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HIV Surveillance in Urban and Nonurban Areas

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1 HIV Surveillance in Urban and Nonurban Areas
For all slides in this series, the following notes apply: Estimated numbers and rates of diagnoses of HIV infection are based on data from 46 that have had confidential name-based HIV infection reporting for a sufficient length of time (i.e., implemented in area since at least January 2007 and reported to CDC since at least June 2007) to allow for stabilization of data collection and for adjustment of the data in order to monitor trends. Estimated numbers and rates of AIDS diagnoses are based on data from the 50 states and the District of Columbia. At the time of development of this slide series, complete 2010 census data were not available from the U.S. Census Bureau. Therefore, all U.S. population estimates and denominators used to calculate rates were based on the official postcensus estimates for 2009.

2 There are many classifications for areas and populations (urban and nonurban). Although each classification system differs slightly, most places designated urban by one system are also designated urban by the others. Some systems distinguish larger and smaller metropolitan areas, some consider proximity to metropolitan areas, and others consider the economic and social integration in a core area of high population. The Centers for Disease Control and Prevention uses the Office of Management and Budget’s system, which designates metropolitan statistical areas (MSAs). Areas are divided into MSAs of populations of 500,000 or more; 50,000 to 499,999; and nonmetropolitan (less than 50,000). This slide series excludes cases reported from U.S. dependent areas because they are not included in the regional classification system used here.

3 The majority of adults and adolescents diagnosed with HIV infection in 2010 resided in metropolitan areas with populations of 500,000 or more in the 46 states with long-term confidential name-based HIV infection reporting. The rate of diagnosis of HIV infection was highest (24.3 per 100,000 population) among adults and adolescents residing in metropolitan areas with populations of 500,000 or more compared with adults and adolescents residing in areas with smaller populations at the time of diagnosis. The following 46 states have had laws or regulations requiring confidential name-based HIV infection reporting since at least January 2007 (and reporting to CDC since at least June 2007): Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data are estimates. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting. Rates are per 100,000 population. Data do not include persons whose county of residence is unknown.

4 The majority of adults and adolescents diagnosed with HIV infection in 2010 resided in metropolitan areas with populations of 500,000 or more in the 46 states with long-term confidential name-based HIV infection reporting. Blacks/African Americans accounted for the largest percentage of diagnoses of HIV infection regardless of the population of the area of residence at diagnosis. Hispanics accounted for a larger percentage of diagnoses of HIV infection in metropolitan areas with populations of 500,000 or more than in areas with smaller populations. Whites accounted for a smaller percentage of diagnoses of HIV infection in metropolitan areas with populations 500,000 or more than in areas with smaller populations. The following 46 states have had laws or regulations requiring confidential name-based HIV infection reporting since at least January 2007 (and reporting to CDC since at least June 2007): Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data are estimates. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting. Data do not include persons whose county of residence is unknown.

5 In each of the population categories in the 46 states with long-term confidential name-based HIV infection reporting, at least 70% of diagnoses of HIV infection among males during 2010 were among those with infections attributed to male-to-male sexual contact, though the percentage decreased as size of population decreased. The percentages of males with HIV infection attributed to heterosexual contact, or to injection drug use, or to male-to-male sexual contact and injection drug use increased as population size decreased. At the national level, the overall pattern of the distribution of risk factors did not differ by the population of area of residence at the time of diagnosis. The following 46 states have had laws or regulations requiring confidential name-based HIV infection reporting since at least January 2007 (and reporting to CDC since at least June 2007): Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data are estimates. Estimated numbers resulted from statistical adjustment that accounted for reporting delays and missing risk-factor information, but not for incomplete reporting. Data do not include persons whose county of residence is unknown. Heterosexual contact is with a person known to have, or to be at high risk for, HIV infection.

6 In each of the population categories in the 46 states with long-term confidential name-based HIV infection reporting, 85% or more of diagnoses of HIV infection among females during 2010 were among those with infections attributed to heterosexual contact. Approximately 15% of females in each population category had diagnosed HIV infections attributed to injection drug use. At the national level, the overall pattern of the distribution of risk factors did not differ by the population of the area of residence at the time of diagnosis. The following 46 states have had laws or regulations requiring confidential name-based HIV infection reporting since at least January 2007 (and reporting to CDC since at least June 2007): Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data are estimates. Estimated numbers resulted from statistical adjustment that accounted for reporting delays and missing risk-factor information, but not for incomplete reporting. Data do not include persons whose county of residence is unknown. Heterosexual contact is with a person known to have, or to be at high risk for, HIV infection.

