HIV Surveillance Summary, Georgia, 2012
HIV/AIDS EPIDEMIOLOGY SECTION EPIDEMIOLOGY PROGRAM DIVISION of HEALTH PROTECTION GEORGIA DEPARTMENT of PUBLIC HEALTH

This HIV Surveillance Summary, Georgia, 2012 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, 2012 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, 2012, 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, 2012.. . . . . . . . . . . . . . . . . 11

Table 2 | Diagnoses of HIV infection and Stage 3 (AIDS) by sex, age, race/ethnicity, Georgia, January 01, 2012 to December 31, 2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Table 3 | Diagnoses of HIV infection and Stage 3, AIDS by transmission category and sex, Georgia, January 01, 2012 to December 31, 2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Table 4 | Diagnoses of HIV infection and Stage 3 (AIDS) by public health district, Georgia, January 01, 2012 to December 31, 2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Table 5 | Persons living with HIV infection and Stage 3 (AIDS) by sex, age, race/ethnicity, Georgia, through December 31, 2012.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Table 6 | Persons living with HIV infection and Stage 3 (AIDS) by transmission category and sex, Georgia, through December 31, 2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Table 7 | Persons living with HIV infection and Stage 3 (AIDS) by public health district, Georgia, as of December 31, 2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Table 8 | Cumulative diagnoses of HIV infection and Stage 3 (AIDS) by sex, age, race/ethnicity, Georgia, as of December 31, 2012.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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, 2012. . . . . . . . . . . . . . . . . . . . 19

Table 10 | Cumulative diagnoses of HIV infection and Stage 3 (AIDS) by public health district, Georgia, as of December 31, 2012.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Table 11 | Quantified estimates of unmet need for HIV primary care, Georgia, Atlanta EMA, Georgia non-EMA, 2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Table 12 | Characteristics of estimates of unmet need for HIV primary care, Georgia, 2012. . . . . . . . . 22

Table 13 | Characteristics of estimates of unmet need for HIV primary care, Atlanta EMA, Georgia, 2012. . . 23

Table 14 | Characteristics of estimates of unmet need for HIV primary care, Georgia non-EMA, 2012. . . . . 24

2012 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, 2012, the prevalence rate of HIV infection in Georgia (508 per 100,000) was almost twice 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 adolescents.2 There were 2,911 new diagnoses of HIV infection in 2012 in Georgia. The majority of these cases were among males (78%). The highest percentage of new HIV diagnoses was seen among those aged 40 to 49 years (23%), and the highest percentage of Stage 3 (AIDS) was among those aged 30-39 years (28%). Among all races/ethnicities, Black/non-Hispanics accounted for the majority of the diagnoses; 55% 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 factors.
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]

Sixty-three percent (1,423) of new HIV infections among males in 2012 were attributed to male to male sexual (MSM) contact. Among women, 61% (387) of new HIV infections were attributed to heterosexual contact (HET).
As of December 31, 2012, there were 50,436 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 (64%) and males (74%). Seventy-two percent (26,735) of HIV cases among males were attributed to the MSM transmission category and 72% (8,929) of cases among females were attributed to heterosexual contact.
Every year, Georgia Department of Public Health (DPH) assesses the unmet need for HIV primary care in the 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 needs.
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, and 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 Sates, 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.

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 the pediatric (age less than 13 years) 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

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 2012, 71% 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

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, 2012 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)" comprise persons with current residence in the state of Georgia
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)

2012 Georgia HIV Infection Surveillance Summary |3

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, 2012 to December 31, 2012 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, 2012.
CUMULATIVE DIAGNOSES of HIV infection and Stage 3 (AIDS) are cases who were reported to the Georgia DPH and diagnosed as of December 31, 2012 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 from selecting,
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 the presumed hierarchical order of probability, the one risk factor most likely to have been responsible for transmission. For surveillance purposes, HIV and AIDS cases 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.

