporting from the public sector tends to be better than from the private sector. Therefore, the numbers presented in this document reflect an underestimate of the true number of cases in the state, so it cannot be said that these databases represent all persons in Georgia with a particular infection. Nevertheless, reporting is considered good overall and very useful for a variety of public health purposes. Additional caveats and limitations to the interpretation of data will be mentioned in the appropriate sections. Most of the data presented in this report are primarily derived from 5 sources: 1) cases of AIDS or STDs reported through surveillance activities to DHR from throughout the state, 2) SHAS interviews of persons with AIDS at the Grady Health System, 3) BRFSS telephone interviews of persons throughout the state, and 4) Before information from specific databases are presented, a brief overview of the demographics and socioeconomic status of Georgia residents will be given to provide an overall perspective of the statewide population for which the HIV/STDrelated activities have been conducted. Additional information is provided for vital statistics. 5 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia DEMOGRAPHICS, SOCIOECONOMIC STATUS, AND VITAL STATISTICS This section shows comparisons of characteristics for persons living in Georgia and the United States. The information also helps provide an overall context for the rest of the information contained in this Epidemiologic Profile. Table 1 is adapted from the Georgia 2001 State Health Profile" published by the CDC, and the other information in this section is adapted from the Georgia Division of Public Health website (www.dhr.state.ga.us). In 1999, the total population in Georgia was 7,789,706 (5,373,666 White and 2,235,945 Black), and there were 126,494 livebirths. Of the 61,634 deaths (44,759 White and 16,732 Black), HIV infection based on ICD-10 codes B20.0-B24 was a cause of death for 771 persons (161 White and 607 Black). The total rate of HIV-related deaths was 10 (per 100,000 population): 3 for Whites and 27 for Blacks. Table 1 Selected Characteristics, 1999: Georgia and the United States Georgia Population 7,788,240 Population density (persons/square mile) 134 Median age 34 Percent of population >= 65 years 10 Percent of population which is female 51 Racial population distribution Percent White 69 Percent Black 29 Percent Asian/Pacific Islander 2 Percent American Indian/Alaska Native 0.2 Ethnic population distribution Percent Hispanic 3 Percent of population below poverty level 13 Percent of school-aged children below poverty level 19 Percent of population aged >= 25 years with HS diploma 81 United States 272,690,813 77 36 13 51 82 13 4 0.9 12 12 16 83 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia 6 AIDS SURVEILLANCE AIDS Surveillance: Caveats to the interpretation of data To understand AIDS reporting data, it is important to note that AIDS represents a condition that occurs on average about 8 to 10 years after the initial HIV infection. Therefore, AIDS information is not representative of the front end of the epidemic. Currently in Georgia, there is not a standardized system of HIV surveillance to help in this regard. AIDS information should be further interpreted with caution because of the advances in HIV/AIDS medications over the last few years. Given the successes of newer HIV/ AIDS medications, AIDS trends are now more likely to reflect persons who take these medications or have access to treatment, as opposed to representing how the epidemic is being spread. Two main ways of presenting AIDS surveillance information are by year of report and year of diagnosis. As with many surveillance systems, there are reporting delays. Although an advantage of presenting data by year of report is that the numbers are likely to remain constant for recent years, data by year of diagnosis actually better reflect the timing of the disease, that is to say, when the diagnosis occurred. Hence, year of diagnosis reflects the epidemic better and will be used in this report. The analyses for this report were conducted on data provided as of January 23, 2002. Because of reporting delays and quality assurance activities, the numbers are expected to change somewhat over time; however, the interpretations of the trends and cumulative information are not likely to substantially change over time. AIDS Surveillance: Statewide Through December 31, 2001, 24,406 cumulative persons with AIDS have been reported in Georgia, of which 12,948 (53%) have died. Based on year of diagnosis, the epidemic in Georgia peaked in the mid-1990s; in 1994, there were 2,251 cases reported which was the highest number since the epidemic began (Chart 1). Since 1994, the number of cases has declined each year. The highest rate (i.e., number of cases per 100,000 population) of AIDS occurred in 1993 and 1994 when the rate was 32 cases per 100,000 population. Although the number of AIDS cases and rate have been declining, it cannot be said that the HIV/AIDS epidemic is waning. Without a more standardized HIV surveillance system in Georgia, it is hard to determine what the incidence of HIV is; however, evidence from some states which do conduct HIV reporting suggests that new cases of HIV are stable or possibly increasing for some groups of persons. New treatments have been responsible for prolonging the lives of persons with AIDS, resulting in decreasing deaths each year since 1995 (Chart 2), and now there are more persons living with AIDS in Georgia than ever before (Chart 3). Through December 31, 2001, there are 11,395 persons living with AIDS in Georgia, including 9,079 (80%) males and 2,316 (20%) females. Of these 11,395 persons, 7,752 (68%) are African American, 3,288 (29%) are White, 312 (2.7%) are Hispanic, 25 (<1%) are Asian/Pacific Islander, and 10 (<1%) are American Indian/Alaska Native. For cases diagnosed in 2000, AIDS rates per 100,000 population are shown in Table 2 by age group, sex, and race/ethnicity. The highest rates occur among persons 30-49 years of age, males, and minorities. 7 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia Table 2 AIDS rates by age group, sex, and race/ethnicity: Georgia, 2000 Age group 0-12 13-19 20-29 30-39 40-49 >= 50 Rate per 100,000 0.2 1.9 15 35 29 8.1 Cases diagnosed 3 16 188 475 353 159 Population 1,578,449 832,321 1,233,946 1,356,241 1,227,790 1,957,706 Total 15 1,194 8,186,453 Sex Male 22 Female 7.6 878 4,027,113 316 4,159,340 Total 15 1,194 8,186,453 Race/ethnicity White 4.1 African American 40 Hispanic 7.6 Asian/PI 2.3 Am. Ind./AN 9.2 220 5,327,281 929 2,349,542 33 435,227 4 177,416 2 21,737 Total 15 1,194 8,186,453 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia 8 Chart 1 Chart 2 Chart 3 AIDS Cases by Year of Diagnosis Georgia, 1981-2001 Number of cases 2500 2000 1500 1000 500 0 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Cases 11 15 47 114 245 433 730 1001 1213 1600 1873 2092 2172 2251 2174 2033 1554 1459 1313 1194 882 AIDS Deaths by Year Georgia, 1981 - 2001 Number of deaths* 1600 1400 1200 1000 800 600 400 200 0 1981 19821983 1984 19851986 1987 1988 19891990 1991 19921993 1994 19951996 1997 1998 19992000 2001 Deaths 1 7 17 57 132 227 356 526 714 887 10331154 1100 996 1497 1189 712 649 627 564 458 * Does not include cases with unknown dates of death Persons Living with AIDS by Year Georgia, 1990 - 2001 Number of cases (Thousands) 12 10 8 6 4 2 0 Cases 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2.452 3.278 4.2 5.267 6.517 7.187 8.027 8.864 9.671 10.353 10.974 11.395 9 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia Table 3 shows the difference in the number of AIDS cases diagnosed in 1999 compared to 1994. For all of the variables