Introduction

The incidence and prevalence of AIDS continue to be a major concern in the state of New Jersey. However, the expansion of a comprehensive intervention program, including prevention efforts and access to effective drug therapies, has had a very significant positive impact.

The incidence of AIDS in New Jersey has declined and it appears likely that most of the year 2000 incidence targets will be met. However, the AIDS incidence rates among minority women continue to be a source of concern. One of the most encouraging signs has been the trend in the AIDS/HIV death rate. In 1996 there was, for the first-time since this data has been collected, a decline in the HIV/AIDS death rate from the previous year. It is likely New Jersey will reach its year 2000 objective for an actual decline in this rate.

Outlook for Reaching Specific Objectives:
	Achieve target:		Likely	Unlikely	Uncertain
6A.	Decrease the AIDS incidence among:
		Children
		White non-Hispanic males, 25-44
		Black non-Hispanic males, 25-44
		Black non-Hispanic females, 15-44
		Hispanic males, 25-44
		Hispanic females, 15-44
6B.	Reduction in HIV death rates for:
		total population
		persons 25-44
6C.	Reduce mothers of newborns with HIV

Data Update

6A. Decrease the incidence of AIDS per 100,000 population in each category to:

5.3 in the pediatric population aged 0-9 years
37.0 in white non-Hispanic males 25-44 years
349.1 in black non-Hispanic males 25-44 years
98.9 in black non-Hispanic females 15-44 years
145.6 in Hispanic males 25-44 years
19.8 in Hispanic females 15-44 years

Achieve target:	Likely	Unlikely	Uncertain
children
white non-Hispanic males, 25-44
black non-Hispanic males, 25-44
black non-Hispanic females, 15-44
Hispanic males, 25-44
Hispanic females, 15-44

Despite the major increases in the incidence rates which resulted from a revision in 1993 by the federal government in the definition of AIDS, New Jersey's rates have declined in each of the high-risk groups in every year since. The incidence rate in children through 9 years of age reached the year 2000 objective in 1994 and continues to decline. Among white, non-Hispanic males, 25 through 44 years of age, the rate had decreased by 1996 to a point virtually meeting the year 2000 target. The rates in the black, non-Hispanic male population and the Hispanic male population, 25 through 44 years, are also declining at rates which make the achievement of the year 2000 targets for these groups likely. The only uncertainty lies with the population of females, 15 through 44 years, both black, non-Hispanic and Hispanic. For both of these groups, the incidence rate is declining, but it is unclear whether the rate of decline is sufficient to meet the target levels in the year 2000.

6B. Decrease the death rates due to HIV infection per 100,000 population to:

12.1 in the total population, age-adjusted
30.1 in the population aged 25-44 years

Achieve target:	Likely	Unlikely	Uncertain
total population
persons 25-44

Between 1988 and 1995, the death rate from HIV infection increased at a steady, albeit slowing, rate annually. In 1996, however, there was an actual decline in the death rate, both for the total population and persons aged 25 through 44 years. This reversal in the trend is probably primarily due to the new medical treatments available to persons with AIDS/HIV infection, which have extended survival for some. It may also reflect the decline in incidence noted in Objective 6A. It is likely that the year 2000 health objectives will be met.

6C. Decrease the percentage of HIV-positive readings in mothers of newborns to:

0.30 percent

Achieve target:	Likely	Unlikely	Uncertain

The year 2000 target was achieved in 1995, and the trend suggests maintenance of this objective, or even improvement over the target level.

Discussion

In 1996, HIV/AIDS infection dropped in the ranking of leading causes of death in New Jersey to eighth place, from sixth in 1995. However, it remains the leading cause of death for black men aged 25 through 44 and black women aged 15 through 44. It is the second leading cause of death for white men aged 25 through 44, and is tied with unintentional injuries as the second leading cause of death for white women in this age group. Because women infected with HIV are the major source of infection for infants, the trends in women's HIV/AIDS mortality are related to HIV/AIDS incidence in children. New Jersey has the second highest incidence rate for pediatric AIDS cases in the country (defined as children from birth through nine years of age).