4 | Georgia Department of Public Health

RATES: Denominators for population rates are based on the 2012 estimates of the resident population retrieved from the Georgia 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, 2012 to December 31, 2012 among HIV positive persons reported to the Georgia eHARS.
PERCENTAGES: Total percentages may not add up to 100% due to rounding and represent the percentage of the total.
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 underestimation of the impact of HIV in 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, transmission category, 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 may limit accurate estimation of unmet need for the state of Georgia and the Atlanta EMA.

Highlights of Analyses
TABLE 1: ESTIMATES AND DISTRIBUTION OF THE GENERAL POPULATION BY RACE/ETHNICITY, GEORGIA, 2012
There were an estimated 9,919,945 persons living in Georgia in 2012
Of these individuals, the majority were White, Non-Hispanic (55%)
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%).
TABLES 2 TO 4: NEW DIAGNOSES OF HIV INFECTION, GEORGIA, JANUARY 01, 2012 TO DECEMBER 31, 2012
There were 2,911 persons with new diagnoses of HIV infection in Georgia during 2012.
The majority of the new HIV diagnoses were among males (78%).
Persons aged 40-49 years at the time of diagnosis represented the largest age group (23%) for new diagnoses of HIV infection in Georgia during 2012.
There were racial/ethnic disparities among persons with new diagnoses of HIV infection in Georgia in 2012. o Black/Non-Hispanics accounted for 55% of new HIV infection diagnoses and comprised 30% of Georgia's population. o White/Non-Hispanics accounted for 11% of new HIV infection diagnoses and comprised 55% of Georgia's population. o Hispanics/Latinos of all races accounted for 4% 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.

2012 Georgia HIV Infection Surveillance Summary |5

Using multiple imputation, 63% of HIV infections diagnosed in 2012 among males in Georgia were attributed to the MSM transmission category.
Among women, 61% of HIV infections diagnosed in 2012 were attributed to
heterosexual contact.
The overall state rate for new diagnoses of HIV infection in 2012 was 29 cases per 100,000 population. In 2012, several Health Districts had newly diagnosed HIV infection rates that exceeded the overall state rate: DeKalb (75 per 100,000), Fulton (69 per 100,000) and Clayton (69 per 100,000).
TABLES 2 TO 4: NEW DIAGNOSES OF STAGE 3 (AIDS), GEORGIA, JANUARY 01 TO DECEMBER 31, 2012
There were 1,370 persons with new diagnoses of Stage 3 (AIDS) in Georgia during 2012.
The majority of the new diagnoses with Stage 3 (AIDS) were among males (76%).
Persons aged 30-39 years at the time of diagnosis represented the largest age group (28%) for new diagnoses of Stage 3 (AIDS) in Georgia during 2012.
There were racial/ethnic disparities among persons with new diagnoses of Stage 3 (AIDS) in Georgia in 2012.
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 11% of new Stage 3 (AIDS) diagnoses and comprised 55% 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, 76% of new Stage 3 (AIDS) diagnoses were attributed to the MSM transmission category.
Among females, 74% 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 2012 was 14 cases per 100,000 population. In 2012, several Health Districts had new diagnoses of Stage 3 (AIDS) rates that exceeded the overall state rate: DeKalb (39 per 100,000), Fulton (37 per 100,000), Clayton (37 per 100,000), South (16 per 100,000) and East Central (15 per 100,000).
TABLES 5 TO 7: PERSONS LIVING WITH HIV INFECTION, GEORGIA, AS OF DECEMBER 31, 2012
There were 50,436 persons living with HIV infection in Georgia as of December 31, 2012.
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 (32%).
There were racial/ethnic disparities among persons living with HIV infection in Georgia in 2012.
o Black/Non-Hispanics accounted for 64% of persons living with HIV infection and comprised 30% of Georgia's population.
o White/Non-Hispanics accounted for 19% of persons living with HIV infection and comprised 55% 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 2012 was 508 cases per 100,000 population. Three Health Districts had HIV prevalence rates that exceeded the overall state rate in 2012: Fulton (1489 per 100,000), DeKalb (1093 per 100,000) and Clayton (684 per 100,000).

