Incidence and Diagnoses of HIV Infection — Puerto Rico, 2006 (MMWR Published 6-05-09)
In 2006, 33 U.S. states and five territories had confidential, name-based, human immunodeficiency virus (HIV) infection reporting; among territories, Puerto Rico had the second highest rate of HIV infection (1). To characterize the HIV epidemic in Puerto Rico in 2006 (the year with the most recent available data), the Puerto Rico Department of Health and CDC analyzed data on diagnoses of HIV infection (including infections that occurred in 2006 and in previous years) and used a stratified extrapolation approach developed by CDC (2) to generate HIV incidence estimates (the number of persons newly infected with HIV in 2006). The results indicated that, in 2006, an estimated 1,440 persons aged >13 years were newly infected with HIV in Puerto Rico, resulting in an estimated incidence rate of 45.0 cases per 100,000 population, twice the rate for the 50 U.S. states and District of Columbia (DC). Males accounted for 65% of new HIV infections in Puerto Rico, and 38% of new HIV infections occurred among persons aged 30–39 years; 39% of new infections were associated with injection-drug use, and 37% with high-risk heterosexual contact. The results provide insight into HIV transmission patterns in Puerto Rico that can help guide allocation of resources and the planning, implementation, and evaluation of HIV prevention programs and other services.
Calculation of diagnoses of HIV infection (i.e., HIV diagnosed with or without a concurrent or later acquired immunodeficiency syndrome [AIDS] diagnosis) was based on the 1,021 diagnoses in 2006 among persons aged >13 years reported to CDC by the Puerto Rico Department of Health through June 2007. Data were categorized by sex, age group, and mode of HIV transmission. The following hierarchy was used for HIV transmission categories: 1) male-to-male sexual contact, 2) injection-drug use, 3) male-to-male sexual contact and injection-drug use, and 4) high-risk heterosexual contact (i.e., with a sex partner known to have or to be at high risk for HIV infection). The number of reported diagnoses was adjusted for reporting delay using a previously reported procedure (3). In addition, for diagnosed cases missing transmission category (32%), a multiple imputation procedure was used (4). Percentages were calculated for sex, age group, and transmission categories. HIV diagnosis rates per 100,000 population were calculated for sex and age group using post census estimates for 2006 (5). HIV incidence for Puerto Rico was calculated using the stratified extrapolation approach (2,6). Remnant diagnostic serum specimens from persons aged >13 years and diagnosed with HIV infection in 2006 in Puerto Rico were tested with the BED HIV-1 capture enzyme immunoassay (BED) to classify infections as recent or long-standing. In addition to the BED result, the estimation method requires HIV testing history, demographic data, and behavioral information for persons with HIV infection diagnosed in 2006. HIV incidence was calculated from cases based on the 1,021 diagnoses of HIV infection, adjusted to 1,460 for reporting delays in 2006. Percentages were calculated for sex, age group, and transmission categories. HIV incidence rates per 100,000 population were calculated for sex and age group using official post census estimates for 2006 (5).
In 2006, after adjustment for reporting delays, 1,460 persons aged >13 years were diagnosed with HIV infection in Puerto Rico (Table 1). Of these, 1,036 (71%) were males and 424 (29%) were females. By age group, the greatest number of diagnoses of HIV infection occurred among those aged 30–39 years, followed by those aged 40–49 years. Among males, the most common mode of HIV transmission was injection-drug use (40%), followed by male-to-male sexual contact (30%). Among females, the most common mode of HIV transmission was high-risk heterosexual contact (73%), followed by injection-drug use (27%). The rate of diagnosis of HIV infection in Puerto Rico in 2006 was 45.5 per 100,000 population.
An estimated 1,440 persons (45.0 per 100,000 population) were newly infected with HIV in 2006. The HIV incidence rate among males (62.0) was twice that among females (29.8). The highest rate of incident HIV infections, among persons aged 30–39 years (103.6), was 1.7 times that of the age group
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