and codings, there have been decreases which are consistent with the overall trend of decreasing cases in recent years. However, the smallest decreases were in females, persons at least 40 years old, minorities, and heterosexuals which suggests that the AIDS epidemic is not abating as much in these groups. Furthermore, because of effective medications that delay the AIDS diagnosis in HIV-infected persons, these groups may represent persons who are not able to access care and medications for their HIV infection as easily as the other groups. Other reasons for these differences could be adherence to medications, education, poverty, unawareness of their HIV risk, and interventions that may work for one group but not another. Note that Asian/Pacific Islanders (3 diagnosed in 1994 and 4 diagnosed in 1999) and American Indian/Alaska Natives (4 diagnosed in 1994 and 2 diagnosed in 1998) are not presented below due to small numbers which result in percentage differences that cannot be interpreted similarly to the groups with larger numbers. According to an AIDS Alert entitled, "Are Native Americans Next Brush Fire in HIV Epidemic?" (source CDC News, CDC HIV/STD/TB Prevention News Update, 3/6/01 email), more than 2,000 cases of AIDS were diagnosed among Native Americans in the United States and its territories in 1999, representing nearly a 25% increase from 1997. Table 3 Number of AIDS cases diagnosed in 1994 and 1999 1994 1999 Percent decrease State 2,251 1,313 42% Age group <= 13 32 6 81% 13-19 15 7 53% 20-29 416 188 55% 30-39 1,080 543 50% >= 40 708 569 20% Sex Male 1,829 961 47% Female 422 352 17% Race/ethnicity White 761 233 69% African American 1,450 1,044 28% Hispanic 33 30 9% Mode MSM 1,032 413 60% IDU 465 166 64% MSM & IDU 128 37 71% Heterosexual 306 228 25% Note: The number of persons reported without a risk increased from 247 in 1994 to 443 in 1999. Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia 10 AIDS Surveillance: Age groups Chart 4 shows trends for four age groups. Throughout the last decade, persons reported with AIDS who are at least 30 years old have each year accounted for the largest proportion of cases, and persons aged 13-19 have each year accounted for the lowest proportion. Of 148 cumulative AIDS cases among persons 13-19 years old, the mode of HIV transmission is listed as 39 (26%) for MSM, 9 (6%) for IDU, 3 (2%) for MSM-IDU, 14 (10%) for adult hemophiliacs, 46 (31%) for heterosexuals, 4 (3%) for transfusion/transplant recipients, and 33 (22%) unknown. The proportion of persons 30 to 39 years old was the highest each year from 1990 to 1998, and since 1999 persons 40-49 years old have had the highest proportion. Chart 5 shows that the number of pediatric AIDS cases (persons less than 13 years old) by year of diagnosis has generally decreased since 1994. Of the 210 cumulative cases of pediatric AIDS reported through the end of 2001, 199 (95%) had mothers who were HIV-infected or at risk for HIV infection (Chart 6). Perinatal AIDS information can be found below in a separate section. Chart 4 AIDS Cases by Age Group at Diagnosis and Year of Diagnosis Georgia, 1990-2001 Percent of cases 50 $ 40 $ $ $ $ $ ) $ ) $ ) $ ) )$ ) $ ) $ 30 ) ) ) ) ) 20 # # # # # # # # # # # # 10 & 13-19 # 20-29 $ 30-39 ) >= 40 0& & & & & & & & & & & & 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 13-19 0.4 0.3 0.7 0.9 0.7 0.6 0.8 0.6 0.3 0.5 1.3 0.5 20-29 22 23 23 23 19 18 16 15 17 14 16 16 30-39 48 47 46 45 48 46 48 47 43 41 40 40 >= 40 29 29 30 31 31 34 35 37 39 43 43 44 11 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia Chart 5 Pediatric AIDS Cases by Year of Diagnosis Georgia, 1982-2001 Number of cases 35 30 25 20 15 10 5 0 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Cases 1 1 1 2 6 11 8 14 15 21 22 19 32 19 9 5 15 6 3 0 Note: Of these 210 pediatric cases (i.e., <13 years old at diagnosis), 199 are perinatal. Chart 6 Cumulative Pediatric AIDS Cases by Risk Category Georgia, Reported 1982 - 2001 N=210 pediatric cases 7 0.5 0.5 3 1 1 20 31 15 21 Percent of all pediatric cases Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia 12 AIDS Surveillance: Sex Although the number of reported AIDS cases among women has decreased in recent years (Chart 7), the proportion of AIDS cases that are female has steadily increased since the 1980s, with the highest number of cases reported in 1996 (n=417). In 2001, females accounted for 27% of all cases reported in Georgia. Chart 7 AIDS Cases in Adolescent/Adult Females by Year of Diagnosis Georgia, 1984-2000 Number of cases 500 Percent of all adolescent/adult cases 30 Number of cases # Percent of all cases 400 # # # 25 ## # 20 300 ## ## 15 200 ## # 10 # 100 # # # # 5 0 0 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Number of cases 4 12 21 39 68 108 183 245 305 327 406 393 417 356 330 347 314 242 Percent of all cases 4 5 5 5 7 9 12 13 15 15 18 18 21 23 23 27 26 27 13 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia AIDS Surveillance: Race/ethnicity Among all race/ethnicities, African Americans continue to carry the largest burden of an increased proportion of cases, increasing from 37% of the cases in 1987 to 77% of the cases in 2001 (Chart 8). Although the overall number and corresponding percentages of Hispanics reported with AIDS are much less than for African Americans or Whites, the proportion of cases in Hispanics has generally been larger in recent years compared to earlier years. Trends for other race/ethnicities are difficult to interpret due to small numbers and corresponding percentages. Chart 8 AIDS Cases by Race/Ethnicity and Year of Diagnosis Georgia, 1987-2001 Percent of all cases 100 ! White , Black # Hispanic ' Asian/PI " AI/AN 80 ,,,,, 60 40 ! , ! , ,! , ! , ! , ! , ! , ! , ! , ! 20 !!!!! 0 "#' "#' "#' "#' "#' "#' "#' "#' "#' "#' "#' "#' "#' "#' "#' 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 White 61 56 52 46 41 36 34 34 34 28 21 20 18 19 18 Black 37 43 47 53 57 62 64 64 64 69 76 78 80 78 77 Hispanic 2.2 1.1 1.4 1.1 1.7 1.7 1.6 1.5 2.6 2.5 2.3 2.4 2.3 2.8 4.3 Asian/PI 0.1 0.1 0.1 0 0.1 0.2 0.1 0.1 0.1 0.1 0.3 0.3 0.3 0.3 0.8 AI/AN 0 0 0.1 0 0 0 0.1 0.2 0 0.1 0.1 0 0.2 0.2 0 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia 14 AIDS Surveillance: Modes of HIV transmission The proportion of cases diagnosed among men who have sex with men (MSM) has decreased through the years, and the proportion among persons with heterosexual contact has increased. Because the no identified risk (NIR) category has increased through the years at the national and state levels, interpreting risk behavior trends has become more difficult. For example, the true proportion of persons reported with AIDS for a given mode such as MSM, IDU, and heterosexual is likely to be larger than current documentation shows. Although some NIRs from recent years will be resolved, it is likely that many NIRs will remain so. Some national data have been presented and published which redistribute the NIRs to make an estimate of the various modes based on previous NIRs being resolved, but adjusting for this unknown information in Georgia is currently not possible. Given the current limitations of interpreting trends of mode of transmission data, cumulative data is helpful because it minimizes the influence of high NIR proportions in recent years. Of the 24,196 cumulative cases among adults and adolescents reported through the end of December 2001, 48% (n=11,596) are MSM, 18% (n=4,311) are IDU, 6% (n=1,331) are MSM and IDU, and 13% (n=3,213) are heterosexuals. Table 4 shows cumulative mode data by sex. Table 4 Cumulative number and proportion of adolescent/adult AIDS cases by mode of HIV transmission and sex:1981-2001 Males # Percent Females # Percent Total # Percent MSM IDU MSM & IDU Heterosexual