title: The HIV epidemic in Greenland--a slow spreading infection among adult heterosexual Greenlanders.
abstract: BACKGROUND
  We aimed to characterise the HIV epidemic in Greenland and to determine incidence, prevalence, mortality rates (MR) and specific causes of deaths.
  
  
  METHODS
  The study design used was population-based nationwide cohort study.
  
  
  METHODS
  We included all patients diagnosed with HIV in Greenland before 2011. Data were obtained from patient files, death certificates and the mandatory reports of HIV cases. Incidence and prevalence were estimated as cases/100,000 adults/year and MR as deaths/1,000 person-years (PYR). MRs were estimated for the pre-HAART (≤1996), early-HAART (1997-2004) and late-HAART (≥2005) periods. Deaths were considered AIDS related, if CD4 count <6 months before death was <200 cells/µL and/or an AIDS-related event occurred <12 months of death.
  
  
  RESULTS
  We identified 171 cases of HIV among adult Greenlanders. Of these, 133 (78%) were infected in Greenland, 17 (10%) in Denmark and 21 (12%) in other places. The majority was infected through heterosexual contact [127 (74%)], 30 (18%) through homosexual contact, 3 (2%) through intravenous drug use and 11 (6%) through other or unknown routes of transmission. The median age at HIV diagnosis was 46 years (interquartile range 34-56). The incidence increased from 3.8 before 1989 to 29.7 cases/100,000 adults/year in the late 1990s. The incidence has slowly declined to approximately eight cases/100,000 adults/year. Prevalence increased to a maximum in 2009 (174.9/100,000 inhabitants), and slowly declined since then. A total of 79 have died and 25 have emigrated. MRs were high in the pre- and early-HAART periods, 65.3 [95% confidence intervals (CI) 40.0-106.6] and 87.0 [95% CI 63.5-119.0], and a large fraction of deaths were AIDS related. In the late-HAART period, MR has declined markedly to 53.4 (95% CI 35.8-79.7) with a substantial decline in AIDS-related MR.
  
  
  CONCLUSIONS
  Heterosexual contact is the main route of HIV infection and the patients are diagnosed at a median age of 46. The incidence of newly diagnosed HIV patients has decreased markedly since year 2000. Mortality is high although declining in recent years.
authors: Department of Internal Medicine, Queen Ingrid's Hospital, Nuuk, Greenland. kbm@peqqik.gl
authors: Karen
authors: K
authors: Bjorn-Mortensen
authors: Karin
authors: K
authors: Ladefoged
authors: Niels
authors: N
authors: Obel
authors: Marie
authors: M
authors: Helleberg
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000401:mortality / Q000706:statistics & numerical data; D001110:Arctic Regions / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006116:Greenland / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology* / Q000401:mortality / Q000635:transmission*; D020010:Heterosexuality / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence
keywords: Greenland; HIV; causes of death; demographics; mortality rate