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AIDS status. (3) The State Enhanced Pediatric HIV Surveillance Program (STEP) is an enhanced pediatric surveillance system that is conducted in four states (New Jersey, South Carolina, Michigan, Louisiana) with adult and pediatric HIV reporting. This system also includes data on HIV-exposed and HIV-infected children. (4) The Pregnancy Risk Assessment Monitoring System (PRAMS) is a population-based surveillance system based on a sample of women with a recent live birth. Information is gathered through a mailed questionnaire with a telephone follow-up. In 1996, 11 states participated. (5) The Perinatal Guidelines Evaluation Project (PGEP) is an in-depth, ongoing four-site project (Connecticut; North Carolina; Brooklyn, New York; and Miami, Florida) using medical chart reviews and interview data of pregnant and postpartum women. The prenatal study population is restricted to women whose health care providers had discussed HIV with them within the previous 60 days. The postpartum study population was a cross section of women delivering in the study's site hospital. (6) Pediatric Spectrum of Disease (PSD) is an eight-site medical record review of HIV-exposed and infected children in care at participating sites since 1989.
HIV/AIDS Trends in Women
The HIV/AIDS epidemic in women is concentrated in the Northeast and in the South, with the highest rates found in New York, New Jersey, Florida, Maryland, Connecticut, and Puerto Rico. States with the greatest number of cases include New York, New Jersey, Florida, California, and Texas. While the highest rates were first observed in the Northeast, during the past five years the greatest increase in rates has been in the South. African-American and Hispanic women are disproportionately affected. Over time, the number of cases among women attributable to injection drug use has declined, while the proportion attributable to heterosexual contacts has increased.
It is estimated that from 6,000 to 7,000 HIV-infected women delivered infants each year from 1989 to 1995. Trend data from the SCBW showed a relatively steady national rate of HIV seroprevalence for childbearing women between 1989 and 1994. There are, however, important regional variations. In the Northeast, where the epidemic started and peaked earliest, there was a 22% decline in the rate of HIV-infected childbearing women giving birth between 1989 and 1994. In the South, where the epidemic started later, there was a 25% increase between 1989 and 1991, which then leveled off. The West and Midwest have had stable and relatively low rates.
HIV/AIDS Trends in Infants and Children
Perinatal transmission accounts for virtually all new HIV infections in children. It is estimated that more than 15,000 HIV-infected children have been born to HIV-infected mothers in the United States. By the end of 1997, more than