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Health Disparities Statistics
HUMAN IMMUNODEFICIENCY VIRUS - HIV
GOAL
Prevent human immunodeficiency virus (HIV) infection and its related illness and death.
OVERVIEW
The HIV/AIDS surveillance program was established in January 1983 to assess the
migration of HIV infection into the United States Virgin Islands’ (USVI) population. The
purpose of the program is to monitor the incidence and prevalence of HIV infection
(including AIDS), morbidity and mortality in adults/adolescents and children, behaviors,
transmission trends, access to care, and resources for treatment.
The first case of AIDS was reported in January 1983, and like the mainland, the number
of cases has increased annually. The mission of the HIV/AIDS surveillance program is to
monitor the progress of HIV infection and AIDS through continuous and systematic
collection, analysis, evaluation and dissemination of HIV/AIDS surveillance data.
The HIV/AIDS Surveillance Program conducts both active and passive surveillance
through a variety of reporting sites. Active surveillance is the direct on site solicitation of
case reports from AIDS care providers, as opposed to passive surveillance, which
depends on the provider voluntarily reporting the case. Currently, active surveillance is
the method used to obtain HIV/AIDS case reports from public and private health clinics,
primary care physicians and two public in-patient hospitals. A combination of active and
passive surveillance techniques is utilized to obtain case reports from private clinical
laboratories in the territory. Each laboratory is required to submit a listing of HIV positive
serology tests to the Surveillance Officer followed by a monthly site visit focusing on
review of laboratory testing logbooks. Either method commands a great deal of time,
establishing the trust of providers, developing a working relationship, and continual
feedback and communication to maintain the providers’ interest in reporting.
ISSUES AND TRENDS
The Virgin Islands has a high case rate of HIV infection, compared to the rest of the
United States, being within the top five states or territories since the territory began to
report statistics. Because of the lack of information about risk and transmission of the
disease, and sexual mores, there is a high rate of other STDs as well, which increases
the risk of HIV transmission. HIV infection is a stigmatized disease in the Territory,
leading many to avoid testing for HIV, so that by the time they present for care, many
patients have severe immuno-suppression, or AIDS. In the Virgin Islands, the most
common risk factor for HIV infection is unprotected heterosexual sex, and the number of
men and women who have the disease is nearly equal. Substance abuse is also an
important factor in transmission, with alcohol and heroin in St. Croix and crack in St.
Thomas being the most frequently abused drugs. Because HIV counseling and testing is
not widely available or acceptable, many people are unaware of their serostatus, and
need to prevent transmission to their sexual partners. It is suspected that there will
continue to be an increase in new cases in the Virgin Islands over the next decade as
previous infections come to diagnosis, and their partners are also tested.
DISPARITIES
In the Virgin Islands, the population majority is Afro-Caribbean, with a small number of
Hispanics and Caucasians. As expected, persons of Afro-Caribbean descent make up
68% of those diagnosed with HIV, but Hispanics make up a larger than expected
percentage at 28%. Additionally, heterosexual transmission is the most common risk
factor for infection, with 55% of the patients in care having this risk factor. Women make
up 43% of the patients in care. Because of the capped nature of the Medical Assistance
program in the Virgin Islands, fewer patients qualify for this federal program and 65% of
patients in treatment must be covered by the Ryan White Emergency Act ADAP for
medications.
OPPORTUNITIES
Strategies for reducing HIV transmission will include enhancing prevention strategies for
the general population and increasing the number of people who know their HIV status to
help them reduce the risk of transmission and to stay healthy. The Virgin Islands now has
HIV surveillance, Prevention and CARE grants from the federal government to work to
ensure that these strategies are carried out.
Source: United States Virgin Islands Healthy Virgin Islands 2010
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