6 | Georgia Department of Public Health

TABLES 5 TO 7: PERSONS LIVING WITH STAGE 3 (AIDS), GEORGIA, AS OF DECEMBER 31, 2012
There were 27,218 persons living with Stage 3
(AIDS) in Georgia as of December 31, 2012.
The majority of persons living with Stage 3 (AIDS) were male (76%).
The largest age category of persons living with Stage 3 (AIDS) in Georgia was 40-49 years (35%).
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 55% 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 274 cases per 100,000 population. Two Health Districts had HIV prevalence rates that exceeded the overall state rate in 2012: Fulton (844 per 100,000), Clayton (365 per 100,000) and DeKalb (592 per 100,000).
TABLE 8 TO 10: CUMULATIVE DIAGNOSES OF HIV INFECTION, GEORGIA, AS OF DECEMBER 31, 2012
There were 64,886 cumulative diagnoses of HIV infection in Georgia as of December 31, 2012.
The majority (76%) of cumulative HIV cases were male.
The largest age category at diagnosis for cumulative cases of HIV infection in Georgia was 30-39 years (35%).

There were racial/ethnic disparities among cumulative HIV infections in Georgia in 2012.
o Black/Non-Hispanics accounted for 65% of cumulative HIV infections
o White/Non-Hispanics accounted for 23% 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 diagnoses of HIV infection in Georgia were in the Fulton (21,385) and DeKalb (10,907) Health Districts.
TABLE 8 TO 10: CUMULATIVE DIAGNOSES OF STAGE 3 (AIDS), GEORGIA, AS OF DECEMBER 31, 2012
There were 42,460 cumulative diagnoses of Stage 3 (AIDS) in Georgia as of December 31, 2012.
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 (39%).
There were racial/ethnic disparities among cumulative Stage 3 (AIDS) cases in Georgia in 2012.
o Black/Non-Hispanics accounted for 66% of cumulative Stage 3 (AIDS) cases
o White/Non-Hispanics accounted for 26% 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, 68% of cumulative stage 3 (AIDS) cases were attributed to the MSM transmission category.
Among female adults/adolescents, 71% of cumulative Stage 3 (AIDS) cases were attributed to the heterosexual contact transmission category.

2012 Georgia HIV Infection Surveillance Summary |7

The highest cumulative numbers of diagnoses of Stage 3 (AIDS) in Georgia were in the Fulton (15,762) and DeKalb (6,851) Health Districts.
TABLE 11 AND 12: UNMET NEED BY HIV/AIDS STATUS AND GEOGRAPHIC LOCATION, GEORGIA, 2012
UNMET NEED: Antiretroviral therapy is recommended for persons with HIV infection to reduce the risk of disease progression and transmission of HIV.7 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-1 RNA (viral load or VL) is the most important indicator of response to ART. The 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 individuals 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 ARTadherent 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 hard-to-reach populations through the Ryan
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).

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 to be aware of their status. Information on provision
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]

8 | Georgia Department of Public Health

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, 2012 to December 31, 2012 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 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, 2012 TO DECEMBER 31, 2012:
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 (14,691), although the highest percentage of unmet need was seen among persons living with HIV disease in the Georgia non-EMA (47%).
UNMET NEED FOR PERSONS LIVING WITH HIV (NOT AIDS), GEORGIA, JANUARY 01, 2012 TO DECEMBER 31, 2012:
Females had a higher percentage of unmet need (48%) than males (47%).
Among adults and adolescents (13 years and older) living with HIV (not AIDS), the highest percentage of unmet need was in the 25-29 years age group (54%).

