FIGURE 2-2 Incidence of tuberculosis, 1980 to 1990.

SOURCE: Center for Prevention Services, Centers for Disease Control.

The TB incidence rate among people infected with HIV is nearly 500 times the rate for the general population. In contrast to some fungal and other bacterial infections that occur only in the late stages of HIV disease, TB is a sentinel disease for HIV infection and tends to occur prior to other opportunistic infections, often before individuals realize they are HIV seropositive. In healthy individuals, pulmonary tuberculosis can be diagnosed and treated with relative ease (the cure rate is approximately 95 percent). In immunocom-promised persons, however, the disease is often disseminated throughout the body, making it much more difficult to diagnose and treat.

Sexual Activity and Substance Abuse

The HIV disease pandemic is the most devastating outbreak of a sexually transmitted disease since the emergence of syphilis almost 500 years ago in Western Europe. Syphilis, a bacterial disease, spread rapidly during the late fifteenth and early sixteenth centuries, quickly reaching a prevalence of 20 percent in many urban areas (Hirsch, 1885). Scholars believe that the disease was disseminated by the sexual activities of soldiers, and heterosexual promiscuity was, and continues to be, the primary mechanism by which the infection is spread. The incidence of syphilis in the United States fell dramatically earlier in this century with the introduction of penicillin. Between 1985 and 1990, however, incidence almost doubled, most notably among

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