| As of December 1996, 59% of US men with AIDS contracted the virus by
having sex with men, while the majority of US women (45%) contracted HIV through injecting
drug use. Thirty-eight percent of women contracted HIV via heterosexual sex, a category
whose rate is notably increasing. The impact of AIDS on minorities has also been felt. Per
the CDC HIV/AIDS surveillance report, as of 1996, blacks represent the majority of cases.
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In viewing these statistics, it is clear who is at high risk for
contracting HIV, and efforts toward screening and prevention education can be targeted
accordingly. These risk groups have not changed since the advent of the epidemic and
include injecting drug users, gay and bisexual men, blood product recipients (especially
between 1978 and 1985), hemophiliacs, sexual contacts of these groups, and newborns of
HIV-seropositive mothers.
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| As the years progress, the number of cases involving receipt of blood products should
continue to shrink. Blood has been screened for the past 12 years, and it can therefore be
assumed, per Levy, that virtually all cases of AIDS obtained in this manner likely would
have been detected by now, especially since virus exposure in this form is much greater
than via percutaneous spread or sex. It is still possible to contract HIV via blood,
particularly in other countries where screening processes are under significantly less
scrutiny. According to a report by Lackritz and associates, the risk is down to
approximately one in 500,000 units in the United States, employing careful history taking
and serologic screening for other sexually transmitted diseases, as well as p24 antigen.
Risk remains because of the conversion window period and the fact that, with the exception
of p24, HIV antigens are not screened. To do so would be cost intensive and at this time
raise the price of a unit of blood to prohibitive levels.
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| Persons at little or no risk for HIV infection include household
contacts, casual contacts, and health care workers. In a study by Friedland et al, among
206 contacts of 90 patients with AIDS who were initially seronegative, none converted
after a 36-month follow-up period. Activities included the sharing of razors (not
recommended), toothbrushes, combs, towels, eating utensils, bed, toilet, and drinking
glasses; other activities included washing patients’ dishes and clothes, toilet
cleaning, bathing, hugging, and kissing.
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The occupational risk among health care workers does not exceed that of the general population. The risk of infection after a needle stick from a documented HIV-infected source is 0.36%, or one in 250 exposures. According to Tokars et al, this has remained consistent over the years through ongoing studies conducted by the CDC. Of course, the risk is less when serologic status of the source is unknown, as not all of these sharp implements will be contaminated with HIV. To date, per the CDC HIV/AIDS | ||
| surveillance report, more than 52 occupationally derived seroconversions
have been documented. According to Mangione et al, there are undoubtedly more, but for
various reasons, including fear of loss of job, they have not been reported. More than a
third of these seroconversions could have been prevented through proper observation of
universal precautions or body substance isolation.
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