Chapter 2
Epidemiology

The current facts about the spread of HIV/AIDS are quite startling. As of 2003 there are 40 million persons globally who are estimated to be living with HIV/AIDS virus (CDC Basic statistics report retrieved from www on 4/2/04). By the year 2010, the projected worldwide cost will exceed $514 billion. The global HIV infection rate is estimated to be 6,000 new cases daily for persons between the ages of 15 and 24. This would mean that a young person becomes infected every 14 seconds (Advisory Board Company and Kaiser Dailey HIV/AIDS Report, 2003). In the United States, it is the leading cause of death among African Americans and the second leading cause of death of all races and genders aged 25-44.

The first year of HIV surveillance in Florida (beginning 7/1/97) demonstrated a ratio of 1.7:1 males to females respectively (compared to 4 to 1 at the beginning of the epidemic. In 2002 the ratios of men to women was 3.3:1. However, it is still potent among gay males and injecting drug users. By 2010, an estimated 25 million children will lose one or both parents to AIDS. Florida is ranked third in adult cases (11% of the U.S. total), second in pediatric cases (16.5%), and second in cases in women (14%). HIV/AIDS is the fourth leading cause of death of persons aged 25-44 in Florida (2nd nationally). Due to the widespread availability of more effective treatment regimens, AIDS cases in Area 1 (and nationally) dropped significantly since 1995 (compare 141 local cases in 1994 with 73 cases in 2002). However, that decline has ended with cases leveling off in the last few years. Most recently, cases reported in 2002 and 2003 showed a significant increase (73 cases in 2002 versus 104 reported in 2003 - a 42% increase). Although some fluctuation is normal, this increase appears to be a clear sign that the decline in AIDS cases seen since 1995 is over. (Area 1 HIV/AIDS Surveillance, Escambia County Health Department).

Women and AIDS

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, growing proportions of persons living with AIDS were women. In 1992, women accounted for 14% of adults/adolescents living with AIDS – by 1999, the proportion had grown to 20% (CDC, Infection Control Today, 2003). Women are estimated to represent almost one in three new HIV infections in the U.S. and the share of women among reported AIDS cases has more than tripled since 1986, from 7% to 26% in 2001 (www.kff.org/content/2003/30031023a). The epidemic has increased most dramatically among minority women (CDC, Infection Control Today, 2003).

Female adolescents (ages 10-19) and young adults women (20-24) are at a higher risk of HIV/STD infection for several reasons:  they may be more likely to have multiple partners, they may be more likely to engage in risky behaviors, they may be more likely to have partners at higher risk of infection, and they may be more biologically susceptible to cervical infections.

Adolescents and HIV/AIDS

Although the number of adolescents with AIDS is relatively small, we know that many more young people are infected with HIV. Since 1 in 5 reported AIDS cases is diagnosed in the 20-29 year age group, and the incubation period between HIV infection and AIDS diagnosis is 8 to ten years, it is clear that large numbers of people became infected with HIV as teenagers. Among those adolescents reported with AIDS, older teens, males, men who have sex with men and racial and ethnic minorities are disproportionately affected.

Additionally, the behaviors of young people living on the street put them at higher risk for infection. It is common for these young people to exchange sex for shelter, security, and food. Also, those addicted to drugs have been known to exchange sex for drugs or money.

HIV/AIDS Among African Americans and Hispanics

Since the early years of the epidemic, African Americans and Hispanics have been disproportionately affected by HIV/AIDS. Together these groups 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, African American and Hispanic women represented even greater proportion (80%) of cases reported in women (CDC: HIV/AIDS general report, retrieved from the www 4/2/2004).

As of 2002, the rate of reported cases among the black population is 78.2 per100,000.  This is more than 2 times greater than the rate for Hispanics (31.5 per 100,000) and more than 9 times greater than that of whites.

HIV/AIDS Exposure

Among men and women who have been reported with AIDS, three HIV exposure groups continue to account for nearly all cases of AIDS through December 2002. These are men who have sex with men (45%), injecting drug use (25%), and heterosexual contact (12%).

In pediatric cases, 96% of reported cases result from perinatal transmission.

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