HIV Surveillance Summary, Georgia, 2011
HIV/AIDS EPIDEMIOLOGY SECTION EPIDEMIOLOGY PROGRAM DIVISION of HEALTH PROTECTION GEORGIA DEPARTMENT of PUBLIC HEALTH

This HIV Surveillance Summary, Georgia, 2011 is published by the Georgia Department of Public Health (DPH), HIV/AIDS Epidemiology Program (HAEP), 2 Peachtree Street, Atlanta Georgia 30303. Data are presented from known diagnoses and laboratory reports entered into the Georgia Enhanced HIV/AIDS Reporting System (eHARS). All data are provisional.
The HIV Surveillance Summary, Georgia, 2011 is not copyrighted and may be used and reproduced without permission. Citation of the source is, however, appreciated.
SUGGESTED CITATION | Georgia Department of Public Health, HIV/AIDS Epidemiology Program HIV
Surveillance Summary, Georgia, 2011, https://dph.georgia.gov/data-fact-sheet-summaries , Published March 2014, [Accessed date]
ACKNOWLEDGEMENTS | Publication of this report was made possible with the contributions of the
Georgia DPH HAEP Core HIV surveillance staff, HIV Case Report Forms submitted by Georgia health care facility staff, HIV infection-related laboratory test results transmitted by laboratory facilities in Georgia, data matches with other public health programs, and the ongoing efforts of multiple individuals from public and private sector organizations dedicated to improving surveillance, prevention, testing, and care of persons living with HIV infection.
Georgia HIV Core Surveillance team contributors: Lauren Barrineau, Marguerite Camp, Raimi Ewetola, Thelma Fannin, Denise Hughes, Rodriques Lambert, Sheila Maxwell, Mildred McGainey, Latoya Moss, A. Eugene Pennisi, Deepali Rane, Akilah Spratling, and Eina Walker
This report was prepared by the following staff of the Georgia Department of Public Health: Deepali Rane, MBBS, MPH; Jane Kelly, MD; Cherie Drenzek, DVM, MS

Table of Contents

Table of Contents

Executive Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Report Changes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Technical Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Definitions of Measures.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Data Limitations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Highlights of Analyses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Table 1 | Distribution of the general population by race/ethnicity, Georgia, 2011.. . . . . . . . . . . . . . . . . . 11

Table 2 | Diagnoses of HIV infection and Stage 3 (AIDS) of HIV infection by sex, age, race/ethnicity, Georgia, January 01, 2011 to December 31, 2011. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Table 3 | Diagnoses of HIV infection and Stage 3 (AIDS) by transmission category and sex, Georgia, January 01, 2011 to December 31, 2011. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Table 4 | Diagnoses of HIV infection and Stage 3 (AIDS) by public health district, Georgia, January 01, 2011 to December 31, 2011. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Table 5 | Persons living with HIV infection and Stage 3 (AIDS) of HIV infection by sex, age, race/ethnicity, Georgia, as of December 31, 2011. . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Table 6 | Persons living with HIV infection and Stage 3 (AIDS) of HIV infection by transmission category and sex, Georgia, as of December 31, 2011. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Table 7 | Persons living with HIV infection and Stage 3 (AIDS) of HIV infection by public health district, Georgia, as of December 31, 2011. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Table 8 | Cumulative diagnoses of HIV infection and Stage 3 (AIDS) of HIV infection by sex, age, race/ethnicity, Georgia, as of December 31, 2011. . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Table 9 | Cumulative diagnoses of HIV infection and Stage 3 (AIDS) of HIV infection by transmission category and sex, Georgia, as of December 31, 2011. . . . . . . . . . . . . . . . . . . . 19

Table 10 | Cumulative diagnoses of HIV infection and Stage 3 (AIDS) by public health district, Georgia, as of December 31, 2011.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Table 11 | Quantified estimates of unmet need for HIV primary care, Georgia, Atlanta EMA, Georgia non-EMA, 2011. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Table 12 | Characteristics of estimates of unmet need for HIV primary care, Georgia, 2011. . . . . . . . . 22

Table 13 | Characteristics of estimates of unmet need for HIV primary care, Atlanta EMA, Georgia, 2011. . . 23

Table 14 | Characteristics of estimates of unmet need for HIV primary care, Georgia non-EMA, 2011. . . . . 24

2011 Georgia HIV Infection Surveillance Summary |C

Executive Summary

Human immunodeficiency virus (HIV) damages specific cells of the immune system called CD4 cells. Untreated, HIV eventually overwhelms the immune system, resulting in a chronic life-threatening condition called acquired immune deficiency syndrome (AIDS). In this report, the term HIV infection refers to HIV diagnoses regardless of stage of disease; that is, HIV infection includes HIV (not AIDS) and AIDS. Based on the CD4 count (cells/ml), HIV infection is defined as Stage 1 (CD4>500), Stage 2 (CD4 200-499 cells/ ml) and Stage 3 (AIDS) (<200 cells/ml). There is no cure for HIV infection, but with antiretroviral therapy (ART), HIV infection can be controlled. Advances in HIV treatment with ART have led to improved quality of life and prolonged lifespan for people living with HIV. Further, achieving viral suppression with effective ART use reduces HIV transmission due to decreased levels of circulating virus.
HIV infection remains an important public health problem in the state of Georgia. As of December 31, 2011, the prevalence rate of HIV infection in Georgia (487 per 100,000) was almost twice that of the national rate (285 per 100, 000 population, year-end, 20101). In 2011, Georgia was ranked fifth highest in the nation for the total number of new diagnoses of HIV Infection among adults and adolescents2. There were 3,023 new diagnoses of HIV infection in 2011 in Georgia. The majority of these cases were among males (77%). The highest percentage of new HIV diagnoses was seen among those aged 30 to 39 years (23%) and the highest percentage of Stage 3 (AIDS) was among those aged 40-49 years (30%). Among all races/ethnicities, Black/non-Hispanics accounted for the majority of the diagnoses; 56% of new HIV infections and 70% of Stage 3 (AIDS).
Multiple imputation, a statistical approach, was used to assign a transmission category for all HIV cases among adults and adolescents in Georgia with no reported or identified risk factor. Sixty-
1, 2 Centers for Disease Control and Prevention. HIV Surveillance Report, 2011; vol.23. http://www.cdc.gov/hiv/topics/surveillance/resources/reports/. Published February 2013. Accessed [August, 2013]

four percent (1,471) of new HIV infections among males in 2011 were attributed to male to male sexual (MSM) contact. Among women, 63% (427) of new HIV infections were attributed to heterosexual contact (HET).
As of December 31, 2011, there were 47,754 persons living with HIV infection in Georgia. Similar to the new diagnoses of HIV infection, the majority of prevalent cases occurred among Black/Non-Hispanic persons (65%) and males (74%). Seventy-two percent (25,430) of HIV cases among males were attributed to the MSM transmission category and 72% (8,597) of cases among females were attributed to heterosexual contact.
Every year, Georgia Department of Public Health (DPH) assesses the unmet primary care need among HIV cases in Atlanta Eligible Metropolitan Area or EMA (a defined geographic region with a high burden of AIDS cases in the most recent five years). During 2012, 43% of the 33,840 persons living with HIV disease in the Atlanta EMA had unmet need.
Monitoring the HIV/AIDS epidemic and understanding the burden of HIV infection in Georgia is essential for meeting the goals stated in the 2010 National HIV/AIDS Strategy to reduce HIV incidence, increase access to care, optimize health outcomes for persons living with HIV and reduce HIV-related health disparities3.
Report Changes
Previously, the HIV/AIDS surveillance summaries from Georgia Department of Public Health (DPH) included data only from cases of HIV (not AIDS) and AIDS cases for which complete information was available for required data elements such as last name, date of birth, race/ethnicity, birth sex, vital status and HIV/AIDS diagnosis information. In recognition of the growing need for data to
3 The White House Office of National AIDS Policy, National HIV/AIDS Strategy for the United States, Washington, DC: The White House, 2010