Other* 11,596 (58%) 3,200 (16%) 1,331 ( 7%) 1,378 ( 7%) 2,569 (13%) --- --1,111 (27%) --- --1,835 (45%) 1,176 (29%) 11,596 (48%) 4,311 (18%) 1,331 ( 6%) 3,213 (13%) 3,745 (16%) Total 20,074 (100%) 4,122 (100%) 24,196 (100%) * represents mostly NIRs 15 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia AIDS Surveillance: Geographic breakdowns The cumulative number of AIDS reported by each district is shown in Chart 9, with a substantial proportion of cases from districts outside of the metropolitan Atlanta area. The districts with the highest number of AIDS reported are Fulton (n=10,910), followed by DeKalb (n=3,456), Augusta (n=1,305), Savannah (n=1,028), Macon (n=938), Marietta (n=926), and Albany (n=877). Chart 10 shows the geographic distribution for districts in 8-county metropolitan Atlanta, districts which include a small metropolitan statistical area (MSA), and rural areas. Atlanta still accounts for the majority of reported AIDS cases; however, the other areas have had slight increases in proportions through the years. From 1990 to 2001, the proportion of cases from districts outside of Atlanta has increased from 27% to 33%. Charts 11 to 29 show trends from 1990 through 2001 for each district. Chart 9 Cumulative AIDS Cases by Public Health District Georgia, 1981 - 2001 Metropolitan Atlanta N = 24,406 cases reported Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia 16 Chart 10 Chart 11 Chart 12 AIDS Cases by Public Health District (HD) Groupings Georgia, 1990-2001 Percent of all cases 80 Atlanta HDs Small MSA HDs Rural HDs 60 40 20 0 199019911992 199319941995 199619971998 199920002001 Atlanta HDs 72 71 66 67 69 65 64 64 65 61 65 66 Small MSA HDs 19 19 25 22 21 22 24 24 22 28 23 21 Rural HDs 8 10 9 12 10 13 13 12 13 11 13 12 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. AIDS Cases by Year of Diagnosis Rome (1-1) Health District, 1990-2001 Number of cases 100 80 60 40 20 0 1990199119921993 19941995199619971998 199920002001 Cases 16 21 26 25 30 21 26 23 14 18 9 4 AIDS Cases by Year of Diagnosis Dalton (1-2) Health District, 1990 -2001 Number of cases 100 80 60 40 20 0 1990199119921993 1994199519961997 199819992000 2001 Cases 13 12 11 19 20 15 15 13 8 8 9 9 17 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia Chart 13 AIDS Cases by Year of Diagnosis Gainesville (2-0) Health District, 1990 -2001 Number of cases 100 80 60 40 20 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Cases 11 25 20 14 15 21 19 12 13 6 13 6 Chart 14 Chart 15 AIDS Cases by Year of Diagnosis Marietta (3-1) Health District, 1990 -2001 Number of cases 200 150 100 50 0 199019911992199319941995199619971998199920002001 Cases 70 67 80 69 89 107 67 40 44 46 41 39 AIDS Cases by Year of Diagnosis Fulton (3-2) Health District, 1990 -2001 Number of cases 1400 1200 1000 800 600 400 200 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Cases 770 921 903 966 1008 897 856 679 616 532 484 377 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia 18 Chart 16 AIDS Cases by Year of Diagnosis Clayton (3-3) Health District, 1990 -2001 Number of cases 100 80 60 40 20 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Cases 28 23 24 36 42 45 52 35 40 29 32 22 Chart 17 Chart 18 AIDS Cases by Year of Diagnosis Gwinnett (3-4) Health District, 1990 -2001 Number of cases 200 150 100 50 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Cases 46 59 52 53 76 62 45 40 32 28 35 35 AIDS Cases by Year of Diagnosis DeKalb (3-5) Health District, 1990 -2001 Number of cases 500 400 300 200 100 0 19901991 199219931994 1995199619971998 199920002001 Cases 245 253 320 326 330 301 271 199 222 165 180 113 19 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia Chart 19 AIDS Cases by Year of Diagnosis LaGrange (4-0) Health District, 1990 -2001 Number of cases 200 150 100 50 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Cases 26 42 47 71 44 88 70 51 52 26 29 29 Chart 20 AIDS Cases by Year of Diagnosis Dublin (5-1) Health District, 1990 -2001 Chart 21 Number of cases 100 80 60 40 20 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Cases 6 10 6 14 7 15 11 10 14 4 5 4 AIDS Cases by Year of Diagnosis Macon (5-2) Health District, 1990 -2001 Number of cases 200 150 100 50 0 1990 1991 1992 19931994 1995 19961997 1998 1999 20002001 Cases 50 53 77 70 98 79 83 87 82 82 58 6 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia 20 Chart 22 AIDS Cases by Year of Diagnosis Augusta (6-0) Health District, 1990 -2001 Number of cases 200 150 100 50 0 1990 1991 19921993 19941995 19961997 19981999 20002001 Cases 94 86 126 105 110 115 99 77 76 80 76 58 Chart 23 Chart 24 AIDS Cases by Year of Diagnosis Columbus (7-0) Health District, 1990 -2001 Number of cases 200 150 100 50 0 19901991 19921993 19941995 19961997 19981999 20002001 Cases 38 42 79 73 91 77 81 70 55 66 43 45 AIDS Cases by Year of Diagnosis Valdosta (8-1) Health District, 1990 -2001 Number of cases 100 80 60 40 20 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Cases 8 13 9 25 22 41 46 25 34 30 37 29 21 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia Chart 25 AIDS Cases by Year of Diagnosis Albany (8-2) Health District, 1990 -2001 Number of cases 200 150 100 50 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Cases 39 60 85 81 78 73 100 69 56 71 48 50 Chart 26 AIDS Cases by Year of Diagnosis Savannah (9-1) Health District, 1990 -2001 Chart 27 Number of cases 200 150 100 50 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Cases 69 92 133 119 70 92 103 51 34 45 32 19 AIDS Cases by Year of Diagnosis Waycross (9-2) Health District, 1990 -2001 Number of cases 100 80 60 40 20 0 19901991 199219931994 19951996 19971998 19992000 2001 Cases 24 44 45 40 58 52 36 31 27 39 32 21 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia 22 Chart 28 AIDS Cases by Year of Diagnosis Brunswick (9-3) Health District, 1990 -2001 Number of cases 100 80 60 40 20 0 19901991 19921993 199419951996 1997 19981999 20002001 Cases 26 23 32 44 33 26 32 20 20 18 19 7 Chart 29 AIDS Cases by Year of Diagnosis Athens (10-0) Health District, 1990 -2001 Number of cases 100 80 60 40 20 0 19901991 19921993 19941995 19961997 19981999 20002001 Cases 21 27 17 22 30 47 21 22 20 20 12 9 23 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia AIDS Surveillance: Perinatal Charts 30 to 34 illustrate information for the 199 perinatal (versus pediatric) cases with the number of cases decreasing since the mid-1990s. Charts 31 and 32 show demographic information and the HIV risk of the mother. Because 19% of the mothers were diagnosed with HIV/AIDS after delivery or the status of the mother is unknown, these cases likely represent missed opportunities for perinatal HIV transmission (Chart 33). Chart 34 shows the number of cumulative perinatal cases by district. Chart 30 Georgia Pediatric AIDS Cases by Year of Diagnosis by type of HIV transmission and year Number of cases 35 30 Perinatal Other 25 20 15 10 5 0 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Perinatal 1 5 9 7 14 15 20 21 18 31 19 9 5 15 6 2 0 Other 1 1 2 1 0 0 1 1 1 1 0 0 0 0 0 1 0 Chart 31 Cumulative Perinatal AIDS Cases Georgia, 1982-2001 ) Age at diagnosis: 67% (n=134) < 2 years 21% (n= 42) 2- 4years 12% (n= 23) 5-12 years ) Gender: 52% (n=103) female 48% (n= 96) male ) Race/ethnicity: 79% (n=157) Black 19% (n= 37) White 2% (n= 4) Asian/PI 1% (n= 1) AI/AN ) Living status: 48% (n= 96) living 52% (n=103) deceased Note: Of 210 cumulative pediatric cases (<13 years old at diagnosis), 199 are perinatal. Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia 24 Chart 32 Cumulative Perinatal AIDS Cases Georgia, 1982-2001 ) Mother's HIV risk: 21% (n=41) Mother has HIV/AIDS 33% (n=65) Mother is injection drug user (IDU) 16% (n=32) Mother had sex with IDU 23% (n=45) Mother had sex with person with HIV/AIDS 7% (n=14) Mother had sex with bisexual male 1% (n= 1) Mother had transfusion 1% (n= 1) Mother had sex with HIV+ transfusion recipient Chart 33 Cumulative Perinatal AIDS Cases Georgia, 1982-2001 ) History of mother's HIV/AIDS status: 8% (n=14) Mother diagnosed with HIV/AIDS before pregnancy 4% (n= 8) Mother diagnosed with HIV/AIDS during pregnancy 24% (n=44) Mother diagnosed before delivery, date unknown 1% (n= 1) Mother diagnosed with HIV/AIDS at delivery 9% (n=16) Mother diagnosed with HIV/AIDS after delivery 45% (n=84) Mother diagnosed with HIV/AIDS, date unknown 10% (n=18) HIV/AIDS status of mother unknown 1% (n= 2) Mother refused HIV testing Chart 34 Cumulative Perinatal AIDS Cases by Public Health District Georgia, 1982 - 2001 Metropolitan Atlanta N = 199 cases reported 25 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia AIDS Surveillance: Corrections-related information Compared to other states, Georgia has had among the highest rates of HIV/AIDS, STDs, and tuberculosis (TB) in recent years. Additionally, the state has also had among the highest rates of federal and state prisoners (Gilliard DK, Beck AJ. Prisoners in 1997. U.S. Department of Justice, Bureau of Justice Statistics. August, 1998). Although persons arrested for criminal offenses are at high risk for drug use, HIV/STDs, and TB, relatively little epidemiologic information exists for this population, hence the usefulness of the AIDS surveillance database to help understand this group of persons. Comparisons of persons diagnosed with AIDS in correctional facilities compared to those diagnosed with AIDS elsewhere are presented below. A limitation to the interpretation of these results is that these data are not likely to include all persons diagnosed with AIDS in correctional facilities, because reporting may not be complete from correctional facilities. Of the 22,444 adolescents/adults reported with AIDS in Georgia through December 31, 2001, 498 (2%) were diagnosed with AIDS in a correctional facility. Of the 498, 125 (25%) were less than 30 years old, 403 (81%) were African American, 79 (16%) were White, and 16 (3.2%) were Hispanic. Table 5 shows mode of HIV transmission by sex. Table 5 Cumulative number and proportion of adolescent/adult corrections-related AIDS cases by mode of HIV transmission and sex:1981-2001 Males # Percent Females # Percent Total # Percent MSM IDU MSM & IDU Heterosexual Other (mostly NIRs) 115 (24%) 167 (36%) 50 (11%) 65 (14%) 74 (16%) --- --11 (41%) --- --12 (44%) 4 (15%) 115 (23%) 178 (36%) 50 (10%) 77 (16%) 78 (16%) Total 471 (100%) 27 (100%) 498 (100%) Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia 26 HIV ESTIMATES According to 2001 CDC statistics, there are an estimated 8,200 to 15,300 living adult/adolescents who are aware of their HIV (non-AIDS) diagnosis in Georgia. Table 6 shows estimates for age group, sex, race/ethnicity, and mode of HIV transmission. Although the data used were adjusted for reporting delays, deaths, and mode of transmission, the reader should be cautioned that all estimates have limitations. For example, these estimates are based on data from 25 states that have HIV reporting, so the data developed for these estimates may not be representative of the epidemic in Georgia. Table 6 Estimates of living adult/adolescents who are aware of their HIV (non-AIDS) diagnosis in Georgia Minimum Age group 13-19 25 20-29 1,173 30-36 2,476 37-44 2,698 >= 45 1,820 Sex Male 5,994 Female 2,206 Race/ethnicity White 2,181 African American 5,781 Hispanic 189 Asian/PI 8 Am. Ind./AN 8 Mode MSM 3,624 IDU 1,624 MSM & IDU 402 Hemo./Transfusion 74 Heterosexual 2,485 Total 8,200 Maximum 46 2,188 4,621 5,034 3,397 11,184 4,116 4,070 10,787 352 15 15 6,763 3,029 750 138 4,636 15,300 27 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) The Behavioral Risk Factor Surveillance System (BRFSS) is a yearly random telephone survey of about 2,000-4,000 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 asked the questions specific to HIV/AIDS. Two caveats to the interpretation of these data are that BRFSS does not represent households without telephones and that persons could potentially be interviewed more than once (from year to year or even within one year). In 2000 and 2001, the sampling process was stratified by Public Health District populations to account for population differences among the districts. The data analyses were weighted so that age, sex, and race distributions would match the age, sex, and race distributions of the state population. For the 2001 questionnaire, several questions were dropped and several others were added. Thus, some trends are not available through 2001. From 1998 to 2001, the proportion of persons who have ever been tested for HIV has generally been a little more than 50% (Chart 35). When asked about their self-perceived 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 6.6% in 2000 (Chart 36). Chart 37 shows the proportion of persons tested within the last 12 months who have received their results, and among those who have, whether they received counseling. The year 2000 results show that 88% of tested persons are receiving their HIV results, and among those receiving results, one-third are receiving counseling. Chart 35 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 1993 1994 1995 1996 1997 1998 1999 2000 2001 Total # 26 35 34 33 39 52 56 55 55 Note: Data from 1998 to 2001 are exclusive of any tests related to blood donation. Data for prior years may include tests related to blood donation. Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia 28 Chart 36 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 0 None Low Medium High $ # None $ Low ) Medium , High ,) 1995 52 ,) 1996 45 ,) 1997 55 ,) 1998 69 42 51 41 25 4.2 3.2 3.7 3.4 2.1 0.7 1.2 2.3 $ ,) 1999 72 21 4.2 2.5 # $ ,) 2000 69 24 3.8 2.8 Chart 37 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 40 20 0 Results Counseling 1998 86 26 Results Counseling 1999 85 30 2000 88 33 29 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia Table 7 shows the frequency distribution and corresponding percentages in 2000 for several variables in the third column, marked "Total." Two points should be kept in mind when viewing the table. The "n's" are based on sample size, and percentages are weighted to age-, race-, sex-, and district population-specific distribu- tions of Georgia residents aged 18 years and older. 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 7 Self-Perceived HIV Risk of Persons Aged 18 to 64 Years Interviewed for the Georgia 2000 BRFSS Study Low/Medium/High n (weighted percent) Age group 18-29 289 (32%) 30-39 322 (30%) 40-49 231 (20%) 50-64 178 (17%) Sex Female 569 (47%) Male 453 (53%) Race White 635 (64%) Black 349 (31%) Other 35 ( 4%) County of residence 20-county Atlanta 375 (48%) Rural 629 (52%) Highest level of education < high school 91 ( 9%) >= high school/GED 931 (91%) Annual household income <$15,000 91 ( 7%) >=$15,000 846 (93%) Have you ever been tested for HIV, excluding blood donations? Yes 649 (64%) No 344 (36%) None n (weighted percent) 458 (25%) 568 (23%) 593 (25%) 663 (27%) 1,451 (53%) 847 (48%) 1,614 (70%) 604 (25%) 64 ( 4%) 800 (46%) 1,466 (54%) 288 (13%) 2,005 (87%) 208 ( 8%) 1,818 (92%) 1,126 (50%) 1,036 (50%) Total n (weighted percent) 747 (27%) 890 (25%) 824 (24%) 841 (24%) 2,020 (51%) 1,300 (49%) 2,249 (68%) 953 (27%) 99 ( 4%) 1,175 (46%) 2,095 (54%) 379 (11%) 2,936 (89%) 299 ( 8%) 2,664 (92%) 1,775 (55%) 1,380 (45%) Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia 30 Table 7( continued) Self-Perceived HIV Risk of Persons Aged 18 to 64 Years Interviewed for the Georgia 2000 BRFSS Study Have you been tested for HIV within the last 12 months, excluding blood donations? Yes No Low/Medium/High n (weighted percent) None n (weighted percent) 252 (23%) 735 (77%) 422 (21%) 1,714 (79%) If tested for HIV within the last 12 months, did you receive the results? Yes No 224 (90%) 26 (10%) 365 (87%) 48 (13%) If tested within the last 12 months and received results, did you receive counseling about the results? Yes 77 (39%) No 147 (61%) 124 (30%) 238 (70%) Total n (weighted percent) 674 (21%) 2,449 (79%) 589 (88%) 74 (12%) 201 (33%) 385 (67%) 31 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia Table 8 shows the frequency distribution and corresponding percentages in 2001 for several variables related to sociodemographics and HIV testing. The same two points for Table 7 should be kept in mind when viewing this table. Table 8 Characteristics of Persons Aged 18 to 64 Years Interviewed for the Georgia 2001 BRFSS Study Total n (weighted percent) Age group 18-29 30-39 40-49 50-64 Sex Female Male Race White Black Other County of residence 20-county Atlanta Rural Highest level of education < high school >= high school/GED Annual household income <$15,000 >=$15,000 Have you ever been tested for HIV, excluding blood donations? Yes No 802 (26%) 1,013 (26%) 991 (24%) 999 (24%) 1,497 (49%) 2,351 (51%) 2,552 (64%) 1,059 (29%) 195 ( 7%) 1,413 (48%) 2,368 (52%) 453 (12%) 3,388 (88%) 348 ( 9%) 3,028 (91%) 2,021 (55%) 1,599 (45%) Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia 32 Charts 38 to 40 show results from questions medical treatment is available to HIV-infected about medical treatment. It is interesting to note pregnant women to help prevent perinatal HIV that only about half of all respondents knew that transmission (Chart 40). Chart 38 Georgia 2001 Behavioral Risk Factor Surveillance System There are medical treatments available that are intended to help a person who is infected with HIV to live longer. True 86% N = 3,769 respondents Don't know 10% False 4% Chart 39 Georgia 2001 Behavioral Risk Factor Surveillance System How effective do you think these treatments are in helping persons with HIV to live longer? Somewhat effective 60% Don't know 14% Not at all 3% Very effective 23% N = 3,243 respondents who answered "True" to the previous question about medical treatments helping HIV-infected persons live longer 33 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia Chart 40 Georgia 2001 Behavioral Risk Factor Surveillance System A pregnant woman with HIV can get treatment to help reduce the chances that she will pass the virus on to her baby. True 56% False 18% N = 3,766 respondents Don't know 26% Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia 34 HIV COUNSELING AND TESTING PROGRAM HIV Counseling and Testing Program: Services in Georgia Information about the HIV Counseling and Testing System (HIV CTS) in Georgia is based on data submitted to the STD/HIV Section by public health and publicly funded testing programs throughout the state. In addition to county health departments and their satellite programs, publicly funded CTS sites include grant-in-aid funded drug treatment centers, community-based organizations, youth detention centers, county jails, hospitals, university student health clinics, and various outreach projects. Because reports submitted to the state contain no individual identifying information, data are representative of testing episodes, rather than of specific individuals tested. More females than males are now being tested for HIV (57% versus 43%), but men represent over twice the number of positives identified (2.2:1). The positivity rate for males (3.8%) is almost three times higher than that for females (1.3%). African Americans continue to bear the disproportionate burden of HIV infection in Georgia, comprising 79% of all positives identified through testing. The positivity rate for all African Americans tested in 2001 was 3.1%, nearly three times higher than that of either whites or Hispanics tested for HIV (1.2% and 1.5%). In 2001, 82,031 individuals received HIV prevention counseling and testing at 342 publicly funded HIV CTS programs in Georgia. Of those clients tested, 1951, or 2.4%, tested positive. Confidential HIV testing is the standard of care for all publicly funded CTS programs in Georgia. In 2001, 93% of all testing provided in public health program sites was done confidentially. Men who have sex with men (MSM), injection drug users (IDU), and heterosexual sex partners of people with HIV/AIDS still represent the highest risk behavior categories for HIV infection, but an STD diagnosis also appears to be a significant risk exposure for HIV infection, regardless of any other population characteristic or risk behavior. Confidential testing has aided providers in notifying clients of their test results. Post test counseling rates are improving statewide, with 88% of individuals testing positive receiving their results and appropriate referrals in 2001. This is an increase of 33% in returns over the previous year. 35 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia HIV Counseling and Testing Program: Racial and ethnic variations in HIV infection In Georgia, African Americans comprise about one third of the population and Hispanics just under two percent. The counseling and testing activities in Georgia's public health programs show that African Americans are disproportionately affected by HIV infection; these proportions and infection rates have remained relatively consistent over the last five years. African Americans represent more than half of all tests provided, but nearly eighty percent of all positives identified. Five African American positive persons were identified for every one white individual who tested positive in 2001. Seroprevalence rates for African Americans were almost three times higher than those for either whites or Hispanics (3.1% vs. 1.2% and 1.5%). Relatively few Hispanics were tested for HIV or tested positive, but these small numbers were proportionately representative of the Hispanic population living or working in Georgia. Other ethnic and racial minorities did not test in numbers large enough to determine a functional seroprevalence rate. The two figures below show HIV positivity rate by race/ethnicity HIV Pos itivity Rates By Race, 1997-2001 4 3 2 1 0 1997 1998 1999 Black Hispanic 2000 W h ite 2001 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia 36 HIV Counseling and Testing Program: Demographics and risk factors in men Men who have sex with men continue to represent one of the highest risk behaviors for HIV infection in males, with a positivity rate of 15.4% in 2001. A relatively small group of men tested disclosed both MSM and injection drug use as risk factors, and these individuals had a positivity rate of 18.0%. Men with these risk behaviors represent only 12% of all men tested, but 49% of all positives identified. Injecting drug users comprise 5% of all positives identified in males tested, and men with a former or current diagnosis of an STD as their primary risk factor represented 10% of all positives. All other heterosexual men tested positive at a rate of 2.0%, but those heterosexual men whose sex partners were at risk because of injection drug use or who had HIV/AIDS were almost twelve times more likely to test positive as those whose female sex partners were not at high risk for HIV infection (16.6 % vs. 1.4%). African American men represented 77% of all positives identified in males in 2001, and tested positive at a rate twice as high as white men (4.7% vs. 2.1%). Positivity rates in Hispanic men, at 3.1%, have increased significantly over the previous year, but relatively few Hispanic men are screened for HIV, representing only 6% of males tested in public health programs. Seroprevalence rates for all men tested for HIV have been slightly variable over the past five years, but with no significant trends, regardless of race/ethnicity. Men over thirty are much more likely to test positive at higher rates than adolescents and young men ages 13 through 29 (5.4% vs. 2.1%). 