There were racial/ethnic disparities among individuals with unmet need in Georgia in 2012. o Unmet need was found for 51% of Black/ Non-Hispanics, 50% of Hispanic/Latinos and 41% of White/Non-Hispanics living with HIV (not AIDS)
IDU had the highest percentage (53%) of unmet need by transmission category.
UNMET NEED FOR PERSONS LIVING WITH AIDS, GEORGIA, JANUARY 01, 2012 TO DECEMBER 31, 2012:
Males had a higher percentage of unmet need (43%) than females (39%).
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 59%.
There were racial/ethnic disparities among individuals with unmet need in Georgia in 2012. o Unmet need was found for 48% of Hispanic/Latinos, 47% of White/NonHispanics, and 41% of Black/Non-Hispanics living with AIDS
Injection drug users (IDU) had the highest percentage (58%) of unmet need by transmission category.
UNMET NEED FOR PERSONS LIVING WITH HIV (NOT AIDS), ATLANTA EMA, GEORGIA, JANUARY 01, 2012 TO DECEMBER 31, 2012:
Females had a higher percentage of unmet need (47%) than males (45%).
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 53%.
There were racial/ethnic disparities among individuals with unmet need in the Atlanta EMA in 2012. o Unmet need was found for 50% of Black/ Non-Hispanics, 48% of Hispanic/Latinos and 38% of White/Non-Hispanics living with HIV (not AIDS)
IDU had the highest percentage (56%) of unmet need by transmission category.

2012 Georgia HIV Infection Surveillance Summary |9

UNMET NEED FOR PERSONS LIVING WITH AIDS, ATLANTA EMA, GEORGIA, JANUARY 01 TO DECEMBER 31, 2012:

UNMET NEED FOR PERSONS LIVING WITH AIDS, ATLANTA EMA AND GEORGIA NON-EMA, JANUARY 01 TO DECEMBER 31, 2012:

Males had a higher percentage of unmet need (42%) than females (38%).
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 60%.
There were racial/ethnic disparities among individuals with unmet need in the Atlanta EMA in 2012.
o Unmet need was 47% among both Hispanic/ Latinos and White/Non-Hispanics and 41% of Black/Non-Hispanics living with AIDS
IDU had the highest percentage (60%) of unmet need by transmission category.

Females had a higher percentage of unmet need (40%) than males (38%).
Among adults and adolescents (13 years and older) living with AIDS, those aged 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 2012.
o Unmet need was found for 49% of Hispanic/ Latinos, 47% of White/Non-Hispanics and 41% of Black/Non-Hispanics.
IDU had the highest percentage (55%) of unmet need by `known' transmission category.

UNMET NEED FOR PERSONS LIVING WITH HIV (NOT AIDS), GEORGIA NON-EMA, JANUARY 01 TO DECEMBER 31, 2012:
Males had a higher percentage of unmet need (53%) than females (50%).
Among adults and adolescents (13 years and older) living with HIV (not AIDS), age groups 30-34 years and 35-39 years had the highest percent of unmet need at 57%.
There were racial /ethnic disparities among individuals with unmet need in the Georgia non-EMA in 2012.
o Unmet need was found among 55% of both Black/Non-Hispanics and Hispanic/Latinos and 46% of White/Non-Hispanics.
IDU had the highest percentage (50%) of unmet need by `known' transmission category.

10 | Georgia Department of Public Health

Table 1 | Distribution of the General Population by Race/Ethnicity, Georgia, 2012

Race/Ethnicity

Number1 (%)

White, Non-Hispanic

5,469,942(55)

Black, Non-Hispanic

3,012,104(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

909,902(9) 344,208(3) 22,543(<1) 5,865(<1) 155,381(2)
9,919,945

1 Population estimates are based on data obtained from Georgia Department of Public Health, Office of Health Indicators for Planning (OHIP)
2012 Georgia HIV Infection Surveillance Summary |11

Table 2 | Diagnoses of HIV infection and Stage 3 (AIDS) by sex, age and race/ethnicity,



Georgia, January 01, 2012 to December 31, 2012

HIV infection

Stage 3 (AIDS)

Sex Male Female Unknown

Count 2,263 645
3

Percent1 78% 22% <1%

Count 1,040 325
5

Percent 76% 24% <1%

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

Count 18 130 513 462 632 656 390 110

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 1,590 307 109
6 16 36 847
2,911

