reporting delays (CDC, 1997a), but by their nature these adjustments cannot be precise.1
HIV data for women and children are more problematic. As of December 1997, HIV cases are reportable in only 30 states (in 3 of these states for children only). These states reported only 28% of all prenatally acquired AIDS cases through September 1997 (CDC, 1997e). Even in these states, the data count only individuals who have been tested, not all HIV-infected individuals.
Between 1988 and 1994, most states anonymously tested newborn heel-stick blood samples for HIV in a program called the Survey of Childbearing Women (SCBW) (Davis et al., 1995). Because newborn blood carries maternal HIV antibodies, data from this survey reflect the prevalence of HIV in childbearing women. As described in Chapter 2, this survey was discontinued, but some states have continued to test newborn blood in the same way and report the results (see Appendix D). In addition, Byers and colleagues (1998) have been able to project the data from this survey to more recent years, yet the lack of recent data complicates the assessment of the impact of the PHS counseling and treatment guidelines.
In 1997, women accounted for 21% of AIDS cases in adults, and the proportion of all cases that are female continues to grow. Most of these cases are attributed to injection drug use (32%) or heterosexual contact (38%). Since most of the women in the second category attribute their infection to sex with an injection drug user (29%) or sex with an HIV-infected partner with unknown risk (64%) (CDC, 1997c), at least two-thirds of AIDS cases in women can be directly or indirectly attributed to injection drug use. Although a subset of women with HIV have injected drugs or have had sex with a known injection drug user, an increasing proportion of women have become infected through sexual activity with men whose risk behaviors were unknown to them.
In 1997, 60% of AIDS cases reported in women were in African-American, non-Hispanic women, and 20% were in Hispanic women (CDC, 1997e). AIDS incidence rates are highest in African Americans (58.8 per 100,000 women) and Hispanics (21.5 per 100,000 women), compared to 3.0 per 100,000 in white, non-Hispanic women. AIDS is more prevalent in women in the Northeast (22.3 per 100,000 women in 1995) and the South (11.1 per 100,000 in 1995). While AIDS in women is also more common in large cities—74% of 1995 cases were in metropolitan areas with more than one million population—the greatest increases
Furthermore, the published data are restricted in order to protect confidentiality. In particular, the APIDS system suppresses table cells with three or fewer cases in a state or MSA (metropolitan statistical area), even if data are aggregated over multiple areas. In addition, the most recent HIV/AIDS Surveillance Report (CDC, 1997c) contains cases reported to CDC through December 1997, while the latest APIDS release (CDC, 1997a) includes cases reported through December 1996.