AIDS in Women in the United States: Recent Trends

ABSTRACT & COMMENTARY

Synopsis: Though areas in the South have seen an increase in cases of HIV, tables in the paper by Wortley and Fleming show that areas all around the country are seeing increases. From early teenage years on, all women need to be informed of the facts surrounding the transmission of HIV.

Source: Wortley PM, Fleming PL. AIDS in women in the United States. JAMA 1997;278:911-916.

Wortley and fleming analyzed the recent trends in the occurrence of cases of AIDS in women in the United States. Specifically, they compared the data concerning the diagnosis of AIDS in women from 1991 to 1995. The authors chose only to analyze cases of AIDS rather than reported cases of HIV infection.

The women were studied with regard to race, mode of transmission, age, geographic region, and urban or rural location. The authors made appropriate adjustments in the rates for changes in the diagnostic criteria for AIDS.

The authors report very disturbing results. While women aged 15-24 years accounted for only 7% of the cases of AIDS diagnosed in 1995, the incidence (occurrence of new cases) of AIDS was highest in these young women. In addition, the incidence of new cases of AIDS acquired from heterosexual contact has markedly increased and now surpasses the incidence from injection drug use.

The Northeast region of the United States originally accounted for most cases of AIDS in women, primarily from the use of intravenous drugs. However, as heterosexual contact has increased as a mode of transmission for HIV, the incidence in other areas of the country have increased. This is particularly true for the South region of the country. This finding was true for both the younger and the older AIDS cases.

In their comment, the authors stress that the incidence of AIDS has increased more in women than in men in recent years, primarily with heterosexual contact. They also stress the importance of early sex education, as young women have had the most profound increase in the incidence of AIDS of any group. Studies have shown that young women who have intercourse with older males are less likely to use condoms than are young women who have same-age partners.

COMMENT BY KENNETH L. NOLLER, MD

This is an important paper for all clinicians who provide health care for women. For many years, gay men were the reservoir of HIV. In more recent years, the incidence of AIDS among gay men has dropped dramatically. Unfortunately, the incidence in women continues to rise.

While I would not recommend that you read this whole paper (even for a person like me who enjoys reading epidemiological studies, this paper was difficult), it contains an important message: All women, from early teenage years, must be made aware of the facts concerning the transmission of HIV. For some time, AIDS prevention in women has centered around avoidance of intravenous drug use and practicing safe sex. It is now clear that the safe sex message must be emphasized, particularly among adolescents. Also, we must be more diligent in those areas of the country that previously remained relatively immune from the AIDS epidemic. The recent increases in the South were emphasized in this article. However, the tables and the paper show clearly that all areas of the country are experiencing a dramatic increase in new cases of AIDS in women. Indeed, the increase in the Midwest (an area which was previously relatively spared) nearly matched that which occurred in the South. (Dr. Noller is Professor and Chairman, Department of OB/GYN, University of Massachusetts Medical Center, Worcester.)

Comparing 1991 to 1995, Wortley and Fleming determined that the greatest increase in the incidence of new cases of AIDS occurred in:

a. gay males.

b. gay females.

c. heterosexual males.

d. heterosexual females.