Percent <1% 4% 18% 16% 22% 23% 13% 4%
Percent 55% 11% 4% <1% <1% 1% 29%

Count 0 15
137 201 380 343 232 62
Count 963 155 64 0 8 44 136
1,370

Percent 0% 1% 10% 15% 28% 25% 17% 5%
Percent 70% 11% 5% 0% <1% 3% 10%

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

Table 3 | Diagnoses1 of HIV Infection and Stage 3 (AIDS) by sex and transmission category,
Georgia, January 01, 2012 to December 31, 2012

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

713

32% 1,423 63%

435

42% 784 76%

8

0%

53

2%

13

1%

47

5%

16

1%

42

2%

15

1%

33

3%

25

1%

92

4%

26

3%

76

7%

1,494 66% 646 29%

547 53%

96

9%

2,256 2,256

1,036

1,036

Female adult or adolescent IDU Heterosexual Other9 Subtotal

Count Percent Count Percent Count Percent Count Percent

6

1%

60

9%

15

5%

49

15%

49

8%

387

61%

44

14% 239 74%

579

91% 186 29%

262 82%

34

11%

634

633

321

322

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

Count Percent

9

50%

9

50%

18

2,908

Count Percent

3

38%

5

63%

8

1,365

1 New diagnoses of HIV infection and stage 3 (AIDS) with no information on birth sex and date of birth were excluded from the table; 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

2012 Georgia HIV Infection Surveillance Summary |13

Table 4 | Diagnoses of HIV infection and Stage 3 (AIDS) by Public Health District of residence
at diagnosis, Georgia, January 01, 2012 to December 31, 2012

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 40 34 35 194 679 184

Rate1 6 8 5 23 69 69

Count 18 11 20 95 365 98

Rate 3 2 3 11 37 37

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

142

14

57

6

530

75

279

39

99

12

47

6

41

27

18

12

96

18

48

9

109

23

72

15

101

27

29

8

63

25

41

16

100

28

38

11

123

21

64

11

75

20

24

7

48

10

26

6

218

20

Total

2,911

29

1,370

14

1 Crude rates are per 100,000 population and are not adjusted for significant factors such as age, sex, and race/ethnicity which might influence the rate. Population denominators used to calculate the rates were retrieved from Georgia Department of Public Health, Office of Health Indicators for Planning (OHIP)
14 | Georgia Department of Public Health

Table 5 | Persons living with diagnosed HIV infection and Stage 3 (AIDS) by sex,
age and race/ethnicity, Georgia through December 31, 2012

HIV infection

Stage 3 (AIDS)

Sex Male Female Unknown

Count 37,516 12,640
280

Percent 74% 25% <1%

Count 20,657 6,466
95

Percent 76% 24% <1%

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

Count 182 378 2,176 4,017
10,081 16,241 12,601 4,736
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
32,320 9,793 2,436
33 187 1,286 4,381
50,436

Percent <1% <1% 4% 8% 20% 32% 25% 9% <1%
Percent 64% 19% 5% <1% <1% 3% 9%

Count 14 104 531
1,240 4,543 9,626 8,044 3,114
2
Count 18,205 5,712 1,415
13 83 826 964
27,218

Percent <1% <1% 2% 5% 17% 35% 30% 11% <1%
Percent 67% 21% 5% <1% <1% 3% 4%

2012 Georgia HIV Infection Surveillance Summary |15

Table 6 | Persons living1 with a diagnosis of HIV Infection and Stage 3 (AIDS)
by sex and transmission category, Georgia, through December 31, 2012

HIV infection

Stage 3 (AIDS)

