Prepared by:
Division of HIV and STD Control
Claudia A. Pollet, M.D., M.P.H., Director
Brian Donohue, Social Health Investigator
Glenda Henry, Public Health Nurse II

History:

Since AIDS was first identified in 1981, the disease has claimed more than 448,000 lives in the United States, and an estimated 28.9 million lives worldwide.^{1, 2} Nationally, the epidemic was first identified among gay men in large cities. Within the next few years, the disease appeared in injection drug users. By 1983, researchers had uncovered much of HIV's basic biology, including that it was transmitted in blood and blood products as well as from sexual activities.

Epidemiology:

In Nassau County, the first AIDS cases were diagnosed in 1981. Between 1981 and 2000, 3127 residents of the county have been diagnosed with AIDS and 1882 people have died from the disease.³

Up until 1995, AIDS was a rapidly fatal disease. The average time between diagnosis and death was eighteen months. In 1995, a new family of antiretroviral drugs called protease inhibitors was released, which prolonged survival for HIV infected persons. Less than one year later, the standard of care for the immunocompromised HIV infected patients included a combination of highly active antiretroviral medication (HAART). This rapid adoption of HAART lead to the decrease in mortality that began in 1995 (Figure 1)

As in the rest of the country, the earliest cases were among men who had sex with men (MSM). MSM remained the most common risk factor as late as 1990. Since that time, the epidemic has shifted; now most of the AIDS cases with known risk factors occur in injection drug users (Figure 4).

AIDS does not discriminate based on race, ethnicity, gender or sexual orientation. However, since early in the epidemic, this disease has disproportionately affected African Americans. Although approximately 10 percent of Nassau County's population is African American, 42 percent of the cumulative AIDS cases have occurred in this group. Over time, African Americans have accounted for an increasing proportion of new AIDS cases (Figure 5). This pattern among new AIDS cases has been reported in other regions of New York State (Figure 6).

Every community in Nassau County has been affected by the AIDS epidemic. People from the richest and poorest areas have died from the disease. Nevertheless, the communities that have shouldered the greatest burden of the disease are Freeport, Hempstead, Inwood, Roosevelt, Uniondale, and Westbury (Figure 3). The residents of these towns also disproportionately suffer from high rates of sexually transmitted disease, teen pregnancy⁴ and poverty.⁵

Both incidence and mortality (the rate of new cases and deaths) in all groups has decreased since the peak of the epidemic 1995. Yet, the proportion of cases among African Americans and Hispanics has increased (Figure 7).

Nassau County and nearby regions have demonstrated a decrease in AIDS incidence since 1995 (Figure 8). Comparison of new case rates for Whites and African American shows that the gap between the two groups has narrowed. However, the discrepancy in new case rates remains significant (Figure 9).

AIDS became a reportable disease in 1983, but HIV infection only became reportable in 2000. Health care providers and laboratories are required to report all newly diagnosed cases of HIV infection, HIV related illness and AIDS to the New York State Department of Health (NYSDOH). This law provides for early identification of HIV infected individuals. Knowledge of new HIV infection allows better targeting of resources and earlier treatment.

Under the same law, either the health care provider or the newly diagnosed person may request assistance with partner notification. For Nassau County residents, reports for persons possibly needing assistance with partner notification are relayed to the Nassau County Department of Health PartNer Assistance Program (PNAP). A Social Health Investigator contacts the medical provider to verify the need for assistance, discuss partners, and assess for risk of domestic violence. If indicated, the infected person is contacted and encouraged to provide the names of needle sharing and/or sexual partners. Accordingly, named individuals are then notified of their exposure to the HIV virus, offered on-site HIV counseling and testing, and provided with referrals as needed.

Preliminary data based on reports to PNAP for 2002 indicates 144 cases possibly needing assistance with partner notification. The disparities in race/ethnicity seen among AIDS cases persist in the HIV infections. Males comprise a higher percentage of cases referred to PNAP than females and the preponderance of cases lies within the 35 to 44 age group.

Number of 2002 PNAP Cases Reported to the
Nassau County Department of Health (preliminary data): 144

References

1. Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention [Online] Available www.cdc.gov/hiv/pubs/facts.htm 2003.
   
   
2. The United States Agency for Industrial Development [Online] Available www.usaid.gov/pop_health/aids/ 2003.
   
   
3. New York State Department of Health, Bureau of HIV/AIDS Epidemiology. Nassau County AIDS Summary Report: Cumulative Number of Cases, Excluding Pediatrics, Through June 30, 2000. Unpublished. 2003.
   
   
4. New York State Department of Health AIDS Institute. The Community Needs Index Series: Community Need Index for the Nassau-Suffolk Region (2000 Edition). Albany, NY: New York State Department of Health.
   
   
5. Nassau County Department of Health. Nassau County Community Health Assessment 2001 Update. Mineola, NY: Nassau County Department of Health.

Technical Notes

1. Interpretation of the New York State Department of Health data is limited by the high percentage of cases in the unknown category, particularly for the last two years.
2. Case data for 1999 and 2000 are incomplete due to the lag in case reporting and time required for case confirmation.
3. Deaths are defined as from among reported AIDS cases and may be different from 'AIDS deaths'.
4. All data excludes inmates.
5. Calculation of all rates based on U.S. Census 2000 data.
6. The AIDS Institute reports Hispanic as a race and some figures with rates present race categories as White, Black and other because there is no population data to match.
7. PNAP information and data are preliminary and subject to revision. NCDOH only receives case reports possibly needing partner notification follow up. Therefore, information on all new diagnosis HIV cases is sent to counties, but many HIV illness cases and some AIDS cases are not.

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