During the 1980s and into the early 1990s, AIDS incidence and death rates increased almost every year in New Jersey. In recent years, however, the incidence rate has declined, as has the overall mortality rate. There has also been a change over the past decade in the impact of AIDS on different segments of New Jersey's population. The following trends have emerged:

· The number of AIDS cases among heterosexual injecting drug users has increased steadily. ·

· AIDS and HIV infection have increased in minority women and children. Eighty-seven percent of New Jersey's pediatric cases are black or Hispanic. ·

· Heterosexual contact cases are increasing very rapidly, accounting for about 16 percent of all HIV and AIDS cases ever reported in New Jersey. The vast majority of cases infected by heterosexual contact are black or Hispanic, more than half of whom are female partners of injecting drug-using men. ·

· The proportion of cases among blacks and Hispanics has steadily increased. These groups account for nearly three-quarters of New Jersey AIDS cases and more than 79 percent of those infected with HIV who have not progressed to AIDS, even though they are less than 20 percent of the State's population. ·

With the increasing impact of the HIV/AIDS epidemic, New Jersey focused on creating and expanding a comprehensive intervention, prevention, care and treatment network. This network, which initially started as an unrelated group of counseling, testing and prevention programs sprinkled across the state, quickly grew to a coordinated system of comprehensive programs where quality care, treatment and prevention programs were established in every county.

With considerable community and stakeholder involvement, the Department developed in 1994 a comprehensive HIV prevention plan for New Jersey. As a result of this plan, prevention efforts are targeted to special populations, including injecting drug users, women at risk of heterosexual transmission, men who have sex with men, and infants infected before birth.

In 1994 a clinical trial involving HIV positive pregnant women demonstrated that Zidovudine (ZDV/AZT) taken during pregnancy is effective in reducing the transmission of HIV infection from mother to child. Since then, New Jersey has made a concerted effort to educate both health care providers and women of childbearing age of the benefits of HIV testing and use of ZDV/AZT for pregnant women who test positive. A law was passed to require providers to counsel pregnant women about these benefits. As a result of these and other measures, the incidence of pediatric AIDS has declined substantially, even though it is still high by national standards.

HIV testing of individuals at risk for infection increased from testing 2,400 in 1986 to more than 65,000 in 1997. Counseling and testing have also been made available to patients at clinics for sexually transmitted diseases, prenatal and family planning clinics, drug treatment programs and TB clinics. Infected individuals among those tested are referred to a network of early intervention programs, where they can receive state of the art treatment for HIV disease. With the emergence and availability of anti-retroviral medications such as AZT, 3TC and ddI in the 1980s and early 1990s, and more powerful drugs such as protease inhibitors and non-nucleoside reverse transcriptase inhibitors in the 1990s, New Jersey has provided a network of care for an estimated 12,000 individuals infected with HIV. Through this network, infected individuals are also able to access other ancillary services to address a multitude of health concerns for them and /or family members.

The federal Ryan White Care Act of 1990 created funding for cities and/or regions (such as Newark, Jersey City and Paterson) which were hit the hardest by the HIV/AIDS epidemic. The greatest growth and impact of Ryan White funding has been in providing financial assistance to uninsured or underinsured patients with HIV to purchase life-sustaining drugs through the state's AIDS Drug Distribution Program (ADDP). Each year, more than 2,600 individuals with HIV directly benefit by having their drugs (many of which cost $5,000 annually) paid for by the ADDP program. ADDP permits these individuals to gain access to critical and life saving drug therapies while maintaining an acceptable standard of living.

As a result of these programs, progress has been made in reducing the incidence of AIDS within designated populations, and in decreasing the rate at which New Jersey citizens are dying from HIV infection. Despite this progress, the toll that AIDS is taking, especially in minority communities, remains too high. The Department will continue to make its efforts to reduce the spread of HIV infection one of its highest priorities.