7 This slide shows the distribution of diagnoses of HIV infection during 2010 among adults and adolescents by age at diagnosis and by population of area of residence in the 46 states with long-term confidential name-based HIV infection reporting. The overall pattern of the distribution of ages at diagnosis differed by population of area of residence for persons aged 13-24, 25-34, and years. That is, in MSAs of 50, ,999, there was a higher percentage of diagnoses among persons aged than those aged 35-44, whereas the reverse was seen among persons residing in MSAs of more than 500,000 and in nonmetropolitan areas. Similarly, in nonmetropolitan areas, very similar percentages of diagnoses were seen among persons aged years and those aged years, compared to MSAs of 500,000 or greater or 50, ,999 where the percentages of persons aged were higher than that of those aged years. In each category, approximately 24% to 28% of diagnoses of HIV infection were among adults aged 25 to 34 years at diagnosis, 22% to 24% were among adults aged 35 to 44 years, and an additional 19% to 21% were among adults aged 45 to 54 years. Approximately 21% to 24% of diagnoses in each population were among persons aged 13–24 years, and 9% to 10% of diagnoses in each category were among adults aged 55 years and older at diagnosis. The following 46 states have had laws or regulations requiring confidential name-based HIV infection reporting since at least January 2007 (and reporting to CDC since at least June 2007): Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data are estimates. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting. Data do not include persons whose county of residence is unknown.

8 This slide shows the numbers and rates of adults and adolescents living with a diagnosis of HIV infection at the end of 2009 in the 46 states with long-term confidential name-based HIV infection reporting, by race/ethnicity and population of area of residence. Blacks/African Americans represent the largest numbers and highest rates of adults and adolescents living with a diagnosis of HIV infection in each population of area of residence, although the rate of diagnosis among blacks/African Americans in areas with populations of 500,000 or more were by far the highest across all racial/ethnic groups in all areas at 1,316.6 per 100,000 population. In each racial/ethnic group, the numbers and rates of diagnoses of HIV infection were highest in those residing in areas with populations of 500,000 or more than those in areas with smaller populations. The following 46 states have had laws or regulations requiring confidential name-based HIV infection reporting since at least January 2007 (and reporting to CDC since at least June 2007): Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data are estimates. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting. Rates are per 100,000 population. Data do not include persons whose county of residence is unknown. The Asian category includes Asian/Pacific Islander legacy cases (cases that were diagnosed and reported under the old Office of Management and Budget race/ethnicity classification system). Hispanics/Latinos can be of any race.

9 The percentage of AIDS diagnoses among adults and adolescents residing in areas with populations of 500,000 or more has decreased slowly since In 1985, 92% of all AIDS diagnoses were in areas with populations of 500,000 or more, and in 2010, 83% of diagnoses were in these areas. Although modest, the increases in areas of smaller populations from 1985 to 2010 reflect the spread of the epidemic in the United States, from large urban areas into smaller suburban and non-urban areas. All displayed data are estimates. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting. Data do not include persons whose county of residence is unknown.

10 The majority of adults and adolescents diagnosed with AIDS in 2010 resided in metropolitan areas with populations of 500,000 or more. Blacks/African Americans accounted for the largest percentage of diagnoses of HIV infection regardless of the population of the area of residence at diagnosis. Hispanics/Latinos accounted for a larger percentage of AIDS diagnoses in metropolitan areas with populations of 500,000 or more than in areas with smaller populations. Whites accounted for a smaller percentage of AIDS diagnoses in metropolitan areas with populations of 500,000 or more compared to areas with smaller populations. All displayed data are estimates. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting. Data do not include persons whose county of residence is unknown. The Asian category includes Asian/Pacific Islander legacy cases (cases that were diagnosed and reported under the old Office of Management and Budget race/ethnicity classification system). Hispanics/Latinos can be of any race.

11 This map shows the 50 states (and the District of Columbia) that are included in each of four regions of the United States. American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, the Republic of Palau, and the U.S. Virgin Islands are not included in this regional classification system, although they report AIDS diagnoses to CDC. Regions of residence are defined as follows: Northeast—Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont Midwest—Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, Wisconsin South—Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia West—Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, Wyoming

12 In 2010, the majority of AIDS diagnoses among adults and adolescents were reported from metropolitan areas with a population of 500,000 or more; the South had the largest numbers of diagnoses regardless of population size. The distribution of diagnoses in the South shows larger percentages in smaller metropolitan (50,000–499,999) and nonmetropolitan areas compared to other regions of the United States. All displayed data are estimates. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting. Data do not include persons whose county of residence is unknown. Regions of residence are defined as follows: Northeast—Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont Midwest—Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, Wisconsin South—Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia West—Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, Wyoming