37 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia HIV Counseling and Testing Program: Demographics and risk factors in women HIV Counseling and Testing Program: HIV infection by risk behavior category The predominant route of HIV transmission for women in Georgia is heterosexual contact; 92% of all women tested in 2001 listed some form of sexual activity as their primary risk factor, and 90% of all positives were linked to these risk categories. However, for the small percentage of women tested who inject drugs, the risk is much higher for HIV infection. Female IDUs tested positive at a rate of 3.7%, almost three times the positivity rate for women who were exposed through sexual contact (1.3%). There are significant differences in risk exposure within the sexual transmission category, however. Women who have partners at risk, such as injection drug users or men who have sex with men, are almost nine times more likely to test positive than those women whose partners have no other risks for HIV (8.1% vs. 0.8%). Exchanging sex for drugs or money also represents a higher risk for HIV infection, with a seroprevalence rate of over four percent. The overall positivity rate for white women is low (0.6%) and has seen no appreciable increase over the last five years. Black women test at rates significantly higher (1.8% in 2001); again, there is no clear trend indicating an increase in infection rates in recent years. As with men, women over thirty are testing positive at higher rates than teens and young women between ages 13 and 29 (2.5% vs. 0.7%). Men who have sex with men and injection drug users continue to be among the individuals most at risk for HIV infection, although they are the least likely to be tested for HIV in public health programs. In 2001, MSMs and IDUs accounted for only eight percent of all tests provided, but for 39% of all HIV positive results. However, positivity rates appear to be decreasing for these risk exposure categories. Men who have sex with men had a positivity rate of 15.5% in 2001, down from 16.6% in 1995. The positivity rate for injection drug users tested dropped over 60% since 1995 (4.7% in 2001 versus 11.9% in 1995). Other drug related exposure categories indicate some risk for HIV infection if an individual exchanges sex for drugs or money (which has been anecdotally associated with crack cocaine use). These individuals tested positive at a rate of 2.7% in 2001; however, this was a sharp decrease over previous years. Having sex while using non-injectable drugs is not as risky, with these individuals testing positive at a rate of 1.1% this year. Seroprevalence rates for heterosexuals in general remain relatively low (1.0%) and stable over the last five years. However, if the sex partner is infected or at risk, the positivity rates for these heterosexuals increase dramatically. Sex partners of people with HIV/AIDS are testing positive at a rate of 21.2% in 2001; female sex partners of MSM at 3.3%; and partners of IDUs at 2.8%. Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia 38 HIV Counseling and Testing Program: High morbidity health districts In 2001, the state's ten highest-morbidity health districts reported a prevalence of HIV positive test results ranging from a little over 1% to 7%. There was a decrease in positivity rates in six of the top ten ranking health districts from the previous year, as well as a shift in district ranking. Table 9 shows district rankings for HIV positivity in 2000 and 2001. Table 9 2000 Rank 1 2 3 4 5 6 7 8 9 10 Health District Fulton * DeKalb * Columbus Marietta Savannah Clayton Gwinnett Dublin Albany Athens Positivity Rate 5.6% 4.5 3.6 2.2 2.1 1.9 1.8 1.5 1.4 1.2 2001 Rank 1 2 3 4 5 6 7 8 9 10 Health District DeKalb * Fulton * Columbus Savannah Clayton Gwinnett Marietta Albany Dalton LaGrange Positivity Rate 7.0% 5.6 3.2 2.6 1.9 1.5 1.4 1.3 1.3 1.3 * Does not include contracted or alternative programs such as AID Atlanta, Grady Hospital, etc 39 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia SUPPLEMENT TO HIV/AIDS SURVEILLANCE (SHAS) PROJECT SHAS is an extensive interview study, which takes about 50-60 minutes for each confidential interview and addresses socioeconomics, alcohol and drug use, sexual behavior, history of STDs and other diseases, maternal and child health, and access to social services. All interviews conducted at the Grady Health System were in 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 that for many of the behaviors, it is not always known whether they occurred before or after HIV infection. A new questionnaire was begun in November 2000. As a result of new and revised questions, many long term trends that have been described in the past are not currently possible, and information for 2000 and 2001 has been combined. Charts 41 and 42 show the demographic information, socioeconomic status, and current insurance status of persons interviewed in 20002001. For these variables, the majority of persons are male (77%), African American (84%), have at least a high school education (69%), are unemployed (77%), live in a household which makes less than $10,000 per year (51%), and have health insurance (64%). Chart 41 SHAS Project: Persons with AIDS at Grady Health System 287 completed interviews, 2000 - 2001 ) Sex: 5 77% (n=222) male 5 23% (n= 65) female ) Race/Ethnicity: 5 84% (n=240) African-American 5 14% (n= 40) White 5 2% (n= 7) Hispanic Chart 42 SHAS Project: Persons with AIDS at Grady Health System 287 completed interviews,2000 - 2001 ) Highest grade completed: 5 31% (n= 89) < high school 5 69% (n=198) >= high school ) Current employment: 5 77% (n=222) no 5 23% (n= 65) yes ) Household income in last year: 5 51% (n=146) < $10,000 5 48% (n=138) >= $10,000 ) Current health insurance: 5 33% (n= 96) no 5 64% (n=183) yes Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia 40 Table 10 shows substance use-related information from 287 persons completing interviews. Table 10 Substance Use-Related Characteristics of 287 Persons Interviewed for the 2000-2001 SHAS Study Have you ever used mind-altering substances Yes other than alcohol? Total / n (percent) 241 (84%) Have you ever used crack cocaine? Yes Have you ever injected drugs with a needle? Yes Possible alcoholism (defined by answering yes Yes to at least 2 of the 4 CAGE* questions) 148 (52%) 66 (23%) 135 (47%) Have you ever enrolled in a drug/alcohol Yes treatment program? 123 (43%) During the past year, did you try to enter Yes a program but were unable to enroll? 26 ( 9%) * Have you ever felt you should cut down on drinking? Have people annoyed you by criticizing your drinking? Have you ever felt bad or guilty about your drinking? Have you ever had a drink first thing in the morning to steady your nerves or rid yourself of a hangover? 41 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia Table 11 shows information related to sexual behavior and STDs from persons completing interviews. Table 11 Sexual Behavior and STD-Related Characteristics of Persons Interviewed for the 2000-2001 SHAS Study Total / n (percent) Has anyone ever given you money/drugs Yes to have sex with them? 104 (36%) Has anyone given you money/drugs Yes to have sex in the past year? 25 ( 9%) Have you ever paid money/given drugs to Yes anyone to have sex with you? 77 (27%) Have you paid money/given drugs to Yes anyone for sex in the past year? 19 ( 7%) Among those having had a steady sex partner in Yes the past year, is the steady partner you last had sex with HIV-infected? 