2 | Georgia Department of Public Health

guide effective prevention program planning, it is necessary to provide an estimate closest to the absolute number of HIV infections in the state of Georgia. Hence, this report includes data on cases with incomplete and/or missing information on some required data elements. This report also differs from previous summaries in that it displays data as HIV infection and stage 3 (AIDS) to remain consistent with other HIV data sources such as the Centers for Disease Control and Prevention. HIV infection includes persons with a diagnosis of HIV infection regardless of the stage of disease at diagnosis; i.e., both HIV (not AIDS) and AIDS.
Concentrated solicitation of case reports by the Georgia DPH, HIV/AIDS Epidemiology Section surveillance staff since 2010 likely contributed to the rise in the number of reported cases of HIV infection in Georgia and consequently led to more accurate representation of the epidemic in Georgia than previously described. The increased prevalence should not necessarily be interpreted as an indication of increased HIV transmission. Additionally, it is likely that not everyone infected with HIV has been diagnosed so this report underestimates the true number of persons living with HIV infection in Georgia.
Recent improvements in the Georgia electronic laboratory reporting (ELR) system have also facilitated the use of laboratory-based measures (e.g., CD4 count, viral load) in estimating the unmet primary medical care needs of persons with a diagnosis of HIV infection in the state of Georgia.
Persons with a diagnosis of HIV infection with no reported and/or identified exposure to HIV through any of the routes listed in the hierarchy of transmission categories by the Centers for Disease Control and Prevention are classified as either `no risk factor identified or no risk factor reported' (NIR/NRR). Georgia has a high proportion of NIR/NRR cases. In 2011, 69% of new diagnoses of HIV infection were reported with no or insufficient risk information to determine transmission category. Multiple imputation, a statistical approach, was used in this report to replace

each missing transmission category with a set of plausible values that represent the uncertainty about the true, but missing value. The methods were applied to HIV cases among the adult and adolescent population only and not to pediatric (age less than 13 years) HIV population of Georgia. To identify and reduce HIV related disparities in prevention and care, it is necessary to have the best available estimate for the distribution of known transmission categories among the HIV infected population of Georgia. Multiple imputation is considered by the Centers for Disease Control and Prevention to be the best method for re-distribution of missing data in large databases.4
Technical Notes
Georgia statutes and regulations (O.C.G.A. 31-12-2(b))5 require healthcare providers (such as nurses, nurse practitioners, doctors, physician assistants) and laboratories to report all cases of HIV infection and/or Stage 3 (AIDS) to the Georgia DPH within seven days of diagnosis. The information is used to monitor the HIV/AIDS epidemic in Georgia and guide program planning and evaluation. The data presented in the accompanying tables are based on confidential case reports collected through the Georgia DPH enhanced HIV/AIDS Reporting System (eHARS).
This report includes surveillance data through December 31, 2011 by diagnostic category for newly diagnosed cases, persons living with and cumulative cases of HIV infection and Stage 3 (AIDS). The data are displayed by date of diagnosis and are not adjusted for reporting delays or incomplete reporting. Persons residing in correctional facilities are included in this report and may inflate rates in certain geographic regions where there are large numbers of HIV-positive inmates. Tables depicting "Persons living with HIV infection and Stage 3 (AIDS)"
4 Harrison KM, Kajese T, Hall HI, Song R. Risk factor redistribution of the national HIV/AIDS surveillance data: an alternative approach. Public Health Rep 2008;123:61827.
5 Department of Public Health, Rules and regulations 290-5-48.11 (2003); Official Code of Georgia Annotated (O.C.G.A.) 31-22-9.2 (2011)

2011 Georgia HIV Infection Surveillance Summary |3

comprise persons with current residence in the state of Georgia based on current information available for them in the Georgia HIV/AIDS surveillance system regardless of where the persons were diagnosed. Persons represented in the "New Diagnoses" and "Cumulative" tables were diagnosed in the state of Georgia. Due to the difference in residency criteria and the influx of cases to Georgia, the number of persons living with HIV infection in Georgia may be higher in some sub-categories than cumulative HIV infections.
Unlike name-based AIDS reporting which began in the early 1980s, name-based HIV reporting did not begin in Georgia until December 31, 2003. Since the HIV surveillance systems is still relatively new in Georgia, and there are known delays with case reporting, we expect that numbers of HIV diagnoses will continue to increase as additional case reports are received.
Definitions of Measures
NEW DIAGNOSES of HIV infection and/or Stage 3 (AIDS) are cases who were diagnosed between January 01, 2011 to December 31, 2011 and reported to the Georgia DPH.
PERSONS LIVING WITH a diagnosis of HIV infection and /or Stage 3 (AIDS) are cases who were diagnosed and alive as of December 31, 2011.
CUMULATIVE DIAGNOSES of HIV infection and Stage 3 (AIDS) of HIV infection are cases who were reported to the Georgia DPH and diagnosed as of December 31, 2011 and include persons living and deceased.
TRANSMISSION CATEGORIES presented in this report follow the standards created by the Centers for Disease Control and Prevention (CDC)6 and have been used for many years. According to the CDC, transmission category is the term for the classification of cases that summarizes a person's possible HIV risk factors. The summary classification results
6 Centers for Disease Control and Prevention. HIV Surveillance Report, 2011; vol.23. http://www.cdc.gov/hiv/topics/surveillance/resources/reports/. Published February 2013. Accessed [August, 2013]

from selecting, from the presumed hierarchical order of probability, the one risk factor most likely to have been responsible for transmission. For surveillance purposes, cases HIV and AIDS are counted only once in the hierarchy of transmission categories. Persons with more than one reported risk factor for HIV infection are classified in the transmission category according to the behavior that is most likely to have resulted in transmission. The exception is men who report sexual contact with other men and injection drug use; this group makes up a separate transmission category. Persons whose transmission category is classified as heterosexual contact are persons who report heterosexual contact specifically with a person known to have, or be at high risk for, HIV infection (e.g., an injection drug user/IDU). The term high-risk is not included in the transmission category label for heterosexual contact in the tables because heterosexual contact itself is the risk factor most likely to have been responsible for transmission. However, the Table 3 footnote regarding this category clarifies how the data are defined: "heterosexual contact with a person known to have, or to be at high risk for, HIV infection." Cases among persons with no reported exposure to HIV through any of the routes listed in the hierarchy of transmission categories are classified as either no risk factor identified or reported (NIR/NRR).
CURRENT RESIDENCE is used to determine the number of persons living with HIV infection in Georgia. Current address is determined using the date of the most recently entered residential address into the Georgia eHARS.
VITAL STATUS: Persons are assumed to be alive unless otherwise documented or reported. The Georgia DPH performs an annual match of the eHARS database with Georgia Vital Records, the National Death Index, and the Social Security Death Index to ascertain vital status and identify any cases deceased from an HIV-related cause yet not otherwise reported.
RATES: Denominators for population rates are based on the 2011 estimates of the resident population retrieved from the Georgia

4 | Georgia Department of Public Health

Department of Public Health, Office of Health Indicators for Planning (OHIP). Rates are per 100,000 population. Rates based on estimated case numbers less than 12 should be interpreted with caution because these rates have relative standard errors greater than 30% and are considered unreliable.
REPORTING PERIOD: Case numbers are based on data entered through June 30, 2013, and are not adjusted for reporting delays.
UNMET NEED: Unmet need for care is the absence of certain components of HIV primary medical care. In this report, unmet need for HIV primary medical care was defined as no evidence of a viral load or CD4 laboratory test between January 01, 2011 to December 31, 2011 among HIV positive persons reported to the Georgia eHARS.

