12th Conference on Retroviruses and Opportunistic Infections Boston, Massachusetts - February 22-25, 2005

Conf Retrovir Opportunistic Infect 2005 Feb 22-25;12:abstract no. 970

Lucia V Torian, Y Bennani, and T Frieden
New York City Dept of Hlth and Mental Hygiene, NY, USA

BACKGROUND: New York State implemented named reporting of HIV infection on June 1, 2000. Despite this mandate, the surveillance system does not capture all persons living with HIV/AIDS (PLWHA). Persons not testing for HIV may remain undiagnosed for 10+ years after seroconversion. Others are diagnosed but remain unreported. Without knowledge of the true size and characteristics of the population of PLWHA in its jurisdiction, New York City (NYC) cannot accurately monitor its HIV epidemic, plan prevention and treatment services, and project the costs of care. The New York City Department of Health and Mental Health used data from surveillance and a variety of research studies to estimate the total number of PLWHA in NYC.

METHODS: As of December 31, 2002, 84,235 PLWHA had been diagnosed in NYC. An unknown number of persons was (1) not tested after June 1, 2000, and thus not diagnosed or reported; (2) diagnosed prior to June 1, 2000, but had no subsequent reportable event; (3) diagnosed after June 1, 2000, but not reported due to provider noncompliance or technical failure of the reporting system. The number of unreported PLWHA was calculated by dividing the NYC population into subpopulations by risk and demographic characteristics, estimating the untested population, and multiplying it by a high- and low-prevalence estimate. The total prevalence is the sum of the estimated prevalence in each of the 3 unknown categories added to the known (reported) HIV/AIDS cases presumed to be living.

RESULTS: An estimated 10,115 to 40,383 PLWHA remain undiagnosed. Between 7,968 and 14,463 may have been diagnosed and are not reportable, while between 5,151 and 8,276 are estimated to be diagnosed and not reported. Therefore at least 107,000, and possibly as many as 147,000 persons, are living with HIV or AIDS in New York City. The lower estimate is concordant with local data on late diagnosis of HIV (concurrent HIV/AIDS) and with Centers for Disease Control and Prevention (CDC) estimate that 25% of PLWHA in the United States are not diagnosed. Estimates for unreported cases were broken down by risk and demographic characteristics.

CONCLUSIONS: The prevalence of HIV in NYC is estimated to be 22% to 43% greater than that measured by the HIV surveillance system. This local exercise provides NYC with valuable data on the size and characteristics of its unreported population. Detailed breakdowns can be used to plan testing and early detection campaigns, as well as to project the need for future services.

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