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Show personal communication). This makes collaboration very important, and planning for prevention and treatment extremely difficult. The number of HIV infections constantly changes as some of these patients progress to AIDS. For example, 63 of the 143 new cases reported as AIDS in 1998 in Utah were people previously known to be HIV positive. This number of new cases is a 4% decrease from 1997 and is the first year that Utah has experienced a decrease in reported AIDS cases compared to the previous year. This decrease is comparable with the rest of the United States and is most likely due to the better available therapies. As mentioned above, it is unclear whether this trend will continue or for how long. 52 new HIV infections were reported in Utah in 1998. This is a 28% decrease from the 71 HIV infections reported in 1997. This could be interpreted in several ways. It may mean that there is a leveling off of the epidemic, but could also mean that the patients are not presenting for diagnosis early in the disease. This could be due to a change of perceived risk or the change in the groups affected which do not seek medical care. Geographic Distribution in Utah The majority of the cases of HIV/AIDS reported in 1998 (87%) live along the Wasatch Front. 66 percent are residents of Salt Lake County. The majority of patients who reside in rural areas commute to Salt Lake City for care. The challenge to try to provide care and consultation to the rural parts of the state is still a major project that is often hampered by the patient's choice to commute for personal reasons. Many of the patients report discrimination based on their serostatus, due to breeches in confidentiality at all levels, including the physician's office, pharmacy and laboratory. There is a definite lack of knowledge among the providers which is evident except to the least knowledgeable patient (Practice Division of Infectious Diseases, personal communication). Much of this may be due to the mistaken idea that HIV is a primary care specialty, when in fact it is a specialized care requiring a multidisciplinary team. This is further confounded by the rapid changes in the science, and thus the recommendations for care. Gender, Exposure Category, Ethnicity and Age Cumulative totals from 1981 through December 1998 reveal that men comprise 91% of HIV disease(HIV and AIDS combined) in Utah. Women account for 10% of the total HIV/ AIDS cases. In 1998, 85% of persons reported with HIV disease were men, 15% were women. This later statistic is comparable with the national trend whereas cumulative AIDS cases are already only 84% in men and 16% in women as of December 31,1998. During 1998, male-to-male sexual contact (MSM) was the most common risk factor for newly reported HIV/AIDS among all races in Utah (53%). This is a decrease from the earlier figures reported in the epidemic and is approaching the national cumulative statistic of 49%. However, the cumulative percent in MSM in Utah AIDS cases is still 65%. Injecting drug use (IDU) was the second highest risk behavior for HIV disease in Utah in 1998, at 14%. MSM plus IDU accounted for another 8 patients in 1998. One previously unreported hemophiliac was reported for the first time. Fourteen of the newly reported cases in 1998 have not been completely investigated as to risk behavior category and remain unknown. For the first time there were no reported cases in the risk category of transfusion or tissue. Cumulative data for Utah is reported in Table 2. The ethnic and racial distribution in Utah appears to be shifting. Of the newly reported HIV/AIDS cases in 1998, only 69% were of white ethnicity as compared to the cumulative of 83%. Six percent of the cases were of Black ethnicity, the same as the cumulative percent. Hispanics accounted for 21% of the reported cases in 1998. This compares to a cumulative percent of 9%. From 1994 through 1997, the HIV/AIDS infection rate among Black persons was ten times higher than for white persons. The rate among Hispanics was almost three times higher than for whites, and the rate appears to be increasing. These rates in the minority population are far in excess of the general population of the state (University of Utah Health Sciences AIDS Center, 1999). There were no new reports of HIV /AIDS in children under the age of 13 in 1998. Eighty- 36 |