Highlights of Analyses
TABLE 1: ESTIMATES AND DISTRIBUTION OF THE GENERAL POPULATION BY RACE/ETHNICITY, GEORGIA, 2011
There were an estimated 9,815,210 persons living in Georgia in 2011
Of these individuals, the majority were White, Non-Hispanic (56%)
The largest minority group in the state was Black, Non-Hispanic (30%)
Individuals who were Hispanic/Latino comprised 9% of the state's population.
The smallest racial/ethnic groups in the state were Asian, Non-Hispanic (3%); American Indian/ Alaskan Native, Non-Hispanic (<1%); Native Hawaiian/Pacific Islander, Non-Hispanic (<1%); and Multiracial/Other, Non-Hispanic (2%).

PERCENTAGES: Total percentages may not add up to 100% due to rounding and represent the percentage of the total.

TABLES 2 TO 4: NEW DIAGNOSES OF HIV INFECTION,
GEORGIA, JANUARY 01 TO DECEMBER 31, 2011
There were 3,023 persons with new diagnoses of HIV infection in Georgia during 2011.

Data Limitations
Complete and timely reporting of HIV infections to the Georgia DPH is critical for monitoring the HIV epidemic. Delays and incomplete reporting lead to an underestimation of the impact of HIV in the state of Georgia. Data in this report are not adjusted for reporting delays. Although multiple imputation methods were used to assign a known risk category to cases with missing information, a proportion of cases remain without any identified and /or reported risk factor. In addition, populations for which data are missing (e.g birth sex, race, transmissioncategory, geographic location) may be fundamentally different. All registered laboratories are also mandated by state law to report laboratory results on any HIV-related laboratory test to the Georgia DPH. However, some facilities may not comply or send only some test results and not others. Missing laboratory data limit accurate estimation of unmet need for the state of Georgia and the Atlanta EMA.

The majority of the new HIV diagnoses were among males (77%).
Persons aged 30-39 years at the time of diagnosis represented the largest age group (23%) for new diagnoses of HIV infection in Georgia during 2011.
There were racial/ethnic disparities among persons with new diagnoses of HIV infection in Georgia in 2011.
o Black/Non-Hispanics accounted for 56% of new HIV infection diagnoses and comprised 30% of Georgia's population.
o White/Non-Hispanics accounted for 10% of new HIV infection diagnoses and comprised 56% of Georgia's population.
o Hispanics/Latinos of all races accounted for 5% of new diagnoses of HIV infection and comprised 9% of Georgia's population.
The number of cases and proportions stratified by transmission category are shown for both unadjusted and adjusted after multiple imputation.

2011 Georgia HIV Infection Surveillance Summary |5

Using multiple imputation, 64% of HIV infections diagnosed in 2011 among males in Georgia were attributed to the MSM transmission category.
Among women, 63% of HIV infections diagnosed in 2011were attributed to heterosexual contact.
The overall state rate for new diagnoses of HIV infection in 2011 was 31 cases per 100,000 population. In 2011, several Health Districts had newly-diagnosed HIV infection rates that exceeded the overall state rate: Fulton (79 per 100,000), Clayton (79 per 100,000), DeKalb (79 per 100,000).
TABLES 2 TO 4: NEW DIAGNOSES OF STAGE 3 (AIDS), GEORGIA, JANUARY 01 TO DECEMBER 31, 2011
There were 1,479 persons with new diagnoses of Stage 3 (AIDS) in Georgia during 2011.
The majority of the new diagnoses with Stage 3 (AIDS) were among males (73%).
Persons aged 40-49 years at the time of diagnosis represented the largest age group (30%) for new diagnoses of Stage 3 (AIDS) in Georgia during 2011.
There were racial/ethnic disparities among persons with new diagnoses of Stage 3(AIDS) in Georgia in 2011.
o Black/Non-Hispanics accounted for 70% of new Stage 3 (AIDS) diagnoses and comprised 30% of Georgia's population.
o White/Non-Hispanics accounted for 13% of new Stage 3 (AIDS) diagnoses and comprised 56% of Georgia's population.
o Hispanics/Latinos of all races accounted for 5% of new diagnoses of Stage 3 (AIDS) and comprised 9% of Georgia's population.
Among males, 74% of new Stage 3 (AIDS) diagnoses were attributed to the MSM transmission category.
Among females, 76% of new Stage 3 (AIDS) diagnoses were attributed to the heterosexual contact transmission category.

The overall state rate for new diagnoses of Stage 3 (AIDS) in 2011 was 15 cases per 100,000 population. In 2011, several Health Districts had new diagnoses of Stage 3 (AIDS) rates that exceeded the overall state rate: Clayton (43 per 100,000), DeKalb (41 per 100,000), Fulton (40 per 100,000), East Central (16 per 100,000) and South (16 per 100,000).
TABLES 5 TO 7: PERSONS LIVING WITH HIV INFECTION, GEORGIA, AS OF DECEMBER 31, 2011
There were 47,754 persons living with HIV infection in Georgia as of December 31, 2011.
The majority of persons living with HIV infection were male (74%).
The largest age category for persons living with HIV in Georgia was 40-49 years (34%).
There were racial/ethnic disparities among persons living with HIV infection in Georgia in 2011.
o Black/Non-Hispanics accounted for 65% of persons living with HIV infection and comprised 30% of Georgia's population.
o White/Non-Hispanics accounted for 20% of persons living with HIV infection and comprised 56% of Georgia's population.
o Hispanic/Latinos of all races accounted for 5% of persons living with HIV infection and comprised 9% of Georgia's population.
Among males living with HIV infection in Georgia, 72% of cases were attributed to the MSM transmission category.
Among females living with HIV infection in Georgia, 72% of cases were attributed to the heterosexual contact transmission category.
The overall state prevalence rate for HIV infection in 2011 was 487 cases per 100,000 population. Three Health Districts had HIV prevalence rates that exceeded the overall state rate in 2011: Fulton (1463 per 100,000), DeKalb (1040 per 100,000) and Clayton (642 per 100,000).

6 | Georgia Department of Public Health

TABLES 5 TO 7: PERSONS LIVING WITH STAGE 3 (AIDS), GEORGIA, AS OF DECEMBER 31, 2011
There were 26,109 persons living with Stage 3 (AIDS) in Georgia as of December 31, 2011.
The majority of persons living with Stage 3 (AIDS) of HIV infection were male (76%).
The largest age category of persons living with Stage 3 (AIDS) in Georgia was 40-49 years (38%).
There were racial/ethnic disparities among persons living with Stage 3 (AIDS) in Georgia in 2011
o Black/Non-Hispanics accounted for 67% of persons living with Stage 3 (AIDS) and comprised 30% of Georgia's population.
o White/Non-Hispanics accounted for 21% of persons living with Stage 3 (AIDS) and comprised 56% of Georgia's population.2
o Hispanic/Latinos of all races accounted for 5% of persons living with Stage 3 (AIDS) and comprised 9% of Georgia's population.
Among males living with Stage 3 (AIDS), 71% of cases were attributed to the MSM transmission category.
Among females living with Stage 3 (AIDS), 74% of cases were attributed to the heterosexual contact transmission category.
The overall state prevalence rate for Stage 3 (AIDS) in 2011 was 266 cases per 100,000 population. Three Public Health Districts had HIV prevalence rates that exceeded the overall state rate in 2011: Fulton (838 per 100,000), DeKalb (568 per 100,000) and Clayton (346 per 100,000)
TABLE 8 TO 10: CUMULATIVE DIAGNOSES OF HIV INFECTION, GEORGIA, AS OF DECEMBER 31, 2011
There were 61,975 cumulative diagnoses of HIV infection in Georgia as of December 31, 2011.
The majority (76%) of cumulative HIV cases were among males.
The largest age category at diagnosis for cumulative cases of HIV infection in Georgia was 30-39 years (36%).