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

Unadjusted Estimates

Adjusted2 Estimates

Unadjusted Estimates

Adjusted Estimates

Count Percent3 Count Percent Count Percent Count Percent

18,435 1,751 1,508 1,616 13,945 37,255

49% 26,735 72% 5% 2,652 7% 4% 2,074 6% 4% 2,548 7% 37% 3,246 9%
37,255

10,900 1,365 1,084 1,187 6,031 20,567

53% 14,633 71%

7% 1,971 10%

5% 1,376 7%

6% 1,833 9%

29% 754

4%

20,567

Female adult or adolescent IDU Heterosexual Other5 Subtotal

Count Percent Count Percent Count Percent Count Percent

1,067 9% 2,537 21%

736

12% 1,453 23%

3,112 25% 8,929 72% 1,995 31% 4,699 74%

8,194 66% 907

3,623 57% 202

3%

12,373

12,373

6,354

6,354

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

Count Percent
361 70% 153 30% 514
50,142

Count Percent

161 80%

40

20%

201

47,689

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; 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 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 diagnoses of HIV infection and Stage 3 (AIDS) by Public
Health District of residence at diagnosis, Georgia, through December 31, 2012

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 799 510 596 2,969
14,561 1,818

Rate1 124 115 94 353 1489 684

Count 460 269 316 1,565 8,253 971

Rate 72 60 50 186 844 365

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

2,915

283

1,515

147

7,731

1093

4,184

592

1,536

190

850

105

649

424

309

202

1,823

346

979

186

2,109

449

1,207

257

1,603

424

749

198

1,017

396

501

195

1,352

379

732

205

2,521

427

1,442

245

1,120

305

581

158

751

161

426

92

4,056

1,909

Total

50,436

508

27,218

274

1 Crude rates are per 100,000 population and are not adjusted for significant factors such as age, sex, and race/ethnicity which might influence the rate. Population denominators used to calculate the rates were retrieved from Georgia Department of Public Health, Office of Health Indicators for Planning (OHIP)
2012 Georgia HIV Infection Surveillance Summary |17

Table 8 | Cumulative cases of diagnosed HIV Infection and Stage 3 (AIDS),
Georgia as of December 31, 2012

HIV infection

Stage 3 (AIDS)

Sex Male Female Unknown

Count 49,579 15,091
216

Percent1 76% 23% <1%

Count 33,289 9,093
78

Percent 78% 21% <1%

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

Count 578 2,013 7,197
10,304 22,775 14,694 5,575 1,730
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 42,080 15,211 2,491
35 195 1,291 3,583
64,886

Percent <1% 3% 11% 16% 35% 23% 9% 3% <1%
Percent 65% 23% 4% <1% <1% 2% 6%

Count 243 429 2,343 5,728
16,746 11,540 4,118 1,311
2
Count 27,981 11,174 1,546
18 104 852 785
42,460

Percent <1% 1% 6% 13% 39% 27% 10% 3% <1%
Percent 66% 26% 4% <1% <1% 2% 2%

18 | Georgia Department of Public Health

Table 9 | Cumulative1 diagnoses of HIV Infection and Stage 3 (AIDS) of HIV infection
by sex and transmission category, Georgia, as of December 31, 2012

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

HIV infection

Stage 3 (AIDS)

Unadjusted Estimates
Count Percent3

Adjusted2 Estimates
Count Percent

Unadjusted Estimates
Count Percent

Adjusted Estimates
Count Percent

24,737 50% 34,043 69% 17,769 54% 22,389 68%

4,082 8% 5,471 11% 3,609 11% 4,634 14%

2,413 5% 3,088 6% 1,941 6% 2,326 7%

2,537 5% 3,856 8% 2,064 6% 3,029 9%

15,518 31% 2,829 6% 7,755 23% 760 2%

49,287

49,287

33,138

33,138

Female adult or adolescent IDU Heterosexual Other5 Subtotal

Count
1,807 4,118 8,868 14,793

Percent Count Percent
12% 3,550 24% 28% 10,465 71% 60% 778 5% 100% 14,793

Count
1,447 3,060 4,432 8,939

Percent
16% 34% 50%

Count
2,413 6,305 221 8,939

Percent
27% 71% 2%

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

Count
437 141 578 64,658

Percent
76% 24%

Count Percent
262 86% 42 14% 304 42,381

1 Cumulative numbers of HIV infection and Stage 3 (AIDS) with no information on birth sex and date of birth were excluded from the table; 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 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
2012 Georgia HIV Infection Surveillance Summary |19

