AIDS diagnoses decline for first time -- CDC
AIDS diagnoses decline for first time CDC
Cases in women still on increase
For the first time in the history of the HIV/AIDS epidemic, the number of Americans diagnosed with AIDS declined, according to the Centers for Disease Control and Prevention.
The incidence of AIDS among people over age 12 declined 6% between 1995 and 1996, from 60,620 cases to 56,730 cases, according to a study in the Sept. 18 Morbidity and Mortality Weekly Report. CDC officials attribute the decline to advances in treatment of HIV infection that have lengthened the healthy lifespan of people living with HIV and the success of HIV prevention and education efforts that have helped reduce the number of Americans becoming infected with HIV.
Despite these positive trends, there is still cause for concern. Although new AIDS diagnoses declined 15% among white gay and bisexual men, the incidence of AIDS among heterosexuals continued to rise, increasing 11% among men and 7% among women.
In a study published in the Journal of the American Medical Association, the CDC also reported that the number of U.S. women diagnosed with AIDS has increased to almost 20% of all adult AIDS cases.1 The authors found an almost sixfold increase in incidence rates between 1991 and 1995 from 0.9 cases per 100,000 women to 5.2 cases. They also discovered that the greatest increases were among women who acquired AIDS through heterosexual contact, rather than through injection drug use. By the end of 1995, the report says, 67,400 U.S. women had been diagnosed with AIDS. Of those, 11,500 were diagnosed in 1995 alone, accounting for 19% of all adult AIDS diagnoses.
Amount of decline varies by location
CDC officials also noted geographic variations in the epidemic. While the AIDS incidence in 1996 declined 12% in the West, 10% in the Midwest, and 8% in the Northeast, it declined only 1% in the South. "The epidemic is slowing in the Northeast and West, but we continue to see increases in the South, largely because of the evolution of the epidemic," says Patricia Fleming, PhD, chief of HIV/AIDS surveillance for the CDC. "We know that we are seeing increases in heterosexual infections, and that is contributing disproportionately to the epidemic in the South."
Indeed, the AIDS incidence rate among women in the South increased from 6.4 adult female cases per 100,000 women in 1991 to 11.1 cases in 1995.
Even greater variations were seen by racial and ethnic groups. Based on estimates of those diagnosed in 1995, AIDS incidence declined or leveled in all racial and ethnic groups. However, it dropped 13% among whites but only 5% among Hispanics and 0% among African-Americans. There was a significant decline in AIDS incidence among gay and bisexual men who also inject drugs (-17% among whites and -13% among African-Americans).
As of December 1996, there were 235,470 Americans reported to be living with AIDS. As progression from HIV infection to AIDS diagnosis slows, the number of people living with HIV (HIV prevalence) will also increase.
Other important trends in AIDS incidence between 1995 and 1996 include:
• AIDS incidence decreased among men (-8%), but continued to increase among women (+2%).
• The greatest proportionate declines in AIDS incidence occurred among white men who have sex with men (MSM) (-15%) and white and black MSM-IDU (-17% and -13%, respectively).
• The greatest proportionate increases occurred among black and Hispanic men and women infected heterosexually. Among black and Hispanic men infected heterosexually, increases were 19% and 13%, respectively. Among black and Hispanic women infected heterosexually, increases were 12% and 5%, respectively.
Concern for young women
Public health officials are troubled by the AIDS incidence trends among women, underscoring the need for prevention programs targeted toward young women before they become sexually active. They noted a twofold increase in the incidence rate of women acquiring AIDS through heterosexual contact between 1991 and 1995, rising from 2.7 cases per 100,000 women to 5.5 cases. If trends continue, successive cohorts of young women may be at risk as they reach adolescence and early adulthood.
"Young women are at risk for HIV infection at an earlier age than young heterosexual men," the authors write. "Adolescent women are becoming infected by older sexual or needle-sharing partners. The role of older partners in HIV transmission to adolescent women must be recognized to design effective prevention interventions that do not assign to adolescent women alone the responsibility for adopting safe behaviors."
[Editor’s note: Women Alive, a national organization dedicated to women with HIV, has released the first-ever comprehensive HIV treatment guide for women. To obtain a copy of Knowledge, Action, Health A Woman’s Guide to HIV Treatments, contact Women Alive, 1566 Burnside Ave., Los Angeles, CA 90019. Telephone: (213) 965-1564.]
Reference
1. Wortley P, Fleming P, et al. AIDS in women in the United States. JAMA 1997; 278:911-916.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.