There were racial/ethnic disparities among cumulative HIV infections in Georgia in 2011.
o Black/Non-Hispanics accounted for 65% of cumulative HIV infections
o White/Non-Hispanics accounted for 24% of cumulative HIV infections
o Hispanic/Latinos of all races accounted for 4% of cumulative HIV infections
Among male adult/adolescents, 69% of cumulative cases were attributed to the MSM transmission category.
Among female adult/adolescents, 71% of cases were attributed to the heterosexual contact transmission category.
The highest cumulative numbers of diag noses of HIV infection in Georgia were in the Fulton (20,706) and DeKalb (10,377) Health Districts.
TABLE 8 TO 10: CUMULATIVE DIAGNOSES OF STAGE 3 (AIDS), GEORGIA, AS OF DECEMBER 31, 2011
There were 41,090 cumulative diagnoses of Stage 3 (AIDS) in Georgia as of December 31, 2011.
The majority of these cumulative Stage 3 (AIDS) cases were male (78%)
The largest age category at diagnosis for cumulative cases of Stage 3 (AIDS) in Georgia was 30-39 years (40%)
There were racial/ethnic disparities among cumulative Stage 3 (AIDS) cases in Georgia in 2011.
o Black/Non-Hispanics accounted for 66% of cumulative Stage 3 (AIDS) cases
o White/Non-Hispanics accounted for 27% were of cumulative Stage 3 (AIDS) cases
o Hispanic/Latinos of all races accounted for 4% of all Stage 3 (AIDS) cases
Among male adult/adolescents, 67% of cumulative Stage 3 (AIDS) cases were attributed to the MSM transmission category.
Among female adult/adolescents, 70% of cumulative Stage 3 (AIDS) cases were attributed to the heterosexual contact transmission category.

2011 Georgia HIV Infection Surveillance Summary |7

The highest cumulative numbers of diagnoses of Stage 3 (AIDS) in Georgia were in the Fulton (15,397) and DeKalb (6,572) Health Districts.
TABLE 11 AND 12: UNMET NEED BY HIV/AIDS STATUS AND GEOGRAPHIC LOCATION, GEORGIA, 2011
UNMET NEED: Antiretroviral therapy is recommended for persons with HIV infection to reduce the risk of disease progression and transmission of HIV7. In 2011, this recommendation varied by pretreatment CD4 T-cell count (CD4 count) and by transmission risks. The CD4 count serves as the major laboratory indicator of immune function among HIV infected persons. It is used to determine the need for ART initiation, decisions regarding prophylaxis for opportunistic infections and monitoring therapeutic response. Plasma HIV-RNA (viral load or VL) is the most important indicatorof response to ART. Guidelines developed by the Department of Health and Human Services for the use of antiretroviral agents in HIV-1 infected adults and adolescents recommend ongoing monitoring of CD4 count and VL. The guidelines recommend CD4 count measurement every 3-6 months for individual not prescribed ART. After ART initiation, in clinically stable patients with suppressed viral load (<200 copies/ml), the guidelines recommend monitoring CD4 count every 6-12 months. Similarly, the guidelines recommend VL measurement every 3-4 months initially, and in clinically stable ART-adherent patients, every 6 months. Monitoring of CD4 count, VL testing and ART are considered essential components of HIV primary medical care by the HIV/AIDS Bureau (HAB), Health Resources and Service Administration (HRSA).
HAB/HRSA aims to provide for the underserved in response to the HIV/AIDS epidemic's growing impact among underserved minority and
7 Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Available at http://aidsinfo.nih. gov/ContentFiles/AdultandAdolescentGL.pdf. Section accessed [2 October, 2013] It is emphasized that concepts relevant to HIV management evolve rapidly. The Panel has a mechanism to update recommendations on a regular basis, and the most recent information is available on the AIDSinfo website (http://aidsinfo.nih.gov).

hard-to-reach populations through the Ryan White HIV/AIDS Program. The Program works with cities, state and local community based organizations to provide HIV- related services to those who do not have sufficient health care coverage and/or financial resources. Part A of the Ryan White CARE Act specifically provides assistance to Eligible Metropolitan Areas (EMA) of a state. To qualify for an EMA status, an area must have reported at least 2000 AIDS cases in the most recent five years and have a population of at least 50,000. Atlanta's Eligible Metropolitan Area consists of 20 counties surrounding the city of Atlanta. It includes Barrow, Bartow, Carroll, Cherokee, Clayton, Cobb, Coweta, DeKalb, Douglas, Fayette, Forsyth, Fulton, Gwinnett, Henry, Newton, Paulding, Pickens, Rockdale, Spalding and Walton counties. In keeping with the principle of providing for the underserved, jurisdictions annually assess the demographics of HIV/AIDS cases throughout the state, territory, or Eligible Metropolitan Area. This information is used to develop and adapt care systems to respond to the primary medical care needs of emerging populations. Continued Ryan White CARE Act funding requires jurisdictions to identify people living with HIV disease who know their status but are not receiving regular HIV related primary care and supportive services through Ryan White CARE Act programs and other sources.
HRSA defines an individual with HIV or AIDS as having an unmet need for care if he or she is living with HIV/AIDS, is aware of his or her HIV status, and is not receiving any of the following three components of HIV primary medical care during a 12-month time frame: (1) VL testing; (2) CD4 count; or, (3) provision of ART. The Georgia DPH assesses the unmet need by HIV/AIDS status and geographic location annually based on a framework developed by University of California, San Francisco8. At this time, there is no way to determine whether HIV positive cases reported to the Georgia eHARS are aware of their status. Hence for the purpose of unmet need analysis, all cases reported to Georgia DPH are assumed
8 A Practical Guide to Measuring Unmet Need for HIV Related Primary Medical Care: Using the Unmet Need Framework. Fty://ftp.hrsa.gov/hab/ unmetneedpracticalguide.pdf [Accessed September 2013]

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to be aware of their status. Information on provision of ART on cases reported to Georgia eHARS is also not available. Unmet need for HIV primary medical care is therefore defined in Georgia as having no evidence of either: (1) viral load (VL) testing; or, (2) CD4 count during a specified 12 month period. This report provides data on unmet need for HIV primary medical care for the state of Georgia, Atlanta Eligible Metropolitan Area (EMA), and the Georgia non-EMA during January 01, 2011 to December 31, 2011 based on current residence of Georgia and/or counties. Cases with unknown information on current residence by zip code or county but residing in Georgia were assumed to be currently living in the Georgia non-EMA. Hence the unmet need of the Georgia non-EMA may be overestimated compared to the Atlanta EMA and/or Georgia statewide. Data are provided for cases living with a diagnosis of HIV (not AIDS) and AIDS. Data are provided for cases living with a diagnosis of HIV (not AIDS) and AIDS.
UNMET NEED FOR PERSONS LIVING WITH HIV/AIDS, GEORGIA, ATLANTA EMA AND GEORGIA NON-EMA, JANUARY 01 TO DECEMBER 31, 2011:
Persons living with AIDS had a higher number of cases with unmet need as compared to persons living with HIV (not AIDS) in all three geographic locations; Georgia statewide, the Atlanta EMA, and the Georgia non-EMA.
The highest number of cases with unmet need among persons living with HIV disease (i.e., HIV (not AIDS) and AIDS) was seen in the Atlanta EMA (12,285), although the highest percentage of unmet need was seen among persons living with HIV disease in the Georgia non-EMA (50%)
UNMET NEED FOR PERSONS LIVING WITH HIV (NOT AIDS), GEORGIA, JANUARY 01 TO DECEMBER 31, 2011:
Males had a higher percentage of unmet need (47%) than females (46%).
Among adults and adolescents (13 years and older) living with HIV (not AIDS), the highest percentage of unmet need (51%) was in the