46 (42%) Among those having had a steady sex partner in Yes the past year, was a condom used during your last vaginal, oral and/or anal sex with your steady partner? 81 (74%) Among those having had a casual partner in the Yes past year, is the casual partner you last had sex with HIV-infected? 24 (23%) Among those having had a casual partner in the Yes past year, was a condom used during your last vaginal, oral and/or anal sex with your casual partner? 79 (76%) At least one visit in the past year to a doctor or Yes clinic for an STD 55 (19%) Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia 42 Table 12 shows information related to antiretroviral medications from persons completing interviews. Table 12 Antiretroviral Medication-Related Characteristics of Persons Interviewed for the 2000-2001 SHAS Study Have you ever received antiretroviral drugs Yes to treat your HIV infection? Total / n (percent) 250 (87%) Among those on therapy, are medications Yes always taken as prescribed? 141 (72%) 43 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia STD SURVEILLANCE In 2001, there were 32,396 cases of chlamydia and 18,247 cases of gonorrhea reported to DHR (data were taken from the DHR website "www.ph.dhr.state.ga.us" on 3/27/02). Charts 43 and 44 show the number of cases in 2001 by age group and sex for gonorrhea and chlamydia, respectively. These findings represent a very large number of persons in Georgia with STDs who are also at risk for HIV, particularly young women. Chart 43 Gonorrhea Cases by Age Group and Sex Georgia, 2001 Age Group 10 - 19 20 - 29 30 - 39 >= 40 Males 1649 4163 1623 966 Females 3673 3988 740 273 Note: Data obtained 2/11/02 from www.ph.dhr.state.ga.us Chart 44 Chlamydia Cases by Age Group and Sex Georgia, 2001 Age Group 10 - 19 20 - 29 30 - 39 >= 40 Males 1398 2799 769 246 Females 11190 12328 1623 341 Note: Data obtained 2/11/02 from www.ph.dhr.state.ga.us Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia 44 HEPATITIS A AMONG MEN WHO HAVE SEX WITH MEN IN ATLANTA Although syphilis, chlamydia, gonorrhea, and HIV are commonly known as STDs, there are many infectious diseases that can be sexually transmitted. In the past ten years, there have been two hepatitis A outbreaks among men who have sex with men (MSM) in metropolitan Atlanta. Whereas the common mode of transmission for HIV and hepatitis B is exposure to semen or blood, the common mode of transmission for hepatitis A is fecal-oral exposure. The Georgia notifiable disease surveillance system database (available at www.ph.dhr.ga.us) was used to describe trends of hepatitis A. As with most basic surveillance systems, there are no useful standardized MSM variables, so a surrogate marker was created. For persons 10 to 49 years old, the male to female ratio over time was examined to postulate disease and behavior changes among MSM. Chart 45 documents over time the total number of hepatitis A cases, the number of cases among adolescent/adult males, and the male to female ratio for persons 10 to 49 years old in 8-county metropolitan Atlanta. Also included are the years when two documented outbreaks occurred among MSM. These data support the idea that education, counseling, and planning to prevent HIV and other STDs need to account for modes of transmission that vary for different diseases. Furthermore, it is interesting to note that the two outbreaks occurred when the male to female ratio was highest, suggesting that tracking this ratio over time may help efforts to describe the epidemiology of infectious diseases among MSM and provide early warnings of outbreaks and changes in behavior Chart 45 Notifiable Disease Surveillance System: Atlant Hepatitis A: all cases, adolescent/adult males, and M:F ratio* by quarter Number of cases All cases Males Ratio Ra tio 250 15 Documented outbreaks among MSM 200 12 150 9 100 6 50 3 0 0 19951,919s5t,129n9d51,939rd51,949th61,919s6t,129n9d61,939rd61,949th71,919s7t,129n9d71,939rd71,949th81,919s8t,129n9d81,939rd81,949th91,919s9t,129n9d91,939rd92,040th02,010s0t,220n0d02,030rd02,040th12,010s1t,220n0d12,030rd1, 4th *Ratio data for ages 10-49 to approximate years persons likely to be most sexually active 45 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia FOCUS ON MINORITIES AIDS surveillance: Charts 46 and 47 show the proportion of cases specific to minority populations by year of diagnosis for males and females, respectively. For both trend charts, African Americans have represented the largest proportion of cases each year since 1990. See earlier sections for related information. Chart 46 AIDS Cases in Males by Race/Ethnicity and Year of Diagnosis Georgia, 1987-2001 Percent of all cases 100 ! White , Black # Hispanic ' Asian/PI " AI/AN 80 ,,,,, 60 40 ! , ! , ! , ,! , ! , ! , ! , ! , ! , ! 20 !!!!! 0 "#' #"' #"' #"' "#' "#' "#' #"' #"' #"' #"' #"' #"' #"' "#' 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 White 62 58 55 49 45 40 37 38 37 32 25 23 21 22 20 Black 35 41 44 50 54 58 61 60 60 65 72 75 77 75 73 Hispanic 2.3 1 1.5 1.1 1.7 1.7 1.7 1.4 2.8 2.6 2.6 2.6 2.6 3 6 Asian/PI 0.1 0 0.1 0 0.1 0.2 0.2 0.1 0.2 0.1 0.4 0.3 0.2 0.3 1 AI/AN 0 0 0.1 0 0 0 0.1 0.2 0.1 0.1 0.1 0 0.1 0.2 0 Chart 47 AIDS Cases in Females by Race/Ethnicity and Year of Diagnosis Georgia, 1987-2001 Percent of all cases 100 80 ,,,,,,,,,,,,,, 60 , ! White , Black # Hispanic ' Asian/PI " AI/AN 40 ! 20 0 "#' ! "#' ! #"' ! #"' ! "#' ! "#' ! "#' ! "#' ! "#' ! "#' ! "#' ! "#' ! "#' ! "#' ! "#' 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 White 36 21 21 22 15 15 16 16 18 13 8 10 10 10 12 Black 64 75 79 76 84 83 83 82 80 84 91 88 88 88 86 Hispanic 0 2.8 0 1.6 1.2 1.9 0.9 1.7 1.7 2.4 1.4 2.1 1.4 2.2 0.4 Asian/PI 0 1.4 0 0 0 0.3 0 0.2 0 0.2 0 0.3 0.6 0.3 0.4 AI/AN 0 00 0 0 0 0.3 0 0 0 0 0 0.3 0 0 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia 46 FOCUS ON HISPANIC/LATINO PERSONS Through December, 2001, there have been 494 cumulative cases of AIDS in Georgia reported in Hispanic persons, of which 4 (1%) were pediatric cases (< 13 years old), 3 (1%) were aged 1319, 124 (25%) were aged 20-29, 222 (45%) were 30-39, 108 (22%) were 40-49, and 33 (7%) were >= 50 years old. Of the 494, 179 (36%) have died. Table 13 below shows the mode of HIV transmission for males and females. Table 13 MSM IDU MSM & IDU Heterosexual No identifiable risk/other Total Male n percent Female n percent Total n percent 199 (47%) 68 (17%) 27 ( 6%) 45 (11%) 89 (21%) ----19 (29%) ----34 (52%) 13 (20%) 199 (40%) 87 (18%) 27 ( 6%) 79 (16%) 102 (21%) 428 (100%) 66 (100%) 494 (100%) 47 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia The information in Table 14 below shows the number of cases among Hispanics by year of diagnosis for the state and for 20-county metropolitan Atlanta. Table 14 Year of diagnosis State (number (number of cases and 1990 18 1991 31 1992 36 1993 35 1994 33 1995 56 1996 52 1997 36 1998 36 1999 30 2000 33 2001 38 Metropolitan Atlanta of cases) percent of all cases) 15 (83%) 18 (58%) 23 (64%) 32 (91%) 23 (70%) 44 (79%) 36 (69%) 26 (72%) 21 (58%) 23 (77%) 26 (79%) 32 (84%) The information in Table 15 below shows Hispanic persons known to be living with AIDS in Georgia as of December 2001 by age group and sex. Table 15 Age group (years) Males < 13 2 13-19 3 20-29 72 30-39 121 40-49 52 > 50 17 Total 267 Females 0 0 14 16 14 1 45 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia 48 FOCUS ON ASIAN/PACIFIC ISLAND PERSONS As of December 2001, there have been 46 Asian/ Pacific Islanders reported with AIDS, of which 21 (46%) have died, 35 (76%) are from 20county metropolitan Atlanta, and 36 (78%) are male. As of December, 2001, there are 25 persons with living AIDS in Georgia whose race/ ethnicity is Asian/Pacific Islander, of whom 22 are male. Tables 16 and 17 show the age group and mode of HIV transmission