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The numbers are small, but Dr. Cecilia Shikuma, University of Hawaii professor of medicine and director of the medical school's HIV/AIDS Program, said she's concerned about the upward trends.
The state Health Department's 2005 HIV/AIDS Surveillance Semiannual report shows a total of 212 female AIDS cases from 1983 to the end of 2004, Shikuma noted.
But 72 female cases, 12 percent of the total, were reported in the past five years, "so it is going up, similar to national trends."
Also, she said, "what concerns me, according to the 2005 epidemiological profile, is 45.8 percent of total female AIDS cases are Asian/Pacific Islanders -- our local community, not the Caucasian population."
She noted that 26.2 percent of the men with AIDS are Asians or Pacific Islanders.
Hawaiians make up 18.2 percent of female cases, compared with 10.2 percent of cases for men.
According to the state report, 1,293 Hawaii residents were living with AIDS at the end of 2004 -- 1,164 men and 129 women.
The risk for becoming infected appears to be changing, Shikuma said, noting it used to be primarily through male-to-male sex.
"Now that females are increasingly being reported, it means an increase in more heterosexual spread, and by intravenous drug use," she said.
The state's needle exchange program has reduced risks of exposure through injecting drugs, she pointed out, so much of the female increase is likely due to heterosexual spread.
A U.S. Centers for Disease Control and Prevention report earlier this month said the estimated number of AIDS cases nationally increased 15 percent among women and only 1 percent among men from 1999 to 2004.
Peter Whiticar, chief of the state Health Department's STD/AIDS Prevention Branch, said CDC reported at a National HIV Prevention Conference two weeks ago that a million Americans are living with HIV/AIDS.
A national goal to reduce 40,000 new infections annually to 20,000 hasn't been met, he said.
The CDC estimates 180,000 to 280,000 people nationally have the HIV virus and don't know it.
"The rate of HIV infections in Hawaii thankfully is small compared to the rest of the nation," Shikuma said. "Needle exchange has a lot to do with it.
"But though it's a small problem, there are hints that the local population (Hawaiians, Asians and Pacific Islanders) are infected more, and deserves to be monitored more ."
Hawaiians accounted for 12.5 percent of reported AIDS cases in the last five years, exceeding their 8.6 percent proportion of the general population, Shikuma said.
She said she also noticed that Hawaiians constitute 16 percent of those receiving free drugs from the state's Drug Assistance Program for qualified HIV/AIDS patients without insurance. "Again, they are overrepresented."
Whiticar said female cases may be increasing proportionately because the share of male cases is going down, probably due to prevention efforts reaching men who have sex with men.
He said his branch is working increasingly with Papa Ola Lokahi, a nonprofit organization dedicated to improving the health status of Hawaiians, and other community-based organizations for training and outreach to Asians and Pacific Islanders.
He said the state must make sure that sexually transmitted disease screening and treatment services and HIV counseling and testing are culturally appropriate and accessible to those who need them.
Whiticar said the state's surveillance report, which lists 2,779 AIDS cases in Hawaii from 1983 through 2004, has become less useful as an indicator of the epidemic.
"People with HIV are accessing medical care, taking medicine and not progressing to AIDS."
It's important to have accurate HIV data because it probably will be incorporated in federal funding formulas, he said.
Whiticar said his major message is that people at risk -- having unprotected sex -- should be tested and treated for sexually transmitted diseases.
The new surveillance report notes a resurgence of syphilis, gonorrhea and chlamydia rates in recent years.
For example, fewer than two male cases of syphilis occurred on an average per year for six years up to 2001-2003, when the number jumped to 35.
"For the vast majority of the population, they may think they're not at risk for HIV, but they're certainly at risk for STD, which increases the risk for HIV transmission," Whiticar said.