25-29 and 30-34 years age groups. There were racial/ethnic disparities among
individuals with unmet need in Georgia in 2011. o Unmet need was found for 51% of Black/
Non-Hispanics, 51% of Hispanic/Latinos, and 44% of White/Non-Hispanics living with HIV (not AIDS) IDU had the highest percentage (57%) of unmet need by transmission category
UNMET NEED FOR PERSONS LIVING WITH AIDS, GEORGIA, JANUARY 01 TO DECEMBER 31, 2011:
Males had a higher percentage of unmet need (45%) than females (40%).
Among adults and adolescents (13 years and older) living with HIV (not AIDS), those age 65 years and older had the highest percentage of unmet need at 60%.
There were racial /ethnic disparities among individuals with unmet need in Georgia in 2011. o Unmet need was found for 54% of White/ Non-Hispanics, 50% of Hispanic/Latinos and 43% of Black/Non-Hispanics living with AIDS
IDU had the highest percentage (60%) of unmet need by transmission category.
UNMET NEED FOR PERSONS LIVING WITH HIV (NOT AIDS), ATLANTA EMA, GEORGIA, JANUARY 01 TO DECEMBER 31, 2011:
Males had a higher percentage of unmet need (43%) than females (42%).
Among adults and adolescents (13 years and older) living with HIV (not AIDS), the 25-29 age group had the highest percent of unmet need at 47%. There were racial /ethnic disparities among individuals with unmet need in the Atlanta EMA, Georgia in 2011. o Unmet need was found for 48% of Black/ Non-Hispanics, 47% of Hispanic/Latinos and 38% of White/Non-Hispanics living

2011 Georgia HIV Infection Surveillance Summary |9

with HIV (not AIDS)
IDU had the highest percentage (55%) of unmet need by transmission category.
UNMET NEED FOR PERSONS LIVING WITH AIDS, ATLANTA EMA, GEORGIA, JANUARY 01 TO DECEMBER 31, 2011:
Males had a higher percentage of unmet need (44%) than females (39%).
Among adults and adolescents (13 years and older) living with AIDS, those aged 65 years and older had the highest percent of unmet need at 62%.
There were racial /ethnic disparities among individuals with unmet need in the Atlanta EMA in 2011. o Unmet need was found for 49% of White/ Non-Hispanics, 48% of Hispanic/Latinos and 43% of Black/Non-Hispanics living with AIDS.
IDU had the highest percentage (60%) of unmet need by transmission category.

UNMET NEED FOR PERSONS LIVING WITH AIDS, ATLANTA EMA AND GEORGIA NON-EMA, JANUARY 01
TO DECEMBER 31, 2011:
Males had a higher percentage of unmet need (48%) than females (42%).
Among adults and adolescents (13 years and older) living with AIDS, those aged of 65 years and older had the highest percentage of unmet need at 56%.
There were racial/ethnic disparities among individuals with unmet need in the Georgia non- EMA in 2011.
o Unmet need was found for 53% of Hispanic/ Latinos, 51% of White/Non-Hispanics and 44% of Black/Non-Hispanics living with AIDS.
IDU had the highest percentage (59%) of unmet need by transmission category.

UNMET NEED FOR PERSONS LIVING WITH HIV (NOT AIDS), GEORGIA NON-EMA, JANUARY 01 TO DECEMBER 31, 2011:
Males had a higher percentage of unmet need (55%) than females (51%).
Among adults and adolescents (13 years and older) living with HIV (not AIDS) the 30-34 years age group had the highest percent of unmet need at 60%.
There were racial /ethnic disparities among individuals with unmet need in the Georgia non-EMA in 2011.
o Unmet need was found among 58% of Hispanic/Latinos, 54% of Black/ Non-Hispanics and 53% of White/ Non-Hispanics living with HIV (not AIDS).
IDU had the highest percentage (59%) of unmet need by transmission category.

10 | Georgia Department of Public Health

Table 1 | Distribution of the General Population1 by Race/Ethnicity, Georgia, 2011

Race/Ethnicity

Number1 (%)

White, Non-Hispanic

5,450,015(56)

Black, Non-Hispanic

2,967,493(30)

Hispanic / Latino, Any Race
Asian, Non-Hispanic
American Indian / Alaskan Native, Non-Hispanic
Native Hawaiian / Pacific Islander, Non-Hispanic
Multiracial / Other, Non-Hispanic
Total

892,010(9) 327,613(3) 22,464(<1) 5,894(<1) 149,721(2)
9,815,210

1 Population estimates are based on data obtained from Georgia Department of Public Health, Office of Health Indicators for Planning (OHIP)
2011 Georgia HIV Infection Surveillance Summary |11

Table 2 | Diagnoses of HIV infection and Stage 3 (AIDS) of HIV infection
by sex, age, race/ethnicity, Georgia, January 01, 2011 to December 31, 2011

HIV infection

Stage 3 (AIDS)

Sex Male Female Unknown

Count 2,325 681
17

Percent1 77% 23% <1%

Count 1,073 395
11

Percent 73% 27% <1%

Age at Diagnosis (years) <13 13-19 20-24 25-29 30-39 40-49 50-59 60+

Count 17 142 543 454 689 652 402 124

Race/Ethnicity Black/Non-Hispanic White/Non-Hispanic Hispanic/Latino, Any Race American Indian/Alaska Native Asian/Native Hawaiian/Pacific Islander Multiple races Unknown
Total

Count 1,699 295 154
1 20 47 807
3,023

Percent <1% 5% 18% 15% 23% 22% 13% 4%
Percent 56% 10% 5% <1% <1% 2% 27%

Count 0 29
142 195 371 447 230 65
Count 1,036 195
77 0 6 40 125
1,479

Percent 0 2%
10% 13% 25% 30% 16% 4%
Percent 70% 13% 5% 0 <1% 3% 8%

1 Total percentages may not add up to 100% due rounding and represent the percentage of the total
12 | Georgia Department of Public Health

Table 3 | Diagnoses of HIV infection and Stage 3 (AIDS) by sex and transmission category1,
Georgia, January 01, 2011 to December 31, 2011

HIV infection

Stage 3 (AIDS)

