This set of slides describes the Hawaii AIDS epidemic and outlines the impact of HIV/AIDS in Hawaii. By studying change over time, it identifies trends in certain groups.

A cumulative total of 2,454 AIDS cases had been reported in Hawaii as of December 31, 2000. AIDS incidence increased each year through 1993. AIDS cases peaked in 1993 and decreased thereafter except in 1998. The increase in AIDS incidence in 1993 was due to the expanded definition of AIDS. The decline in AIDS incidence shown since 1996 is due to the introduction of successful treatment therapies that delay the progression of HIV infection.

3. AIDS Rates per 100,000 population by Year of Diagnosis, 1983-2000, Hawaii

The annual AIDS rates increased gradually from the beginning of the epidemic through 1993, then decreased thereafter except 1998. The large increase (25.4 per 100,000 population) in 1993 was due to expansion of the definition of AIDS.

4. AIDS–Related Death, 1983-2000, Hawaii

Of the 2,454 cumulative AIDS cases, 1,452 (59.2%) had died as of December 31, 2000. Deaths peaked in 1994 with 170 then declined annually. Thirty-three deaths occurred in 1999, an 80.6% decline compared to 1994, and a 13.4% decline compared to the 38 deaths in 1998. The decrease of AIDS–related deaths has been ascribed largely to the effect of new successful treatments.

5. AIDS Incidence by Three Time Periods (1983-2000), Hawaii

Of the 2,454 cumulative AIDS cases, 25.7% were reported during 1983-1990, 47.2% during 1991-1995, and 27.1% during 1996-2000.

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6. AIDS Cases by Race/Ethnicity, 1983-2000, Hawaii

Caucasians comprised the majority of cumulative AIDS cases (1,557, 63.4%), but accounted for only 33.4% of the state’s population*. African Americans were also disproportionately represented (4.3% of AIDS cases versus 2.5% of the state population). All other racial/ethnic groups had a lower proportion of AIDS cases than their proportion of population.

*1990 population, U.S Census

7. Percentage of AIDS Cases by Race/Ethnicity, Three Time Periods (1983-2000), Hawaii

The proportional distribution of AIDS cases among racial/ethnic groups has changed over time since the beginning of the epidemic. The proportion of cases among Caucasians decreased from 72.9% before 1991 to 62.7% in 1991-1995, to 55.9% in 1996-2000, while it increased among Hispanics, African-Americans and Asian/Pacific Islanders.

8. Percentage of AIDS Cases Among APIs, Three Time Periods (1983-2000), Hawaii

Asian/Pacific Islanders (APIs) comprised 26.8% (657) of the AIDS cases through December 2000. APIs include Hawaiians, Filipinos, Japanese, and other APIs. Except Chinese, the proportion of AIDS cases* has increased in each of the three time periods for all API groups. The "Other API" category contains many different ethnic groups, each with too few cases to be shown separately.

* All API groups are shown as a percent of total AIDS cases.

9. AIDS Cases by Sex, 1983-2000, Hawaii

As of December 31, 2000, 2,294 (93.5%) male and 160 (6.5%) female AIDS cases had been reported in Hawaii. The figure in the right shows that females accounted for an increasing proportion and number of AIDS cases (3.2% and 20 cases before 1991, to 5.9% and 68 cases in 1991-1995, to 10.8% and 72 cases in 1996-2000), but males still accounted for a considerably larger proportion and number in the same time periods.

10. AIDS Cases by Age, 1983-2000, Hawaii

Most AIDS cases (74.6%) are diagnosed in individuals in their thirties and forties. There have been 8 adolescent cases (13-19 years of age) and 16 pediatric cases (diagnosis before age 13). On average, there has been less than one case per year of pediatric AIDS.

11. AIDS Cases by Age, Three Time Periods (1983-2000), Hawaii

Over time, there was a decrease in the proportion of AIDS cases for people in their twenties, a slight decrease in the proportion of AIDS cases for people in their thirties, and an increase in the proportion of cases of those in their forties and over 49.

12. AIDS Cases by Risk, 1983-2000, Hawaii

Men who have sex with men (MSM) accounted for the majority of cases (1,866, 76.0%), followed by injection drug users (IDU) (168, 6.8%), MSM/IDU (167, 6.8%), heterosexual contact (127, 5.2%) and without an identified risk (68, 2.8%). The remaining 2.4% of AIDS cases included those attributed to hemophilia, the receipt of blood or blood products, and perinatal.

13. Percentage of AIDS Cases by Risk, Three Time Periods (1983-2000), Hawaii

The proportion of AIDS cases attributed to MSM had decreased, from 80.6% before 1991, to 78% in 1991-1995 to 68.3% in 1996-2000. The downward shift can also be seen in MSM/IDU. The increase in proportion attributed to IDU was relatively slight in the current period, from 7.3% in 1991-1995 to 8.1% in 1996-2000. The proportion attributed to heterosexual contact increased from 1.6% before 1991 to 4.8% in 1991-1995 and to 9.2% in 1996-2000.

14. IDU-Related AIDS Cases, 1983-2000, Hawaii

Through December 31, 2000, a cumulative total 388 (15.8%) AIDS cases were associated with injection drug use. Of these, 43.3% (168) were IDU, 43.0% (167) were MSM/IDU. Twelve percent (47) of IDU-related cases were heterosexual partners of an IDU. The remaining 1.6% (6) of IDU-related cases was IDU mother and mother with IDU partner.

