By the end of 2003, an estimated 1 million to 1.2 million persons in the U.S. were living with HIV/AIDS.  Of those, an estimated 24-27% were undiagnosed and unaware that they were HIV positive (CDC, 2004).  In 2004, there were approximately 1,330 new cases of HIV reported in Pennsylvania excluding Philadelphia County (Kaiser Family Foundation, 2006).  Because Philadelphia does not practice names-based HIV reporting, there are not currently any comparable estimates of HIV incidence for Philadelphia.  This means that the incidence and prevalence of HIV in Philadelphia must be estimated using other indicators. 

Awareness of HIV status may be one important way to reduce HIV transmission.  Newly proposed CDC guidelines would recommend that physicians offer HIV testing as part of routine medical exams for all 13- to 64-year olds.  This article will review current national, state, and county-level information on the incidence of HIV and AIDS.  The article then examines findings from PHMC’s 2004 Southeastern Pennsylvania (SEPA) Household Health Survey regarding HIV testing among adults in SEPA.

AIDS AND HIV: NATIONAL AND LOCAL INCIDENCES

The incidence of AIDS in the United States peaked in 1992 and has since been steadily declining.  This decline is primarily attributable to the mid-1990’s introduction of Highly Active Antiretroviral Therapy (HAART), which turned HIV/AIDS into a chronic condition.  Like the nationwide AIDS incidence, the incidence of AIDS in the state of Pennsylvania has similarly been declining since its peak in 1993.  However, within Pennsylvania, the region with the highest AIDS incidence for 1999-2001 was SEPA, comprised of Bucks, Chester, Delaware, Montgomery, and Philadelphia counties (PA Dept. of Health, 2002). 

Philadelphia County has both the highest prevalence and the highest incidence rate for AIDS cases in the state.  The most recent data available indicate that the AIDS incidence rate in Philadelphia in 2002 was 901 cases per 100,000 people, and that 63% of people living with AIDS in Pennsylvania live in Philadelphia County alone (PA Department of Health, 2004).  Delaware, Montgomery, Chester and Bucks Counties have incidence rates that are similar to each other: 23, 21, 17 and 15 per 100,000 in 2002, respectively (PA Department of Heath, 2004).

RACE/ETHNICITY AND HIV/AIDS

Despite the declining AIDS incidence rates nationally, statewide and within SEPA, the incidence of HIV infection is still rising in many populations.  Minority populations have been particularly impacted, and African Americans and Latinos are disproportionately represented in the current incidence of both HIV and AIDS (CDC MMWR, 2006).  While race and ethnicity are not considered risk factors, they are associated with other factors that put people at increased risk for HIV/AIDS.  Minority populations face many common barriers to healthcare, including lack of medical insurance, lack of education and limited or no means of transportation.  Furthermore, the stigma attached to HIV and sexuality pushes some to avoid testing and treatment (Greeley, 1995). 

Nationally:
·  According to the 2000 U.S. census, African Americans make up 12% of the U.S. population, but account for 50% of the of the estimated new HIV diagnoses (CDC, 2006).

Pennsylvania:
·  Collectively, Black and Latino individuals account for about 13% of the general population in Pennsylvania and yet they account for 70% of all newly diagnosed AIDS cases in 2002 (PA Department of Health, 2004).
·  Within Pennsylvania Black males have the highest incidence rates of AIDS followed by Latino males, Black females, Latino females, White males and White females (PA Department of Health, 2004).

SEPA:
·  In 2003, Black and Latino individuals accounted for only 26% of the population in SEPA, yet they accounted for 75% of the people living with AIDS (PA Department of Health, 2004).

HIV TESTING IN SEPA BY RACE, POVERTY STATUS, AND GENDER

Within SEPA, minority populations, specifically Black and Latino adults, were more likely to have received HIV testing in 2004 (Figure 1).  Within SEPA in 2004, 34% of Black adults and 33% of Latino adults reported having had an HIV test in the previous year, as opposed to only 13% of Asians and 11% of whites. 

Individuals living below poverty level in SEPA were also more likely to receive HIV testing in 2004, which corresponds with the considerable overlap of low-income and minority populations (Figure 1).  About 32% of adults in poverty within SEPA had received an HIV test in the previous year in 2004 as compared to only 15% of those above the poverty line. 

In 2004, very similar proportions of men and women in SEPA reported receiving an HIV test in the previous year (Figure 1).  Approximately 18% of men reported having been tested for HIV versus approximately 16% of women.

LACK OF HIV TESTING

Given the Centers for Disease Control’s push for routine testing, it is also important to consider the individuals who have never been tested for HIV (Figure 2).  About 60% of adults in Southeastern Pennsylvania report never having received an HIV test.  Montgomery, Bucks, Chester, and Delaware Counties all have approximately equivalent proportions of adults who have never been tested (65%, 65%, 64%, and 63%, respectively).  In Philadelphia County, only about half of the adult population has never received an HIV test. 

Within Bucks, Delaware, Montgomery and Philadelphia Counties the percentage of Black and Latino adults who have never been tested for HIV is lower than that of White and Asian adults (Figure 2).  The percentage of Latino adults in Chester County who have never been tested for HIV is only slightly lower than that of Asian adults.  Within Philadelphia County, about 70% of Asian and 64% of White adults have never been tested for HIV/AIDS, as opposed to 40% of Black and 33% of Latino adults.

CONCLUSION

This article presented information on HIV/AIDS in the region in the context of state- and national-level information, and considered the frequency with which adults are receiving HIV testing in SEPA.  Although rates of AIDS diagnosis are declining across the country due to improved treatment and knowledge of HIV/AIDS, HIV incidence continues to rise, particularly among vulnerable populations.  HIV testing in the region is not currently a routine part of medical care.  In each of the five counties, one-half to two-thirds of each county’s population reported having never received an HIV test.   Nevertheless, sizable proportions of local populations are indeed accessing HIV testing, providing a strong base upon which to build expanded HIV education and health-related services.

This month’s Data Findings article was a collaboration between Athena Samaras, a Swarthmore College senior who has just completed a summer internship with PHMC, and Allegra Gordon, CHDB Research Associate.  If you have further questions, please contact Allegra at the CHDB: (215) 985-6238, or agordon@phmc.org.