"Worldwide, the majority of human immunodeficiency virus (HIV) infections result from heterosexual transmission." By contrast, in the US, HIV transmission has been primarily between gay or bisexual men but that is now changing. More and more, the newly diagnosed HIV cases in the US are among heterosexuals and/or intravenous drug users. The majority are black and the majority are women.

These latest grim statistics are contained in a new report (below) compiled by the CDC. It is important to compile these numbers at this time. The International Conference on Women and Infectious Diseases will be held Feb. 27-28, 2004 in Atlanta, GA. How to protect women from HIV infection will be a major topic under discussion.

Persons in certain racial/ethnic populations continue to have disproportionate numbers of HIV infections. Non-Hispanic black and Hispanic populations constituted 21% of the total population of the 29 states in the study, according to the 2000 U.S. Census, yet these populations accounted for 84% of heterosexually acquired HIV infections during 1999--2002. HIV infections are concentrated in populations that traditionally have had limited access to prevention services, medical care, and effective therapies. Lack of knowledge about HIV, decreased perception of risk, use of drugs or alcohol, and different interpretations of so-called "safe sex" might contribute to the risk for HIV infection among non-Hispanic blacks and Hispanics (6). In addition, because of social patterns, non-Hispanic black and Hispanic females are more likely than other females to be exposed to HIV because of a higher prevalence of infection among non-Hispanic black and Hispanic males (7).

Diagnosis of HIV and AIDS in the same calendar month occurred with 20% of the heterosexually acquired HIV infections, reflecting HIV diagnosis late in the course of infection and suggesting late testing in the course of the disease. A previous study determined that 41% (43,089 of 104,780) of persons with reported HIV infections also received an AIDS diagnosis within 1 year, which might indicate treatment failure or late testing (8).

The findings in this report are subject to at least three limitations. First, although AIDS is a reportable condition in the United States, during 1999--2002, name-based HIV case data were available from only 29 states, which reported an estimated 39% of all AIDS cases. Nationwide reporting of HIV diagnoses would improve data regarding the HIV-infected population. Second, cases with no identified mode of exposure were classified into exposure categories on the basis of follow-up investigation. Cases with follow-up information were assumed to constitute a representative sample of all cases initially reported with no identified exposure, and the distribution among exposure categories was assumed to be consistent during the preceding 10 years. Finally, completeness of reporting and potential duplicate reporting by states are being evaluated in accordance with CDC's performance standards for HIV/AIDS surveillance (2). Reported HIV infections are estimated to represent >85% of all HIV infections (9).

CDC recommends reporting on the prevalence of HIV infection to detect patterns in HIV transmission. New testing technology that distinguishes between recent and long-term infections will allow for better characterization of HIV-transmission patterns and more rapid and targeted preventive measures (10). CDC is working in areas of high morbidity (i.e., >300 AIDS cases per year) to integrate this technology into routine HIV case surveillance.

Racial/ethnic disparities continue among persons with HIV infections. Culturally sensitive HIV-prevention messages are needed to target those populations most affected. Prevention and education programs targeting heterosexually active teens, especially females and persons in certain racial/ethnic populations, should be developed. In addition, non-Hispanic black and Hispanic populations, which historically have less access to treatment and prevention services, are affected disproportionately by HIV. Barriers to care and prevention services for these populations should be removed.

References

Joint United Nations Programme on HIV/AIDS (UNAIDS). Report on the global HIV/AIDS epidemic, 2002. Geneva, Switzerland: World Health Organization, July 2002.

CDC. Guidelines for national human immunodeficiency virus case surveillance, including monitoring for human immunodeficiency virus infection and acquired immunodeficiency syndrome. MMWR 1999;48(No. RR-13).

Green T. Using surveillance data to monitor trends in the AIDS epidemic. Stat Med 1998;17:143--54.

Brookmeyer R, Liao J. The analysis of delays in disease reporting: methods and results for the acquired immunodeficiency syndrome. Am J Epidemiol 1990;132:355--65.

Lee LM, Fleming PL. Trends in human immunodeficiency virus diagnoses among women in the United States, 1994--1998. J Am Med Womens Assoc 2001;56:94--9.

Essien EJ, Meshack AF, Ross MW. Misperceptions about HIV transmission among heterosexual African-American and Latino men and women. J Natl Med Assoc 2002;94:304--12.

Kellerman S, Wortley P, Fleming P. The changing epidemic of HIV. Curr Infect Dis Rep 2000;2:457--65.

Neal JJ, Fleming PL. Frequency and predictors of late HIV diagnosis in the United States, 1994 through 1999 [Poster]. Presented at the 9th Conference on Retroviruses and Opportunistic Infections, Seattle, Washington, February 24--28, 2002.

CDC. HIV/AIDS Surveillance Report, 2002. Vol. 14. Available at http://www.cdc.gov/hiv/stats/hasrlink.htm.

CDC. Advancing HIV prevention: new strategies for a changing epidemic---United States, 2003. MMWR 2003;52:329--32.