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Women & HIV-CDC Updates HIV/AIDS Surveillance Among Women in US
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The US Centers for Disease Control and Prevention (CDC) on September 23, 2004 updated its HIV/AIDS surveillance information on adult women and adolescents in the US through 2002. Following this introduction on minority & young women is the updated surveillance data provided by the CDC in slideset format.
HIV/AIDS Among US Women: Minority and Young Women at Continuing Risk
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Between 1992 and 1999, the number of persons living with AIDS increased, as a result of the 1993 expanded AIDS case definition and, more recently, improved survival among those who have benefited from the new combination drug therapies. During that 7-year period, a growing proportion of persons living with AIDS were women, reflecting the ongoing shift in populations affected by the epidemic. In 1992, women accounted for 14% of adults/adolescents living with AIDS -- by 1999, the proportion had grown to 20%.
Since 1985, the proportion of all AIDS cases reported among adult and adolescent women has more than tripled, from 7% in 1985 to 25% in 1999. The epidemic has increased most dramatically among women of color. African American and Hispanic women together represent less than one-fourth of all U.S. women, yet they account for more than three-fourths (78%) of AIDS cases reported to date among women in our country. In 2000 alone (see chart above), African American and Hispanic women represented an even greater proportion (80%) of cases reported in women.
While HIV/AIDS-related deaths among women continued to decrease in 1999, largely as a result of recent advances in HIV treatment, HIV/AIDS was the 5th leading cause of death for U.S. women aged 25-44. Among African American women in this same age group, HIV/AIDS was the third leading cause of death in 1999.
Heterosexual Contact Now Is Greatest Risk for Women
Sex with drug users plays large role
In 2000, 38% of women reported with AIDS were infected through heterosexual exposure to HIV; injection drug use accounted for 25% of cases. In addition to the direct risks associated with drug injection (sharing needles), drug use also is fueling the heterosexual spread of the epidemic. A significant proportion of women infected heterosexually were infected through sex with an injection drug user. Reducing the toll of the epidemic among women will require efforts to combat substance abuse, in addition to reducing HIV risk behaviors.
Many HIV/AIDS cases among women in the United States are initially reported without risk information, suggesting that women may be unaware of their partners' risk factors or that the health care system is not documenting their risk. Historically, more than two-thirds of AIDS cases among women initially reported without identified risk were later reclassified as heterosexual transmission, and just over one-fourth were attributed to injection drug use.
Prevention Needs of Women
Pay attention to prevention for women.
The AIDS epidemic is far from over. Scientists believe that cases of HIV infection reported among 13- to 24-year-olds are indicative of overall trends in HIV incidence (the number of new infections in a given time period, usually a year) because this age group has more recently initiated high-risk behaviors --and females made up nearly half (47%) of HIV cases in this age group reported from the 34 areas with confidential HIV reporting for adults and adolescents in 2000. Further, for all years combined, young African American and Hispanic women account for three-fourths of HIV infections reported among females between the ages of 13 and 24 in these areas.
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--Implement programs that have been proven effective in changing risky behaviors among women and sustaining those changes over time, maintaining a focus on both the uninfected and infected populations of women.
--Increase emphasis on prevention and treatment services for young women and women of color. Knowledge about preventive behaviors and awareness of the need to practice them is critical for each and every generation of young women -- prevention programs should be comprehensive and should include participation by parents as well as the educational system. Community-based programs must reach out-of-school youth in settings such as youth detention centers and shelters for runaways.
--Address the intersection of drug use and sexual HIV transmission. Women are at risk of acquiring HIV sexually from a partner who injects drugs and from sharing needles themselves. Additionally, women who use noninjection drugs (e.g., "crack" cocaine, methamphetamines) are at greater risk of acquiring HIV sexually, especially if they trade sex for drugs or money.
--Develop and widely disseminate effective female-controlled prevention methods. More options are urgently needed for women who are unwilling or unable to negotiate condom use with a male partner. CDC is collaborating with scientists around the world to evaluate the prevention effectiveness of the female condom and to research and develop topical microbicides that can kill HIV and the pathogens that cause STDs.
--Better integrate prevention and treatment services for women across the board, including the prevention and treatment of other STDs and substance abuse and access to antiretroviral therapy.
EIGHT SLIDES
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The proportion of AIDS cases among women and adolescent girls (aged >13 years) increased from 7% in 1985 to 26% in 2002.
AIDS incidence among female adults and adolescents rose steadily through 1993, when the AIDS surveillance case definition was expanded, and leveled off at approximately 13,000 AIDS cases each year from 1993 through 1996. In 1996, incidence among women and adolescent girls began to decline, primarily because of the success of antiretroviral therapies.
