HIV Infection and AIDS -- Georgia, 1991

Public health surveillance efforts for acquired immunodeficiency syndrome (AIDS) in the United States have documented an increasing proportion of cases among persons who reside outside the largest metropolitan areas (1,2). These findings, coupled with results of human immunodeficiency virus (HIV) prevalence studies, have led to the development of HIV-related prevention and treatment services in smaller cities and rural areas. This report presents results of HIV-infection and AIDS surveillance in Georgia (1990 population: 6.5 million) for 1991 and compares these findings for urban and rural areas.

During 1991, AIDS was diagnosed in 1286 persons residing in Georgia (Figure 1). Of these, 920 (72%) were reported from the state health district that includes Atlanta, in which approximately 36% of the state's total population resides; 236 (18%) cases were reported from health districts that include smaller cities *; and 130 (10%) were from districts that include only outlying or rural areas **. Overall, 74% of men with AIDS were reported from Atlanta, compared with 56% of women with AIDS. When compared with 1990, in 1991 the incidence of AIDS decreased 4% in Atlanta but increased 16% in the rest of the state.

In an anonymous, population-based HIV serosurvey among women delivering infants in Georgia during 1991, the prevalence of HIV infection was 1.6 per 1000 women in Atlanta; 1.8, in health districts including smaller cities; and 0.9, in rural areas. Based on extrapolation from these rates, during 1991 there were an estimated 70 births to HIV-positive women in Atlanta, compared with 94 in other areas of the state.

In a special study conducted in three hospitals in rural Georgia in 1991, residual blood specimens collected from patients aged 15-54 years for routine diagnostic purposes were tested anonymously for HIV (3). Overall, seven (0.5%) of 1319 patients were HIV positive.

Reported by: BM Whyte, MD, JA Wilber, MD, State Epidemiologist, Georgia Dept of Human Resources. HIV Seroepidemiology Br, Surveillance Br, Div of HIV/AIDS, National Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Public health surveillance efforts have confirmed that the HIV/AIDS epidemic affects not only large cities but also some smaller cities and rural areas (4). Ensuring appropriate medical care and other services are available for persons with HIV infection who reside outside major metropolitan centers presents challenges in training providers, assuring access to care, establishing referral networks, and integrating health and social services.

The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 *** provides grants to states to improve the quality, accessibility, and organization of health care for persons with HIV infection. In Georgia, these funds have supported the establishment of clinic services in health districts outside Atlanta, including satellite clinics in remote locations and transportation or reimbursement of costs for travel to clinics. Services provided in these clinics are multidisciplinary and include referral to other service organizations as needed, especially for mental health and substance-abuse counseling. Ryan White CARE Act funds are administered by local consortia that include public and private medical providers, community-based organizations, local governments, business groups, persons with HIV infection, and others. Additional partnerships between small businesses and public health agencies have resulted in donation of food services for persons with AIDS and the construction of a hospice.

The Georgia Department of Human Resources has used AIDS surveillance and HIV-prevalence data to guide development of services for persons with HIV/AIDS. Surveillance data also have enabled the efficient use of resources in planning comprehensive programs for all parts of the state, including small cities and rural areas.

References

1. Green T, Karon JM, Nwanyanwu O. Changes in AIDS incidence trends in the United States. J Acquir Immune Defic Syndr 1992;5:547-55.

2. Ellerbrock TV, Bush TJ, Chamberland ME, Oxtoby MJ. Epidemiology of women with AIDS in the United States, 1981 through 1990. JAMA 1991;265:2971-5.

3. Murrill CS, Kuncl KA, Weeks HR, Whyte BM, Petersen LR, Janssen RS. HIV seroprevalence in hospital patients in rural Georgia. Southern Med J 1992;85:969-71.

4. Whyte BM, Carr JC. Comparison of AIDS in women in rural and urban Georgia. Southern Med J 1992;85:571-8.

• Albany, Athens, Augusta, Columbus, Macon, Savannah; population of the county of the core city 88,000-255,000, 1990 U.S. census. ** Areas not including a metropolitan statistical area central county. *** Public Law 101-381.

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