HIV/AIDS Prevention

The HIV epidemic among U.S. women has grown substantially since the last time this newsletter focused on women and HIV (see April 1991 issue -- Vol. 2, No. 1). Recently, the epidemic among women has drawn national and international attention following release of the NIH study of microbicide use in Africa (see related article, NIH and Family Health International Release Preliminary Results from Cameroon Nonoxynol-9 Study), the National Women and HIV Conference last month, and continuing reports documenting advances in the prevention of HIV transmission from mothers to their newborns. The year-end 1996 edition of CDC's HIV/AIDS Surveillance Report documented the following trends in the epidemic among U.S. women:

• The proportion of total AIDS cases reported among women continues to increase. From 1985 through 1996, the proportion of adolescent/adult women reported to CDC with AIDS increased steadily each year, from 7 percent to 20 percent of reported cases.

• Of the total cases reported among women, the proportion attributable to heterosexual contact also is increasing. In 1994, the number of AIDS cases in women attributed to heterosexual HIV transmission surpassed the number attributed to transmission through injection drug use; however, sexual contact with a man who injects drugs accounts for the majority of heterosexually acquired HIV cases among women.

Although most AIDS cases in women are reported from metropolitan areas, the epidemic is increasing in rural areas, especially through heterosexual transmission. In CDC's Supplement to HIV/AIDS Surveillance Project conducted in five small cities/rural areas of the South during 1995 and 1996, 66 percent of HIV/AIDS cases among women interviewed for the project were attributable to heterosexual contact. Of the 222 women interviewed, 25 percent had sex in exchange for money or drugs, 26 percent used "crack" cocaine in the past 6 months, and 57 percent reported having had a sexually transmitted disease in the previous 10 years. (See related article, The Role of STD Testing and Treatment in HIV Prevention) After finding out about their infection, 24 percent continued to engage in behaviors that could lead to transmission of HIV.

One-third (34 percent) of women in this project had only lived and practiced risk behaviors in the rural area or small city where they were interviewed. More than half (57 percent) had moved to the rural area from somewhere else; of those who moved, about half moved after finding out about their infection.

Prevention programs in these rural areas and small cities should focus on preventing sexual transmission of HIV and other STDs. Because sexual behaviors may be difficult to change for persons who are addicted to "crack" cocaine or other drugs, there also is a strong need for drug abuse prevention and treatment services. Programs should be able to ensure confidentiality and security of information, issues that may be very important to persons living in rural areas and small cities.

Status of the AIDS Epidemic

From June 1982 through December 1996, CDC received reports of 581,429 cases of AIDS among persons of all ages and racial/ethnic groups in the United States, including 85,500 cases (15 percent) among women. HIV infection is the third leading cause of death among women aged 25-44 and is the leading cause of death among black women in this same age group.

In 1996 alone, 69,151 AIDS cases were reported to CDC and, of these cases, 13,820 (20 percent) were reported among women. More than 80 percent of these cases were reported from metropolitan statistical areas with populations greater than 500,000. Black and Hispanic women have been disproportionately affected, accounting for 59 percent and 19 percent, respectively, of women reported in 1996. AIDS rates for black and Hispanic women are 17 and 6 times higher than for white women (61.7 and 22.7 compared with 3.5 per 100,000, respectively). Women under age 30 accounted for 22 percent of reported cases in 1996. Because the time from initial infection with HIV to the development of AIDS is variable and can be long, it is apparent that many of these young women acquired their infections in their teens and early twenties.

The states with the highest overall AIDS rates per 100,000 population in 1996 were New York, New Jersey, Florida, Maryland, and Delaware. The states with the highest number of AIDS cases reported in 1996 were New York (3,249), Florida (1,825), New Jersey (1,050), California (940), and Texas (722).

For further analysis of surveillance trends in the HIV/AIDS epidemic, consult the HIV/AIDS Surveillance Report. The most recent issue of the report, as well as many other resources, can be obtained by contacting the CDC National AIDS Clearinghouse (see telephone number and address). You also may access the report and related information via the Internet at DHAP's web site or the CDC National AIDS Clearinghouse web site.

For further reading on Women and HIV...

Ellerbrock TV, Bush TJ, Chamberland ME, et al. Epidemiology of Women with AIDS in the United States, 1981 through 1990: A Comparison with Heterosexual Men with AIDS. JAMA 1991;265:2971-5

Miller KS, Clark LF, and Moore JS. Heterosexual Risk for HIV among Female Adolescents: Sexual Initiation with Older Male Partners. Family Planning Perspectives (in press)

Selik RM, Chu SY, Buehler JW. HIV Infection as Leading Cause of Death Among Young Adults in U.S. Cities and States. JAMA 1993; 269: 2991-4

CDC's Morbidity and Mortality Weekly Report articles:

Update: Trends in AIDS Incidence, Deaths, and Prevalence -- United States, 1996. MMWR 1997;46:165-73

AIDS Associated with Injecting-Drug Use -- United States, 1995. MMWR 1996; 45:392-8

Update: AIDS Among Women -- United States, 1994. MMWR 1995; 44:81-4. Erratum: MMWR 1995;44:135

AIDS Among Children -- United States, 1996. MMWR 1996;45(46):1005-1010

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