From 1996 through 2002, an average of 11,000 cases of AIDS were diagnosed in female adults and adolescents each year.
Data for this slide were statistically adjusted for reporting delays.
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In 2002, 67% of female adults and adolescents reported with AIDS were black; the rate was 49.1 cases per 100,000 black female adults and adolescents.
Although the numbers of cases reported among Hispanic and white female adults and adolescents were similar, the rate among Hispanic female adults and adolescents was more than 5 times that among whites.
Among all female adults and adolescents, the number of AIDS cases reported was lowest among Asians/Pacific Islanders and American Indians/Alaska Natives; however, the rate among American Indians/Alaska Natives was higher than among Asians/Pacific Islanders.
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CDC estimates that 68% of the 10,955 AIDS cases diagnosed among female adults and adolescents in 2002 can be attributed to heterosexual transmission: 15% of these cases are from heterosexual contact with an injection drug user and 53% from sexual contact with high-risk partners such as bisexual men or HIV-infected men with unspecified risks.
Of the cases in female adults and adolescents, 29% were attributed to injection drug use and 3% to other or unidentified risks.
Data for this slide were statistically adjusted for reporting delays and redistribution of cases initially reported without risk.
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Most of the AIDS cases diagnosed in 2002 among females aged greater than 13 years were attributed to heterosexual contact.
Of cases among women aged 35-44 years, 33% were attributed to injection drug use, compared with 14% of cases in females aged 13-19 years, 19% in women aged 20-24 years, 24% in women 25-34, and 31% in women over 45.
Of females aged 13-19 years, 21% were exposed to HIV through perinatal transmission, and are included in the "other/not identified" exposure category.
Data for this slide were statistically adjusted for reporting delays and redistribution of cases initially reported without risk.
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Rates of reported cases of AIDS per 100,000 female adults and adolescents are shown for each state and the District of Columbia. The highest rates were found in the District of Columbia, Maryland, New York, Florida, Louisiana, Delaware, South Carolina and New Jersey.
Rates were lowest in states in the Midwest. Nearly every state reported some AIDS cases among females in 2002.
The high rate in the District of Columbia should be interpreted with consideration that D.C. is more similar to a city than a state.
Rates were not calculated for states that reported fewer than 5 AIDS cases in females in 2002.
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Most female adults and adolescents diagnosed with AIDS through 2002 were exposed through injection drug use and heterosexual contact with an HIV-infected partner. By the end of 2002, more than 146,000 AIDS cases among female adults and adolescents had been attributed to injection drug use and heterosexual contact.
Most cases have been among female adults and adolescents in the Northeast and South. More than half of the female adults and adolescents with AIDS attributed to injection drug use resided in the Northeast, and more female adults and adolescents there, in contrast to the other regions, were exposed through injection drug use.
In the South, the majority of female adults and adolescents with AIDS were exposed through heterosexual contact. Approximately 4 to 5 times more cases resided in the South compared to the Midwest and the West.
In the Midwest and West, more female adults and adolescents were exposed through heterosexual contact than injection drug use.
Data for this slide were statistically adjusted for reporting delays and redistribution of cases initially reported without risk.
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Most reported AIDS cases among female adults and adolescents resided in the Northeast and the South; in these regions, most cases were among black, not Hispanic female adults and adolescents.
In the Midwest region, most cases were among black, not Hispanic female adults and adolescents. In the West, there was less disparity in the AIDS case counts among white, black, and Hispanic female adults and adolescents.
Data are not shown for Asian/Pacific Islander and American Indian/Alaska Native female adults and adolescents because the numbers reported in 2002, when stratified by region of residence, were low.
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In 2002, there were 50,595 female adults and adolescents aged 15-44 years reported to be living with AIDS in the United States.
An additional 42,047 female adults and adolescents in this age group were reported living with HIV infection (not AIDS) in areas that conduct name-based, confidential, HIV surveillance in adults and adolescents.
States with integrated HIV and AIDS surveillance data may be better able to target programs and services to reduce transmission to newborns.
The numbers presented here are an underestimate of female adults and adolescents living with HIV or AIDS, since many reside in states without integrated HIV/AIDS surveillance. In addition, there may be many infected females who have not been tested or not reported in areas with relatively new HIV infection surveillance systems.
In most states with HIV surveillance, the number of reported HIV infected female adults and adolescents who have not progressed to AIDS exceeds the number of female adults and adolescents with AIDS. Together these numbers indicate the burden of HIV and the number of persons in need of HIV-related medical and social services for themselves and to prevent transmission of HIV to their children.
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