Hawai‘i State Department of Health

AIDS cases increased in Hawai`i through 1993. Comparisons over time are complicated by expansions of the AIDS case definition, as well as changes in reporting practices. Failure to report cases continues to be a problem and restricts our understanding of the extent and nature of the epidemic in Hawai`i. The data below are shown by year of AIDS diagnosis, which differs from other reports by year of report.

The most important measure of changes in the AIDS epidemic is the annual incidence of HIV infection. However, we are unable to track this incidence rate, since there is no population-based surveillance for HIV infection (people who are HIV positive may not have been tested and diagnosed) and because there is no mechanism to obtain an unduplicated count of positive HIV tests in Hawai`i. The incidence of diagnosed AIDS cases is the best measure available to track the epidemic.

Males (95% of AIDS cases in Hawai`i), males who have had sex with other men (80%), and Caucasians (68%) are over-represented in proportion to their contribution to the state population. However, the number of females diagnosed with AIDS has steadily increased every year with 22 cases diagnosed in 1993.

Healthy Hawai`i 2000 Objective Baseline (1990)⁷¹ and current data 18.A Confine annual Incidence of AIDS*1990 1991 1992 1993 1994 incidence of diagnosed AIDS cases per 100,000 15.0 18.3 21.1 24.2 17.8 cases to no more than 20 cases per 100,000. Male Cases 160 199 229 266 198 Female Cases 6 8 14 22 12 *by year of diagnosis

NOTE: The AIDS case definition was expanded in 1993, which may be responsible in part for the increase in cases that year.
⁷¹Hawai`i Department of Health, AIDS Surveillance Program, Communicable Disease Division, special tabulation.

AIDS cases in Hawai`i are reported in accordance with the national reporting requirements of the Centers for Disease Control and Prevention (CDC). The standardized reports of AIDS cases are used to determine federal funding levels.

Although physicians and hospitals are required to report AIDS cases under Hawai`i law, problems of late and incomplete reporting persist. The actual number of cases may be higher. The Hawai`i Department of Health also conducts active surveillance of AIDS cases through close coordination with infection control personnel in hospitals, death registry reviews, and outreach to physicians.

Because of the social sensitivity of this disease, it is not possible to collect accurate, population-based data on incidence and seroprevalence of HIV. However, the seropositivity rates of HIV among men tested at state anonymous test sites has been tracked since 1986.

Three important components of HIV prevention are broad-based education to encourage adoption of behaviors that reduce risk of infection, targeted interventions with high-risk populations, and accessible counseling and testing services to increase the number of people who are aware of their HIV status. Risk reduction practices are often more rapidly and completely adopted by people who know that they are infected with HIV.

Concerted efforts by all health agencies and community organizations are necessary to implement effective culture and agespecific risk reduction programs. Such programs should aim to reduce highrisk behavior throughout the entire population, with particular emphasis on highrisk groups such as people with large numbers of sexual partners, adolescents (both in and out of school), intravenous drug users and sex partners of drug injectors, men who have sex with men and their partners, people who exchange sex for money or drugs, and people already infected with HIV.