Epidemiology A near-logarithmic increase in AIDS cases over the years has occurred, with approximately 1000 cases reported in 1983, progressing to 10,000 in 1985, 100,000 in 1989, and 500,000 in 1995. While it took 9 years to see the first 100,000 cases, the second 100,000 were observed in less than 3 years, and the third 100,000 in about 2 years. According to a Centers for Disease Control and Prevention (CDC) HIV/AIDS surveillance report, 581,429 cases had been reported in the United States as of December 1996. While the rate increase has been leveling off in this country, according to Piot, this is not the case in the developing world, where an increase in cases surpasses any rate the United States has experienced.
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| Another noteworthy fact is that the numbers cited represent cases of AIDS, not those
who are HIV infected, a group whose number exceeds those diagnosed with AIDS and most of
whom are asymptomatic, according to Kron and coworkers. It is believed that of the 750,000
persons in the United States thought to be HIV infected, one third are unaware of their
positive status, according to Steinbrook’s observations. Thus, the obligation to
screen and find these persons becomes paramount, as monitoring of recently infected
persons helps in evaluating prevention programs and estimating resources to be used in
treatment.
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Although the modes of transmission (as noted by Chamberland and associates) have not changed since first determined in the early 1980s, the category percentages have, according to a MMWR 1997 update on disease trends. Through intensive educational efforts, the proportion of persons who acquire HIV through homosexual activity (men having sex with men) still represents the largest group but is yielding to injecting drug use, with needle sharing the category that will inevitably predominate. There are a number of reasons for this, including lack of access to health care, psychiatric disorders, poor social support, and distrust of authority.
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| More disturbing is the rate of transmission noted in the heterosexual population,
including women (the fastest growing group) and adolescents, per the MMWR 1997
trend report and research by Lindegren et al. Although knowledge of AIDS and its
consequences has been well established through educational efforts, high-risk behavior
among teenagers continues in light of perceptions of immortality that are difficult to
overcome. According to a study by Padian et al, not only are women up to 20 times more
likely to contract HIV from a male sex partner than the converse, but until recently, per
a Fact Sheet from the National Pediatric HIV Resource Center, women have routinely been
denied access to new therapies. This is because of their potential to become pregnant and
because women often function as caretakers and heads of households, taking care of ill
partners as well as children and other household members. Newborns constitute another group whose rate is high, but inroads are being made through screening interventions of pregnant women. Finally, through the screening of donated blood and blood products, the number of persons contracting HIV through this mode decreases every year and will hopefully shrink to insignificant numbers in the near future, according to Selik and colleagues. A recent report by Altman showing a decline for the first time in the annual number of AIDS-related deaths garnered much attention in the press. Although this was good news, it was not nearly as satisfying as a decrease in new cases would be. Therefore, until an effective vaccine is developed, education toward prevention will continue to be more important than the latest advances in medical therapies.
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