Male adult or adolescent MSM4 IDU5 MSM & IDU6 Heterosexual7 Other8 Subtotal

Unadjusted Estimates

Adjusted2 Estimates

Unadjusted Estimates

Adjusted Estimates

Count Percent3 Count Percent Count Percent Count Percent

775

33% 1,471 64%

455

42% 789 74%

20

1%

73

3%

29

3%

69

6%

12

1%

39

2%

19

2%

38

4%

34

1%

108

5%

29

3%

88

8%

1,475 64% 625 27%

539 50%

87

8%

2,316

2,316

1,071

1,071

Female adult or adolescent IDU Heterosexual Other9 Subtotal

Count Percent Count Percent Count Percent Count Percent

19

3%

83

12%

17

4%

64

16%

54

8%

427 63%

54

14% 296 76%

601

89% 164 24% 319 82%

30

8%

674

674

390

390

Child (<13 years at diagnosis) Perinatal10 Other11 Subtotal
Total

Count Percent

8

47%

9

53%

17

3,023

Count Percent

3

38%

5

63%

8

1,479

1 New diagnoses of HIV infection with no information on birth sex and date of birth were excluded from the table, so subtotals may not add up to the totals 2 Adjusted estimates resulted from multiple imputation , a statistical adjustment that accounted for missing risk factor information but not for incomplete reporting 3 Total percentages may not add up to 100% due to rounding and represent the percentage of the subtotal 4 MSM: Male-to-male sexual contact 5 IDU: Injection drug use 6 MSM & IDU: Male-to-male sexual contact and injection drug use 7 Defined as sexual contact with someone of the opposite sex with known risk such as injection drug use, bisexual male (applies to females only),
person with hemophilia/coagulation disorder, transfusion recipient with HIV documentation, and /or person with AIDS or documented HIV 8 Includes hemophilia , blood transfusion, perinatal exposure and risk factor not reported 9 Includes hemophilia , blood transfusion, perinatal exposure and risk factor not reported 10 Perinatal: Includes cases born to HIV/AIDS positive mother 11 Includes hemophilia, blood transfusion and risk factor not reported

2011 Georgia HIV Infection Surveillance Summary |13

Table 4 | Diagnoses of HIV infection and Stage 3 (AIDS) of HIV infection by Public Health
District of residence at diagnosis, Georgia, 2011

Public Health Districts

HIV infection

Stage 3 (AIDS)

1-1 Northwest (Rome) 1-2 North Georgia (Dalton) 2 North (Gainesville) 3-1 Cobb-Douglas 3-2 Fulton 3-3 Clayton (Jonesboro)

Count 48 29 37 200 754 207

Rate1 7 7 6 24 79 79

Count 24 10 26 94 384 113

Rate 4 2 4 11 40 43

3-4 East Metro (Lawrenceville) 3-5 DeKalb 4 LaGrange 5-1 South Central (Dublin) 5-2 North Central (Macon) 6 East Central (Augusta) 7 West Central (Columbus) 8-1 South (Valdosta) 8-2 Southwest (Albany) 9-1 Coastal (Savannah) 9-2 Southeast (Waycross) 10 Northeast (Athens) Unknown Health District

156

15

52

5

552

79

287

41

117

14

53

7

28

18

9

6

108

21

72

14

106

23

74

16

115

31

47

13

79

31

41

16

106

30

36

10

144

25

81

14

59

16

25

7

50

11

31

7

128

20

Total

3,023

31

1,479

15

1 Rates are calculated as number of cases per 100, 000 population and are based on population data retrieved from the Georgia Department of Public Health, Office of Health Indicators for Planning (OHIP)
14 | Georgia Department of Public Health

Table 5 | Persons living with a diagnoses of HIV infection and Stage 3 (AIDS) of HIV infection
by sex, age and race/ethnicity, Georgia, as of December 31, 2011

HIV infection

Stage 3 (AIDS)

Sex Male Female Unknown

Count 35,410 12,067
277

Percent1 74% 25% <1%

Count 19,805 6,214
90

Percent 76% 24% <1%

Age at Diagnosis (years) <13 13-19 20-24 25-29 30-39 40-49 50-59 60+ Missing

Count 181 409 2,126 3,793 9,778
16,214 11,228 4,001
24

Race/Ethnicity Black/Non-Hispanic White/Non-Hispanic Hispanic/Latino, Any Race American Indian/Alaska Native Asian/Native Hawaiian/Pacific Islander Multiple races Unknown
Total

Count
30,937 9,539 2,338
26 171 1,257 3,486
47,754

Percent <1% <1% 4% 8% 20% 34% 24% 8% <1%
Percent 65% 20% 5% <1% <1% 3% 7%

Count 20 127 523
1,196 4,495 9,827 7,246 2,673
2
Count 17,436 5,608 1,360
13 75 787 830
26,109

Percent <1% <1% 2% 5% 17% 38% 28% 10% <1%
Percent 67% 21% 5% <1% <1% 3% 3%

1 Total percentages may not add up to 100% due to rounding and represent the percentage of the total
2011 Georgia HIV Infection Surveillance Summary |15

Table 6 | Persons living with a diagnosis of HIV Infection and Stage 3 (AIDS)
by sex and transmission category1, Georgia as of December 31, 2011

HIV infection

Stage 3 (AIDS)

Male adult or adolescent MSM IDU MSM & IDU Heterosexual Other4 Subtotal

Unadjusted Estimates

Adjusted Estimates2

Unadjusted Estimates

Adjusted Estimates

Count Percent3 Count Percent Count Percent Count Percent

17,782 1,763 1,504 1,602 12,645 35,296

50% 25,430 72% 5% 2,635 7% 4% 2,049 6% 5% 2,482 7% 36% 2,700 8%
35,296

10,531 1,370 1,079 1,177 5,562 19,719

53% 13,964 71%

7% 1,954 10%

5% 1,357 7%

6% 1,786 9%

29% 659

4%

19,720

Female adult or adolescent IDU Heterosexual Other5 Subtotal

Count Percent Count Percent Count Percent Count Percent

1,075 9% 2,502 21%

733

12% 1,426 23%

3,079 26% 8,597 72% 1,963 31% 4,510 74%

7,823 65% 878

7% 3,409 57% 169

3%

11,977

11,977

6,105

6,105

Child (<13 years at diagnosis) Perinatal Other6 Subtotal
Total

Count Percent

111 54%

94

46%

205

47,754

Count Percent

221 86%

36

14%

257

26,109

1 Persons living with HIV infection and Stage 3 (AIDS) with no information on birth sex and date of birth were excluded from the table, so subtotals may not add up to the totals
2 Adjusted estimated resulted from multiple imputation, a statistical adjustment that accounted for missing risk factor information but not for incomplete reporting
3 Total percentages may not add up to 100% due to rounding and represent the percentage of the subtotal 4 Includes hemophilia, blood transfusion, perinatal exposure and risk factor not reported 5 Includes hemophilia, blood transfusion, perinatal exposure and risk factor not reported 6 Includes hemophilia, blood transfusion and risk factor not reported
16 | Georgia Department of Public Health

Table 7 | Persons living with a diagnosis of HIV Infection and Stage 3 (AIDS)
of HIV infection by Public Health District of residence at diagnosis, Georgia, 2011

Public Health Districts

HIV infection

Stage 3 (AIDS)

1-1 Northwest (Rome) 1-2 North Georgia (Dalton) 2 North (Gainesville) 3-1 Cobb-Douglas 3-2 Fulton 3-3 Clayton (Jonesboro)

Count 768 483 564 2,782
13,890 1,678

Rate1 120 109 90 335 1,463 642

Count 446 266 302 1,483 7,962 906

Rate 70 60 48 178 838 346

3-4 East Metro (Lawrenceville) 3-5 DeKalb 4 LaGrange 5-1 South Central (Dublin) 5-2 North Central (Macon) 6 East Central (Augusta) 7 West Central (Columbus) 8-1 South (Valdosta) 8-2 Southwest (Albany) 9-1 Coastal (Savannah) 9-2 Southeast (Waycross) 10 Northeast (Athens) Unknown Health District