Table 10 | Cumulative cases diagnosed with HIV Infection and Stage 3 (AIDS) by Public Health
District of residence at diagnosis, Georgia, through December 31, 2012

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 993 664 694 3,311
21,385 2,548

Count 613 402 451 2,035
15,762 1,482

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

2,631 10,907 2,172
739 2,759 3,046 2,310 1,316 2,251 3,566 1,356 1,038 1,200

1,551 6,851 1,314 396 1,718 2,081 1,387 742 1,504 2,360 855 706 250

Total

64,886

42,460

20 | Georgia Department of Public Health

Table 11 | Quantified estimates of unmet need for HIV primary care, Georgia,
Atlanta EMA and Georgia non-EMA, 2012

Population

Atlanta EMA1 Georgia non-EMA

Row

Population

Cases

Cases

Cases

Row A.

Number of persons living with AIDS (PLWA) as of 12/31/2012

26,862

18,643

8,219

Row B.

Number of persons living with HIV (PLWH)/not AIDS as of 12/31/2012 22,492

15,197

7,295

Row C.

Total number of persons living with HIV Disease as of 12/31/2012

49,354

33,840

15,514

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, 01/01/2012 to 12/31/2012

15,627

10,916

4,711

Row E.

Number of persons living with HIV (PLWH)/not AIDS who received the specified HIV primary medical care during the 12-month period, 01/01/2012 to 12/31/2012

11,744

8,233

3,511

Row F.

Total number of persons living with HIV disease who received the specified HIV primary medical care during the 12-month period, 01/01/2012 to 12/31/2012

27,371

19,149

8,222

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 11,235 42 7,727 41 3,508 43 care during the 12-month period, 01/01/2012 to 12/31/2012

Row H.

Number of persons living with HIV (PLWH)/not AIDS who did not receive the specified HIV primary 10,748 48 6,964 46 3,784 52 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 21,983 45 14,691 43 7,292 47 primary medical care during the 12 month period, 01/01/2012 to 12/31/2012

1 EMA stands for Eligible Metropolitan Area

2012 Georgia HIV Infection Surveillance Summary |21

Table 12 | Characteristics of estimates of unmet need for HIV primary care, Georgia,
January 01, 2012 to December 31, 2012

HIV (not AIDS)

AIDS

Total

Gender

Count

Percent1

Count

Percent

Count

Percent

Male

7,741

47%

8,710

43%

16,451

45%

Female

2,888

48%

2,474

39%

5,362

44%

Subtotal2

10,629

11,184

21,813

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 7 78 29
830 1440 1509 1310 1467 1404 1187 754 402 310 10,727

Percent 39% 62% 28% 47% 54% 53% 51% 47% 43% 43% 45% 44% 47%

Count <5 <5 10 143 352 640 919
1,545 2,355 2,098 1,502 885 780 11,229

Percent <5% 0% 21% 25% 29% 34% 35% 39% 42% 44% 48% 51% 59%

Count <5 82 39 973
1,792 2,149 2,229 3,012 3,759 3,285 2,256 1,287 1,090 21,874

Percent <5% 59% 26% 42% 46% 46% 43% 42% 43% 44% 47% 49% 55%

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

Count 6,940 1,620 494 202 1,492 10,748

Percent 51% 41% 50% 36% 45%

Count 7,385 2,642 676 210 322 11,235

Percent 41% 47% 48% 23% 34%

Count 14,325 4,262 1,170
412 1,814 21,983

Percent 45% 44% 49% 28% 43%

Transmission Category MSM IDU MSM&IDU Heterosexual Other4 NIR/NRR5 Subtotal

Count 3,168 370 185 692
79 6,254 10,748

Percent 43% 53% 45% 46% 36% 51%

Count 4,536 1,208 541 1,439 106 3,405 11,235

Percent 42% 58% 50% 46% 42% 36%

Count 7,704 1,578 726 2,131 185 9,659 21,983

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'
22 | Georgia Department of Public Health