13 Numbers and rates (per 100,000) of AIDS diagnoses among adults and adolescents in 2010 are shown for each region of residence by population category. The highest rate for each region is found in metropolitan areas with a population of more than 500,000. The South had the highest numbers and rates of AIDS diagnoses in each of the population categories. All displayed data are estimates. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting. Rates are per 100,000 population. Data do not include persons whose county of residence is unknown. Regions of residence are defined as follows: Northeast—Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont Midwest—Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, Wisconsin South—Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia West—Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, Wyoming

14 In 2010, in the Northeastern region of the United States, the highest rates of AIDS diagnoses in each population category were among blacks/African Americans. The rates of AIDS diagnoses among blacks/African Americans, Hispanics/Latinos, whites, and persons reporting multiple races decreased as population size decreased. In large metropolitan areas (500,000 or greater) in the Northeast, persons reporting multiple races had the second highest rate of AIDS diagnoses in 2010, followed by Hispanics/Latinos. The rate of AIDS diagnoses in Native Hawaiians/other Pacific Islanders should be interpreted with caution because the number of diagnoses in this group is small. All displayed data are estimates. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting. Rates are per 100,000 population. Data do not include persons whose county of residence is unknown. The Northeast region of the United States includes Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont. The Asian category includes Asian/Pacific Islander legacy cases (cases that were diagnosed and reported under the old Office of Management and Budget race/ethnicity classification system). Hispanics/Latinos can be of any race.

15 In 2010, in the Midwestern region of the United States, the highest rates of AIDS diagnoses in each population category were among blacks/African Americans, although the rate in metropolitan areas with populations of 500,000 or more was higher than in areas with smaller populations. In large metropolitan areas (500,000 or greater) in the Midwest, Native Hawaiians/other Pacific Islanders had the second highest rate of AIDS diagnoses in 2010, followed by persons reporting multiple races. The rate of AIDS diagnoses in Native Hawaiians/other Pacific Islanders should be interpreted with caution because the number of diagnoses in this group is small. All displayed data are estimates. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting. Rates are per 100,000 population. Data do not include persons whose county of residence is unknown.    The Midwest region of the United States includes Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin. The Asian category includes Asian/Pacific Islander legacy cases (cases that were diagnosed and reported under the old Office of Management and Budget race/ethnicity classification system). Hispanics/Latinos can be of any race.

16 In 2010, in the Southern region of the United States, the highest rates of AIDS diagnoses in each population category were among blacks/African Americans, although the rate in metropolitan areas with populations of 500,000 or more was higher than in areas with smaller populations. The rates of AIDS diagnoses in American Indians/Alaska Natives, Hispanics/Latinos, Native Hawaiians/other Pacific Islanders, whites and persons reporting multiple races were higher in areas with populations of 500,000 or more than in areas with smaller populations. The highest rates among Asians in the South were in areas with populations of 50, ,999; however, this rate should be interpreted with caution because the number of AIDS diagnoses among Asians is small. All displayed data are estimates. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting. Rates are per 100,000 population. Data do not include persons whose county of residence is unknown. The South region of the United States includes Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia. The Asian category includes Asian/Pacific Islander legacy cases (cases that were diagnosed and reported under the old Office of Management and Budget race/ethnicity classification system). Hispanics/Latinos can be of any race.

17 In 2010, in the Western region of the United States, the highest rates of AIDS diagnoses in each population category were among blacks/African Americans, although the rate in metropolitan areas with populations of 500,000 or more was higher than in areas with smaller populations. The rates of AIDS diagnoses among all other races/ethnicities were also higher in areas with populations of 500,000 or more than in areas with smaller populations. All displayed data are estimates. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting. Rates are per 100,000 population. Data do not include persons whose county of residence is unknown. The West region of the United States includes Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming. The Asian category includes Asian/Pacific Islander legacy cases (cases that were diagnosed and reported under the old Office of Management and Budget race/ethnicity classification system). Hispanics/Latinos can be of any race.

18 In each region of the United States, the majority of adults and adolescents living with an AIDS diagnosis at the end of 2009 were from metropolitan areas with populations of 500,000 or more; the fewest were from nonmetropolitan areas. The South had the largest number of persons living with an AIDS diagnosis in metropolitan areas with populations of 500,000 or more, as well as areas with populations of 50, ,999, but the Northeast had the highest rates for both areas population sizes. The South had the largest number and highest rate of adults and adolescents living with an AIDS diagnosis in nonmetropolitan areas. Although metropolitan areas with populations of more than 500,000 have the largest number of AIDS cases, smaller metropolitan and nonmetropolitan areas, especially in the South, share a substantial burden of the AIDS epidemic. All displayed data are estimates. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting. Rates are per 100,000 population. Data do not include persons whose county of residence is unknown. Rates are per 100,000 population. Regions of residence are defined as follows: Northeast—Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont Midwest—Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, Wisconsin South—Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia West—Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, Wyoming


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