2,758

273

1,459

144

7,280

1,040

3,978

568

1,447

179

823

102

608

395

294

191

1,739

332

953

182

2,011

433

1,143

246

1,516

405

730

195

945

368

464

181

1,276

358

706

198

2,404

414

1,393

240

1,031

280

566

154

714

154

413

89

3,860

1,822

Total

47,754

487

26,109

266

1 Rates are calculated as number of cases per 100, 000 population and are based on population data retrieved from the Georgia Department of Public Health, Office of Health Indicators for Planning (OHIP)
2011 Georgia HIV Infection Surveillance Summary |17

Table 8 | Cumulative diagnoses with HIV Infection and Stage 3 (AIDS) of HIV infection
by sex, age, race/ethnicity, Georgia, as of December 31, 2011

HIV infection

Stage 3 (AIDS)

Sex Male Female Unknown

Count 47,316 14,446
213

Percent 76% 23% <1%

Count 32,249 8,768
73

Percent 78% 21% <1%

Age at Diagnosis (years) <13 13-19 20-24 25-29 30=39 40-49 50-59 60+ Missing

Count 560 1,883 6,684 9,842
22,143 14,038 5,185 1,620
20

Race/Ethnicity Black/Non-Hispanic White/Non-Hispanic Hispanic/Latino, Any Race American Indian/Alaska Native Asian/Native Hawaiian/Pacific Islander Multiple races Unknown
Total

Count 40,490 14,904 2,382
29 179 1,255 2,736
61,975

Percent <1% 3% 11% 16% 36% 23% 8% 3% <1%
Percent 65% 24% 4% <1% <1% 2% 4%

Count 243 414 2,206 5,527
16,366 11,197 3,886 1,249
2
Count 27,018 11,019 1,482
18 96 808 649
41,090

Percent <1% 1% 5% 13% 40% 27% 9% 3% <1%
Percent 66% 27% 4% <1% <1% 2% 2%

18 | Georgia Department of Public Health

Table 9 | Cumulative diagnoses of HIV Infection and Stage 3 (AIDS) of HIV infection
by sex and transmission category1, Georgia as of December 31, 2011

HIV infection

Stage 3 (AIDS)

Male adult or adolescent MSM IDU MSM & IDU Heterosexual Other4 Subtotal

Unadjusted Estimates

Adjusted Estimates2

Unadjusted Estimates

Adjusted Estimates

Count Percent3 Count Percent Count Percent Count Percent

24,024 51% 32,620 69% 17,334 54% 21,605 67%

4,074 9% 5,418 12% 3,596 11% 4,587 14%

2,397 5% 3,046 6% 1,926 6% 2,294 7%

2,512 5% 3,764 8% 2,038 6% 2,952 9%

14,024 30% 2,183 5% 7,208 22% 664 2%

47,031

47,031

32,102

32,102

Female adult or adolescent IDU Heterosexual Other5 Subtotal

Count
1,801 4,069 8,289 14,159

Percent Count Percent
13% 3,489 25% 29% 10,078 71% 59% 592 4%
14,159

Count
1,432 3,016 4,170 8,618

Percent
17% 35% 48%

Count
2,364 6,067 187 8,618

Percent
27% 70% 2%

Child (<13 years at diagnosis) Perinatal Other6 Subtotal Total

Count
430 132 562 61,975

Percent
77% 23%

Count Percent
259 88% 37 13% 296 41,090

1 Cumulative cases with no information on birth sex and date of birth were excluded from the table , so subtotals may not add up to the totals 2 Estimated numbers resulted from multiple imputation , a statistical adjustment that accounted for missing risk factor information
but not for incomplete reporting 3 Total percentages may not add up to 100% due to rounding and represent the percentage of the subtotal 4 Includes hemophilia, blood transfusion, perinatal exposure and risk factor not reported 5 Includes hemophilia, blood transfusion, perinatal exposure and risk factor not reported 6 Includes hemophilia, blood transfusion and risk factor not reported
2011 Georgia HIV Infection Surveillance Summary |19

Table 10 | Cumulative diagnoses with HIV infection and Stage 3 (AIDS) of HIV Infection by
Public Health District of residence at diagnosis, Georgia, as of December 31, 2011

Public Health Districts

HIV infection

Stage 3 (AIDS)

1-1 Northwest (Rome) 1-2 North Georgia (Dalton) 2 North (Gainesville) 3-1 Cobb-Douglas 3-2 Fulton 3-3 Clayton (Jonesboro)

Count 953 630 659 3,117
20,706 2,364

Count 595 391 431 1,940
15,397 1,384

3-4 East Metro (Lawrenceville) 3-5 DeKalb 4 LaGrange 5-1 South Central (Dublin) 5-2 North Central (Macon) 6 East Central (Augusta) 7 West Central (Columbus) 8-1 South (Valdosta) 8-2 Southwest (Albany) 9-1 Coastal (Savannah) 9-2 Southeast (Waycross) 10 Northeast (Athens) Unknown Health District

2,489 10,377 2,073
698 2,663 2,937 2,209 1,253 2,151 3,443 1,281 990 982

1,494 6,572 1,267 378 1,670 2,009 1,358 701 1,466 2,296 831 680 230

Total

61,975

41,090

20 | Georgia Department of Public Health

Table 11 | Quantified Estimate of Unmet Need for HIV Primary Care, Georgia, Atlanta EMA1,
Georgia non-EMA, 2011

Population

Atlanta EMA1 Georgia non-EMA

Row

Population

Cases

Cases

Cases

Row A.

Number of persons living with AIDS (PLWA) as of 12/31/2011

25,709

16,625

9,084

Row B.

Number of persons living with HIV 19,818 (PLWH)/not AIDS as of 12/31/2011

12,058

7,760

Row C.

Total number of persons living with HIV Disease as of 12/31/2011

45,527

28,683

16,844

Care Patterns

Cases

Cases

Cases

Row D.

Number of persons living with AIDS (PLWA) who received the specified HIV primary medical care during the 12-month period, 01/01/2011 to 12/31/2011

14,394

9,483

4,911

Row E.

Number of persons living with HIV (PLWH)/not AIDS who received the specified HIV primary medical care during the 12-month period, 01/01/2011 to 12/31/2011

10,506

6,915

3,591

Row F.

Total number of persons living with HIV Disease who received the specified HIV primary medical care during the 12-month period , 01/01/2011 to 12/31/2011

24,900

16,398

8,502

Calculated Results

Cases Percent Cases Percent Cases Percent

Row G.

Number of persons living with AIDS (PLWA) who did not receive the specified HIV primary medical 11,315 44 7,142 43 4,173 46 care during the 12 -month period 01/01/2011 to 12/31/2011

Row H.

Number of persons living with HIV (PLWH)/not AIDS who did not receive the specified HIV primary 9,312 47 5,143 43 4,169 54 medical care during the 12-month period 01/01/2011 to 12/31/2011

Row I.

