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Emerging U.S. Heterosexual AIDS Epidemic

Since the HIV pandemic began, patterns of HIV transmission in the U.S. have changed. To assess rising rates of heterosexual transmission, CDC investigators verified initial reports of the mode of HIV exposure to confirm heterosexual risk and to determine the proportion of that risk among cases initially reported as having no risk. Risk was reclassified using a hierarchy that considered sexual practices, receipt of blood products, and injection drug use (IDU).

AIDS cases from six sites underwent multi-source chart review to identify route of infection, using the CDC hierarchy to reclassify patients with multiple heterosexual risks. Of 8,637 cases, 3,649 (42%) that met study requirements were randomly selected. Through routine surveillance, 378 cases (10.4%) had already been reclassified. Among the 3,271 remaining cases, heterosexual risk was validated for 76% of men and 87% of women. Of 893 cases (27.3%) initially reported as having no risk, 22% of men and 60% of women were reclassified as having heterosexual risk. Nearly half of all patients initially classified as heterosexual contacts of HIV-infected partners with unspecified risk were reclassified as IDUs, and an additional 43% of women were reclassified as contacts of IDUs. Odds of reclassification differed significantly by gender, race, age (for men), and study site.

Comment: Accurate recording of risks for HIV infection is considered essential for design, implementation, and evaluation of HIV-prevention programs. These data confirm the existence of a U.S. heterosexual AIDS epidemic. The role of IDU deserves further evaluation and incorporation into prevention and control strategies.

— LM Mundy

Published in Journal Watch Infectious Diseases March 1, 1999

Citation(s):

Klevens RM et al. Is there really a heterosexual AIDS epidemic in the United States? Findings from a multisite validation study, 1992-1995. Am J Epidemiol 1999 Jan 1 149 75-84.

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