15. Male AIDS Cases by Risk, 1983-2000, Hawaii

A cumulative total of 2,294 male AIDS cases were reported in Hawaii through December 2000. Of these, over four-fifths of male AIDS cases were MSM, and 7.3% cases were MSM/IDU. IDUs accounted for 5.2% of male AIDS cases. Heterosexual contact accounted for 1.8% of male AIDS cases.

16. Percentage of Male AIDS Cases by Risk, Three Time Periods (1983-2000), Hawaii

The proportion of male AIDS cases attributed to MSM and MSM/IDU has decreased over time. The proportion of male AIDS cases attributed to IDU and heterosexual contact has increased.

17. Male AIDS Cases by Race/Ethnicity, 1983-2000, Hawaii

Of the 2,294 male AIDS cases, more than half were Caucasian, 25.2% APIs, 4.9% Hispanic, 4.3% African-American and 0.4% American/Indian. The figure on the right shows the breakdown of male AIDS cases for the API group. Hawaiians accounted for 9.8% and Filipinos for 4.7% of male AIDS cases

* All API groups are shown as a percent of total male AIDS cases.

18. Female AIDS Cases by Race/Ethnicity, 1983- 2000, Hawaii

Of the160 female AIDS cases, approximately half were APIs, with Hawaiians being the largest single API group (20.0%). Caucasians accounted for 40.0% and Hispanics for 6.9% of female AIDS cases.

* All API groups are shown as a percent of total female AIDS cases.

19. Female AIDS Cases by Risk, 1983-2000, Hawaii

More than half of female AIDS cases are attributed to heterosexual contact; 30.0% are IDU. Heterosexual contact and IDU are major risk factors for females. The figures on the right show the risks of women ‘s partners. Over two thirds of women with AIDS are partners of male IDUs or of HIV+ men whose specific risk factors are not identified in the case report.

* All groups are shown as a percent of total female AIDS cases.

20. The Geographic Distribution of HIV/AIDS Infection in Hawaii, 1983-2000

Of the 2,454 reported AIDS cases, over two-thirds (1,797, 73.2%) were reported from Honolulu County. The remaining 26.8% of cases were reported from Hawaii County (316, 12.9%), Maui County (239, 9.7%) and Kauai County (103, 4.2%).

21. AIDS Cases by County, 1983-2000, Hawaii

The largest number of AIDS cases was reported in 1991-1995 and decreased in 1996-2000 in each county. The greatest number of AIDS cases was reported in Honolulu County in each of the three time periods. The figures on the right show the proportion of AIDS cases by county in 1996-2000. In 1996-2000, the proportion of AIDS cases in Maui County exceeded its proportion of the state’s population* (12.2% versus 10.1%), and the proportion of AIDS cases in Honolulu and Kauai Counties was lower than that of the state’s population.

*1998 estimated population, U.S.

22. AIDS Rates per 100,000 Population by County, Three Time Periods (1983-2000), Hawaii

AIDS rates were highest in 1991-1995 and decreased in 1996-2000 for each county. In 1996-2000, Maui County had the highest AIDS rate (67.1 per 100,000 population), followed by Hawaii County (55.7), Honolulu County (54.9) and Kauai County (48.0).

23. AIDS Cases by County and Sex, 1996-2000, Hawaii

Compared to the state AIDS profile (male 89.2%, female 10.8%), Hawaii County has a much larger proportion of the total AIDS cases among females (19.0%); Kauai County and Maui County have a greater proportion of the total AIDS cases among males (96.3% and 93.8%).

24. Persons Living with AIDS at the End of Each Year, Hawaii

Since the number of newly diagnosed AIDS cases each year has exceeded the number of deaths, the number of persons living with AIDS continues to increase. At the end of 2000, a total of 1,002 persons were living with AIDS in Hawaii, resulting in the prevalence rate of 82.7 AIDS cases per 100,000 population

25. Persons Living with AIDS, as of December 31, 2000, Hawaii

Of the 1,002 individuals reported living with AIDS, 915 were male and 87 female. Most persons living with AIDS (755, 75.3%) were aged 30-49 years old at diagnosis. Honolulu County had the highest number and percentage (689, 68.8%) of persons living with AIDS, followed by Hawaii County (152, 15.2%), Maui County (124, 12.4%), and Kauai County (37, 3.7%).

26. Persons Living with AIDS by Race/Ethnicity, as of December 31, 2000, Hawaii

The majority of individuals living with AIDS were Caucasians (634 cases, 63.0%,), followed by APIs (238, 23.6%,), Hispanics (69, 6.9%,), African-Americans (56, 5.6%,) and other (5, 0.5%,). Among APIs, Hawaiians accounted for 84 (8.3%) of total living AIDS cases, followed by Filipinos (53, 5.3%), Japanese (42, 4.2%), Chinese (19, 1.9%) and other APIs combined (10, 4.0%).

* All API groups are shown as a percent of total persons living with AIDS.

27. Persons Living with AIDS by Risk, as of
December 31, 2000, Hawaii

The majority of people living with AIDS acquired their HIV via MSM (71.7%, 718 cases). The second and third highest risk behaviors were IDU (7.9%, 79 cases) and MSM/IDU (7.3%, 73 cases). Heterosexual contact accounted for 7.2% (72) of the cases.

28. Acknowledgments.

Sincere appreciation to the following individuals for contributions and support:

Peter Whiticar, Chief of STD/AIDS Prevention Branch, Hawaii Department of Health

Jamie Leonard, Community Planning Group Coordinator, STD/AIDS Prevention Branch, Hawaii Department of Health