• Elaine Daniels, M.D., Ph.D.

A thorough overview of the epidemiology of HIV in the U.S. was given by Dr. Elaine Daniels. Against the backdrop of the overwhelming numbers of people globally currently living with HIV, she proceeded to provide comprehensive data on HIV in different age groups, genders, geographic areas and racial groups.

Globally, there were an estimated 15,000,000 people newly infected with HIV in the year 2000. In the same year, there were an estimated three million deaths, bringing the cumulative death toll worldwide to 21.8 million. The World Health Organization estimates the number of people living with HIV at 36.1 million globally.

Although the estimate of 920,000 people living with HIV in North America pales in comparison to the 25.3 million in sub-Saharan Africa, the details of U.S. epidemiology raise many issues of major concern, particularly in the African American community.

In 1999, African Americans, who make up 12% of the U.S. population, represented 47% of AIDS cases in the U.S. In addition, the much-publicized declines in mortality rates among people with AIDS have not been seen in African Americans to anywhere near the same degree. Although in the 25-44 year age group, AIDS has not been the number one cause of death since 1996, it remains number one among African American men aged 25-44, and number two among African American women of the same age.

Geographically, increasing numbers of people with HIV disease live in the southern U.S. In the South as well as in smaller towns, the prevalent mode of transmission in women was heterosexual intercourse, whereas in larger cities injection drug use predominated.

For the best indication of recent trends, Dr. Daniels turned to rates of infection in the 13-19 year age group. In this group, risk factors among males were predominantly men who have sex with men and men living with hemophilia, whereas among females the major mode of transmission was heterosexual. In the 20-24 year age group, homosexual transmission predominated in men, and in women injection drug use as well as heterosexual activity predominated. Male to female ratios in these age groups were informative. In the 13-19 year age group, males and females were about equally represented, with men assuming increasing prevalence with age beyond that. Dr. Daniels discussed factors for susceptibility of youth including behavioral, biological and socioeconomic as well as gender power imbalance.

Dr. Daniels stressed several times that injection drug use was fueling the heterosexual spread of HIV. In light of recent data, it is important to add that male homosexual activity, particularly in the African American community, is also a crucial accelerant to the spread of HIV. Of note, data are available to support the fact that 75% of women are unaware of their sexual partner's risk.

In closing, Dr. Daniels touched on an often-overlooked additional risk of having spent at least one night in jail. Dr. Daniels' overview of epidemiology provided an important insight into evolving trends in the epidemic and potential targets for intervention. She noted that with continued funding of programs aimed at providing services to the HIV-infected communities, outcomes would be assessed to ensure that moneys were directed appropriately.