for these 46 persons. Table 16 Age group (years) Number (percent) < 13 13-19 20-29 30-39 40-49 > 50 1 ( 2%) 0 ( 0%) 10 (22%) 20 (44%) 9 (20%) 6 (13%) Table 17 HIV Mode MSM IDU MSM & IDU Heterosexual NIR/Other Number (percent) 16 (35%) 3 ( 7%) 2 ( 4%) 5 (11%) 20 (44%) 49 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia FOCUS ON AFRICAN AMERICAN WOMEN AGED >= 13 YEARS Of the 24,406 persons with AIDS reported to DHR through December 2001, 3,454 (14%) were African American women at least 13 years old. Of these 3,454, 821 (24%) were 13 to 29 years old at AIDS diagnosis, and 1,538 (45%) are known to be deceased. The primary modes of HIV transmission are shown below in Table 18. Because 430 of the women acquired HIV through heterosexual contact with an IDU, 1,371 (941 + 430) or 40% of all of these women acquired HIV through IDU-related means. Chart 48 shows the number of cases reported by year of diagnosis. The information in Table 19 shows African American women (aged >=13 years) known to be living with AIDS in Georgia as of December 2001 by age group and geography. Table 18 HIV Mode Heterosexual IDU Transfusion/transplant recipient NIR/Other Number (percent) 1,520 (44%) 941 (27%) 112 ( 3%) 881 (26%) Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia 50 Chart 48 AIDS Cases in African American Women, >= 13 Years Old Georgia, 1983-2001 Number of cases 400 300 200 100 0 Cases 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2 3 8 13 25 51 85 138 205 253 272 333 313 351 326 290 304 273 209 Table 19 Age group (years) State (number (number of cases and 13-19 20-29 30-39 40-49 > 50 Total 35 421 808 466 175 1,905 20-county Atlanta of cases) percent of all cases) 22 (63%) 204 (49%) 473 (59%) 272 (58%) 103 (59%) 1,074 (56%) 51 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia FOCUS ON AFRICAN AMERICAN MEN WHO HAVE SEX WITH MEN Of the 24,406 persons with AIDS reported to DHR through December 2001, 5,217 (21%) were African American MSM. Of these 5,217, 1,447 (28%) are less than 29 years old, 2,634 (51%) are known to be deceased, and 745 (14%) were also reported with the IDU risk factor. Charts 49 and 50 show the number of cases reported by year and the number living with AIDS, respectively. Chart 49 African American Men Who Have Sex With Men AIDS cases in Georgia, 1983-2001 Number of cases 700 600 500 400 300 200 100 0 Cases 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 6 16 44 70 135 192 230 344 411 464 483 490 467 435 362 348 277 254 186 Chart 50 African American Men Who Have Sex With Men Living with AIDS in Georgia, 1990-2001 Number of cases 3000 2500 2000 1500 1000 500 0 Cases 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 487 688 901 1149 1443 1575 1776 1986 2198 2338 2475 2566 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia 52 FOCUS ON AFRICAN AMERICAN MEN WHO HAVE SEX WITH MEN AGED 13-29 YEARS Of the 24,406 persons with AIDS reported to DHR through December 2001, 1,447 (6%) were African American MSM aged 13 to 29 years old. Of these 1,447, 737 (51%) are known to be deceased, and 140 (10%) were also reported with the IDU risk factor. Charts 51 and 52 show the number of cases reported by year and the number living with AIDS, respectively. Chart 51 African American Men Who Have Sex With Men, 13-29 Years AIDS cases in Georgia, 1983-2001 Number of cases 300 250 200 150 100 50 0 Cases 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 3 6 18 21 50 70 85 108 127 141 160 137 125 84 68 72 63 63 44 Chart 52 African American Men Who Have Sex With Men, 13-29 Years Living with AIDS in Georgia, 1990-2001 Number of cases 1000 800 600 400 200 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Cases 171 238 308 390 482 508 531 556 601 637 674 702 53 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia FOCUS ON AFRICAN AMERICAN HETEROSEXUALS AGED 13-19 YEARS Of the 24,406 persons with AIDS reported to DHR through December 2001, 41 (<1%) were African American heterosexuals aged 13 to 19 years old. Of these 41, 35 (85%) are female, and 21 (51%) are known to be deceased. Charts 53 and 54 show the number of cases reported by year and the number living with AIDS, respec- tively. Chart 53 African American Heterosexuals, 13-19 Years AIDS cases in Georgia, 1983-2001 Number of cases 20 15 10 5 0 Cases 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 0002010419644622000 Chart 54 African American Heterosexuals, 13-19 Years Living with AIDS in Georgia, 1990-2001 Number of cases 100 80 60 40 20 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Cases 5 4 13 16 19 21 24 23 24 22 21 20 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia 54 FOCUS ON AFRICAN AMERICAN HETEROSEXUALS AGED 20-29 YEARS Of the 24,406 persons with AIDS reported to DHR through December 2001, 606 (2.5%) were African American heterosexuals aged 20 to 29 years old. Of these 606, 413 (68%) are female, and 290 (48%) are known to be deceased. Charts 55 and 56 show the number of cases reported by year and the number living with AIDS, respectively. Chart 55 African American Heterosexuals, 20-29 Years AIDS cases in Georgia, 1983-2001 Number of cases 100 75 50 25 0 Cases 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 0 1 1 1 10 11 23 31 47 59 72 50 66 53 51 54 35 25 14 Chart 56 African American Heterosexuals, 20-29 Years Living with AIDS in Georgia, 1990-2001 Number of cases 500 400 300 200 100 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Cases 44 70 103 148 186 208 224 252 285 304 316 314 55 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia FOCUS ON AFRICAN AMERICAN INJECTION DRUG USERS AGED 20-29 YEARS Of the 24,406 persons with AIDS reported to DHR through December 2001, 368 (1.5%) were African American injection drug users aged 20 to 29 years old. Of these 368, 233 (63%) are male, and 220 (60%) are known to be deceased. Charts 57 and 58 show the number of cases reported by year and the number living with AIDS, respectively. Chart 57 African American Injection Drug Users, 20-29 Years AIDS cases in Georgia, 1983-2001 Number of cases 100 75 50 25 0 Cases 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 0 2 6 3 9 26 21 28 47 44 41 46 25 27 15 18 6 2 1 Chart 58 African American Injection Drug Users, 20-29 Years Living with AIDS in Georgia, 1990-2001 Number of cases 500 400 300 200 100 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Cases 40 73 99 121 150 146 150 151 163 155 148 148 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia 56 FOCUS ON WHITE MEN WHO HAVE SEX WITH MEN AGED 13-29 YEARS Of the 24,406 persons with AIDS reported to DHR through December 2001, 1,159 (5%) were White MSM aged 13 to 29 years old. Of these 1,159, 137 (12%) were also reported with an HIV mode of IDU, and 702 (61%) are known to be deceased. Charts 59 and 60 show the number of cases reported by year and the number living with AIDS, respectively. Chart 59 White Men Who Have Sex With Men, 13-29 Years AIDS cases in Georgia, 1983-2001 Number of cases 300 250 200 150 100 50 0 Cases 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 8 14 32 58 63 112 102 113 107 124 90 85 76 70 34 24 19 19 7 Chart 60 White Men Who Have Sex With Men, Aged 13-29 Years Living with AIDS in Georgia, 1990-2001 Number of cases 1000 800 600 400 200 0 Cases 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 234 261 317 349 376 383 408 430 441 441 452 454 57 Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia FOCUS ON WHITE MEN WHO HAVE SEX WITH MEN AGED 13-19 YEARS There were 2 white MSM aged 13 to 19 years old, both of whom are now deceased. FOCUS ON WHITE HETEROSEXUALS AGED 13-19 YEARS There were 5 white heterosexuals aged 13 to 19 years old, all of whom were female, and 3 of whom are now deceased. Year 2002 Epidemiologic Profile for HIV Prevention Community Planning in Georgia 58