Urban and Nonurban Areas - HIV

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  • HIV Surveillance in Urban and Nonurban Areas
  • 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.
  • The majority of adults and adolescents diagnosed with HIV infection in 2009 resided in metropolitan areas with populations of 500,000 or more in the 40 states with confidential name-based HIV infection reporting since at least January 2006. The rate of diagnosis of HIV infection was highest (26.7 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 40 states have had laws or regulations requiring confidential name-based HIV infection reporting since at least January 2006: Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.   Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been estimated. 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 majority of adults and adolescents diagnosed with HIV infection in 2009 resided in metropolitan areas with populations of 500,000 or more in the 40 states with confidential name-based HIV infection reporting since at least January 2006. 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 40 states have had laws or regulations requiring confidential name-based HIV infection reporting since at least January 2006: Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.   Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been estimated. 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.
  • In each of the population categories in the 40 states with confidential name-based HIV infection reporting since at least January 2006, at least two-thirds of diagnoses of HIV infection among males during 2009 were in 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 40 states have had laws or regulations requiring confidential name-based HIV infection reporting since at least January 2006: Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.   Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been estimated. 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.
  • In each of the population categories in the 40 states with confidential name-based HIV infection reporting since at least January 2006, 85% or more of diagnoses of HIV infection among females during 2009 were in 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 40 states have had laws or regulations requiring confidential name-based HIV infection reporting since at least January 2006: Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.   Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been estimated. 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.
  • This slide shows the distribution of diagnoses of HIV infection during 2009 among adults and adolescents by age at diagnosis and by population of area of residence in the 40 states with confidential name-based HIV infection reporting since at least January 2006. The overall pattern of the distribution of ages at diagnosis only differed by population of area of residence for persons aged 25-34 and 35-44 years. That is, slightly higher percentages of diagnoses were seen among persons aged 25-34 years compared to persons 35-44 years in areas with populations of 500,000 or greater, as well as in areas with populations of 50,000-499,999; meanwhile, the reverse was seen among persons residing in nonmetropolitan areas. In each category, approximately 25% to 26% of diagnoses of HIV infection were among adults aged 35 to 44 years at diagnosis, 24% to 27% were among adults aged 25 to 34 years, and an additional 19% to 21% were among adults aged 45 to 54 years. Approximately 18% to 22% of diagnoses in each population were among persons aged 13–24 years, and 8% to 10% of diagnoses in each category were among adults aged 55 years and older at diagnosis.   The following 40 states have had laws or regulations requiring confidential name-based HIV infection reporting since at least January 2006: Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.   Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been estimated. 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.
  • This slide shows the numbers and rates of adults and adolescents living with a diagnosis of HIV infection at the end of 2008 in the 40 states with confidential name-based HIV infection reporting since at least January 2006, 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 1,379.7 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 40 states have had laws or regulations requiring confidential name-based HIV infection reporting since at least January 2006: Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.   Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been estimated. 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 race/ethnicity classification system).   Hispanics/Latinos can be of any race.
  • The percentage of AIDS diagnoses among adults and adolescents residing in areas with populations of 500,000 or more has decreased slowly since 1985. In 1985, 91% of all AIDS diagnoses were in areas with populations of 500,000 or more, and in 2009, 82% of diagnoses were in these areas. Although modest, the increases in areas of smaller populations from 1985 to 2009 reflect the spread of the epidemic in the United States, from large urban areas into smaller suburban and non-urban areas.   All displayed data have been estimated. 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 majority of adults and adolescents diagnosed with AIDS in 2009 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 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 500,000 or more compared to areas with smaller populations.   All displayed data have been estimated. 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 race/ethnicity classification system).   Hispanics/Latinos can be of any race.
  • 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, 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
  • In 2009, 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 have been estimated. 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
  • Numbers and rates (per 100,000) of AIDS diagnoses among adults and adolescents in 2009 are shown for each region and population category for area of residence. 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 have been estimated. 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
  • In 2009, in the Northeastern region of the United States, the highest rates of AIDS diagnoses in each population of area of residence were among blacks/African Americans. The rates of AIDS diagnoses in Hispanics/Latinos and whites decreased as population size decreased. In large metropolitan areas (500,000 or greater) in the Northeast, Native Hawaiians/other Pacific Islanders had the second highest rate of AIDS diagnoses in 2009, 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 have been estimated. 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 residence 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 race/ethnicity classification system).   Hispanics/Latinos can be of any race.
  • In 2009, in the Midwestern region of the United States, the highest rates of AIDS diagnoses in each population of area of residence 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 Blacks/African Americans, Hispanics/Latinos, and whites were lowest in smaller metropolitan areas (50,000-499,999) compared to areas of other population sizes. The rates of AIDS diagnoses in American Indians/Alaska Natives and Native Hawaiians/other Pacific Islanders were highest in smaller metropolitan areas compared to areas of other population sizes.   All displayed data have been estimated. 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 residence 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 race/ethnicity classification system).   Hispanics/Latinos can be of any race.
  • In 2009, in the Southern region of the United States, the highest rates of AIDS diagnoses in each population of area of residence 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 nonmetropolitan areas; however, this rate should be interpreted with caution because the number of AIDS diagnoses among Asians in Southern nonmetropolitan areas is small.   All displayed data have been estimated. 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 residence 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 race/ethnicity classification system).   Hispanics/Latinos can be of any race.
  • In 2009, in the Western region of the United States, the highest rates of AIDS diagnoses in each population of area of residence 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, 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 of AIDS diagnoses among Asians in the West were in smaller metropolitan areas (50,000–499,999); however, this rate should be interpreted with caution because the number of AIDS diagnoses among Asians in smaller metropolitan areas in the West is small.   All displayed data have been estimated. 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 residence 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 race/ethnicity classification system).   Hispanics/Latinos can be of any race.
  • In each region of the United States, the majority of adults and adolescents living with an AIDS diagnosis at the end of 2008 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 50,000-499,999, 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 have been estimated. 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
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