Percent 43% 57% 49% 46% 39% 44%

Table 13 | Characteristics of estimates of unmet need for HIV primary care, Atlanta EMA,
Georgia, January 01, 2012 to December 31, 2012

HIV (not AIDS)

AIDS

Total

Gender

Count

Percent1

Count

Percent

Count

Percent

Male

5,285

45%

6,252

42%

11,537

44%

Female

1584

47%

1,438

38%

3,022

42%

Subtotal2

6,869

7,690

14,559

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 6 23 18
523 987 1,046 887 980 888 736 447 247 161 6,949

Percent 43% 38% 26% 46% 53% 52% 49% 44% 40% 42% 42% 44% 41%

Count <5 <5 8 90 245 475 633
1,056 1,661 1,457 1005 607 485 7,722

Percent <5% 0% 45% 24% 28% 34% 34% 38% 42% 44% 48% 54% 60%

Count <5 27 26 613
1,232 1,521 1,520 2,036 2,549 2,193 1,452 854 646 14,673

Percent <5% 38% 25% 40% 45% 44% 42% 41% 42% 43% 46% 50% 54%

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

Count 4,594 975 342 145 908 6,964

Percent 50% 38% 48% 35% 38%

Count 5,067 1814 481 148 217 7,727

Percent 41% 47% 47% 22% 29%

Count 9,661 2,789 823 293 1125 14,691

Percent 45% 43% 47% 27% 36%

Transmission Category MSM IDU MSM&IDU Heterosexual Other4 NIR/NRR5 Subtotal

Count 2,407 221 142 324
55 3,815 6,964

Percent 43% 56% 48% 47% 35% 48%

Count 3,510 798 415 682
66 2,256 7,727

Percent 42% 60% 51% 44% 41% 35%

Count 5,917 1019 557 1006 121 6,071 14,691

Percent 42% 59% 51% 45% 38% 42%

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'
2012 Georgia HIV Infection Surveillance Summary |23

Table 14 | Characteristics of estimates of unmet need for HIV primary care,
Georgia non-EMA , 2012

HIV (not AIDS)

AIDS

Total

Gender

Count

Percent1

Count

Percent

Count

Percent

Male

2,456

53%

2,158

38%

4,914

48%

Female

1,304

50%

1,036

40%

2,340

45%

Subtotal2

3,760

3,194

7,254

%

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 55 11 307 453 463 423 487 516 451 307 155 149
3,777

Percent NA 85% 32% 50% 55% 57% 57% 52% 48% 46% 49% 45% 56%

Count <5 <5 2 53 107 165 286 489 694 641 497 278 295
3,507

Percent NA NA 17% 26% 31% 34% 39% 42% 43% 43% 49% 46% 56%

Count <5 <5 13 360 560 628 709 976
1,210 1,092 804 433 444 7,229

Percent NA NA 28% 44% 48% 49% 47% 46% 45% 45% 49% 46% 56%

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

Count 2,346 645 152
57 584 3,784

Percent 55% 46% 55% 37% 65%

Count 2,318 828 195
62 105 3,508

Percent 41% 47% 49% 27% 49%

Count 4,664 1,473 347 119 689 7,292

Percent 46% 47% 52% 31% 62%

Transmission Category MSM IDU MSM&IDU Heterosexual Other4 NIR/NRR5 Subtotal

Count 761 149 43 368 24 2,439 3,784

Percent 45% 50% 38% 44% 36% 57%

Count 1,026 410 126 757
40 1,149 3,508

Percent 42% 55% 47% 48% 45% 37%

Count 1,787 559 169 1,125
64 3,588 7,292

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 43% 54% 44% 47% 41% 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
2012 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