Total number of persons living with HIV disease who did not receive the specified HIV pri- 20,627 45 12,285 43 8,342 50 mary medical care during the 12-month period 01/01/2011 to 12/31/2011

1 EMA stands for Eligible Metropolitan Area

2011 Georgia HIV Infection Surveillance Summary |21

Table 12 | Characteristics of estimates of unmet need for HIV primary care, Georgia,
January 01, 2011 to December 31, 2011

HIV (not AIDS)

AIDS

Total

Sex

Count

Percent1

Count

Percent

Count

Percent

Male

6,750

47

8,827

45

15,577

46

Female

2,551

46

2,486

40

5,037

43

Subtotal2

9,301

11,313

20,614

Age in years <2 2-12 13-17 18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Subtotal

Count <5 85 38 721
1,175 1,255 1,141 1,332 1,328 1,026 630 327 228 9,286

Percent <5 63 35 45 51 51 49 46 44 44 45 46 45

Count <5 6 13 143 371 669 978
1,723 2,460 2,030 1,399 856 664 11,312

Percent <5 30 25 25 32 37 38 41 45 46 50 55 60

Count <5 91 51 864
1,546 1,924 2,119 3,055 3,788 3,056 2,029 1,183 892 20,598

Percent <5 59 31 40 44 45 44 43 44 46 48 52 55

Race/Ethnicity Black/Non Hispanic White/Non Hispanic Hispanic/Latino, Any Race Other3 Unknown Subtotal

Count 6,554 1,703 448 199 408 9,312

Percent 51 44 51 40 24

Count 7,554 2,791 646 229
95 11,315

Percent 43 50 50 30 15

Count 14,108 4,494 1,094
428 503 20,627

Percent 47 47 50 34 22

Transmission Category

Count

Percent

Count

Percent

Count

MSM

3,187

47

4,837

47

8,024

IDU

391

57

1,224

60

1,615

MSM&IDU

186

48

548

53

734

Heterosexual

657

43

1,478

47

2,135

Other4

86

41

117

47

203

NIR/NRR5

4,805

47

3,111

35

7,916

Subtotal

9,312

11,315

20,627

1 Percentages are row percentages. The denominators for these percents are persons living with HIV disease in the specified group. 2 Subtotals may not be equal due to missing information for sex and age 3 Other includes Non-Hispanic Asian, American Indian/Alaskan Native, Native Hawaiian/Pacific Islander, Multiracial 4 Includes hemophilia, blood transfusion, transplant and pediatric transmission 5 NIR/NRR includes cases with ` no identified risk or no risk reported'
22 | Georgia Department of Public Health

Percent 47 59 51 46 44 41

Table 13 | Characteristics of estimates of unmet need for HIV primary care, Atlanta EMA1,
Georgia, January 01, to December 31, 2011

HIV (not AIDS)

AIDS

Total

Sex

Count

Percent2

Count

Percent

Count

Percent

Male

3,963

43

5,842

44

9,805

44

Female

1,176

42

1,299

39

2,475

40

Subtotal3

5,139

7,141

12,280

Age in years <2 2-12 13-17 18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Subtotal

Count <5 24 24 424 688 718 623 739 750 540 320 164 116
5,130

Percent <5 41 33 43 47 46 43 41 40 41 40 40 43

Count <5 6 8 77 218 411 592
1,071 1,592 1,316 889 566 394 7,140

Percent <5 40 22 22 28 34 36 39 44 46 50 58 62

Count <5 30 32 501 906
1,129 1215 1,810 2,342 1,856 1,209 730 510 12,270

Percent <5 41 29 38 40 41 39 40 43 45 47 53 56

Race/Ethnicity Black/Non Hispanic White/Non Hispanic Hispanic/Latino, Any Race Other4 Unknown Subtotal

Count 3,669 848 289 132 205 5,143

Percent 48 38 47 38 16

Count 4,778 1,732 431 158
43 7,142

Percent 43 49 48 29 9

Count 8,447 2,580 720 290 248 12,285

Percent 45 45 48 32 14

Transmission Category

Count

Percent

Count

Percent

Count

Percent

MSM

2,088

44

3,463

46

5,551

45

IDU

210

55

791

60

1,001

59

MSM&IDU

142

51

416

54

558

53

Heterosexual

258

42

667

48

925

46

Other5

51

38

69

46

120

42

NIR/NRR6

2,394

40

1,736

32

4,130

36

Subtotal

5,143

7,142

12,285

1 Atlanta EMA stands for Atlanta Eligible Metropolitan Area

2 Percentages are row percentages. The denominators for these percents are persons living with HIV disease in the specified group.

3 Subtotals may not be equal due to missing information for sex and age

4 Other includes Non-Hispanic Asian, American Indian/Alaskan Native, Native Hawaiian/Pacific Islander, Multiracial

5 Includes hemophilia, blood transfusion, transplant and pediatric transmission

6 NIR/NRR, includes cases with `no identified risk or no risk reported'

2011 Georgia HIV Infection Surveillance Summary |23

Table 14 | Characteristics of estimates of unmet need for HIV primary care,
Georgia non-EMA , 2011

HIV (not AIDS)

AIDS

Total

Sex

Count

Percent1

Count

Percent

Count

Percent

Male

2,787

55

2,985

48

5,772

51

Female

1,375

51

1,187

42

2,562

47

Subtotal2

4,162

4,172

8,334

Age in years <2 2-12 13-17 18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Subtotal

Count
<5 61 14 297 487 537 518 593 578 486 310 163 112
4,156

Percent <5 81 38 47 57 60 59 55 50 49 52 53 47

Count <5 0 5 66 153 258 386 652 868 714 510 290 270
4,172

Percent <5 0 31 32 38 43 43 45 46 46 49 50 56

Count <5 61 9 363 640 795 904
1,245 1,446 1200 820 453 382 8,318

Percent <5 76 36 43 51 53 51 49 48 47 50 51 53

Race/Ethnicity Black/Non Hispanic White/Non Hispanic Hispanic/Latino, Any Race Other3 Unknown Subtotal

Count 2,885 855 159
67 203 4,169

Percent 54 53 58 45 45

Count 2,776 1,059 215
71 52 4,173

Percent 44 51 53 34 30

Count 5,661 1,914 374 138 255 8,342

Percent 49 52 55 39 41

Transmission Category

Count

Percent

Count

Percent

Count

MSM

1,099

55

1,374

49

2,473

IDU

181

59

433

59

614

MSM&IDU

44

37

132

49

176

Heterosexual

399

44

811

46

1,210

Other4

35

46

48

48

83

NIR/NRR5

2,411

55

1,375

40

3,786

Subtotal

4,169

4,173

8,342

1 Percentages are row percentages. The denominators for these percents are persons living with HIV disease in the specified group. 2 Subtotals may not be equal due to missing information 3 Other includes non Hispanic Asian, American Indian/Alaskan Native, Native Hawaiian/Pacific Islander, Multiracial 4 Includes hemophilia, blood transfusion, transplant and pediatric transmission 5 NIR/NRR includes cases with `no identified or no reported risk'
24 | Georgia Department of Public Health

Percent 52 59 46 46 47 48

HIV/AIDS Resources:
Georgia Department of Public Health
http://dph.georgia.gov/what-hiv-and-aids
Centers for Disease Control and Prevention
http://www.cdc.gov/hiv/
AIDSVu
http://aidsvu.org/
Reporting All health care providers diagnosing and/or providing care to a patient with HIV are required by Georgia law (O.C.G.A. 31-12-1) to report HIV infection using the HIV/AIDS Case Report Form Case report forms should be completed within seven (7) days of diagnosing a patient with HIV and/or AIDS or within seven (7) days of assuming care of an HIV positive patient who is new to the provider, regardless of whether the patient has previously received care elsewhere Adult and Pediatric case report forms are available at http://dph.georgia.gov/reporting-forms-data-requests For more questions on HIV case reporting in Georgia please contact the HIV Surveillance Coordinator at 1-800-827-9769
2011 Georgia HIV Infection Surveillance Summary |25

FOR MORE INFORMATION CONTACT:
Georgia Department of Public Health HIV/AIDS Epidemiology Program
https://dph.georgia.gov/hiv-care-continuum