No Time to Lose Getting More from HIV Prevention (2001) / Chapter Skim
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Appendix A: The Changing Epidemic
Appendix A: The Changing Epidemic
Pages 137-151
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Appendixes
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metropolitan areas. American Journal of Public Health 86:642~54.
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. Cases reported in the United States account for less than 1 percent of the estimated cases reported worldwide (Text Box A.1~.
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. Modes of Transmission In the United States, the primary modes of HIV transmission have been sexual intercourse and injection drug use.
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were infected in the course of pregnancy, delivery, or breast feeding (IOM, 19991. In the early 1990s, roughly 1,000 children were diagnosed with 4since the surveillance system is hierarchical, any admission by an HIV-infected person of injection drug use after 1977 will result in assignment to that risk exposure category, even if a given individual might be much more likely to have acquired HIV through heterosexual routes.
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One of the greatest successes in HIV prevention occurred with the 1994 finding that administration of the antiretroviral drug zidovudine during pregnancy and childbirth could reduce the chances of perinatal transmission by two-thirds (Connor et al., 1994~. The rapid implementation and use of zidovudine and other antiretroviral drugs in clinical settings, combined with efforts to identify and treat HIVinfected pregnant women through HIV screening in prenatal care settings, led to dramatic declines in the number of pediatric AIDS cases (Figure Aid.
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Adjusted for reporting delays and redistribution of NlRs, data reported through December 1999 FIGURE A.3 Perinatally acquired AIDS cases by quarter-year of diagnosis, 19851998, United States.
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Furthermore, a proportion of "risk not specified" cases would fall into these risk exposure categories if the data were available (CDC, 2000b) .5 AIDS Cases in Racial and Ethnic Minorities Racial and ethnic minorities, particularly African Americans and Hispanics, have been disproportionately affected by the AIDS epidemic.
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Among Caucasians of the same age group, AIDS is the fifth leading cause of death (Murphy, 2000~. In 1998, the most recent year for which data are available, the death rate from AIDS for African Americans (32.5 per 100,000)
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In 1999, 79 percent of AIDS cases were diagnosed in metropolitan areas with populations of 500,000 or more. Ten metropolitan areas (New York City, Los Angeles, San Francisco, Miami, Washington, D.C., Chicago, Houston, Philadelphia, Newark, and Atlanta)
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Many of these individuals lack access to necessary health services, including primary medical care, substance abuse treatment, and HIV care (including treatment with new antiretroviral therapies) (scuff et al., 1999~.
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Epidemiological studies suggest that people may be two to five times more likely to become HIV-infected when other STDs are present (Levine et al., 1998; Patterson et al., 1998; IOM, 1997~. Similarly, studies suggest that for HIV-infected individuals, the presence of another STD infection increases the likelihood of transmitting HIV to sexual partners (e.g., through genital lesions or increased concentration of HIV in genital secretions)
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Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report 48(RR-13~:1-31.
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Morbidity and Mortality Weekly Report 46:861-867. Centers for Disease Control and Prevention (CDC)
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1990. The family of HIV seroprevalence surveys: Objectives, methods, and uses of sentinel surveillance for HIV in the United States.
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