evolving during the same period that dramatic declines occurred in perinatally acquired pediatric AIDS cases, it is useful to look at whether declines in pediatric AIDS reflect more than declines in PCP. CDC surveillance findings show substantial declines not only in PCP, but also in other opportunistic infections for which specific prophylaxis was not available, indicating that the decline in pediatric AIDS cases is not being driven solely by changes in PCP, but appears to reflect true declining perinatal HIV transmission rates.
Pediatric AIDS cases are concentrated in eastern states, and especially in the New York metropolitan area. In 1996, three states alone—New York, New Jersey, and Florida—reported 330 cases. This represents 49% of the diagnosed cases, even though only 15% of children are born in those states (CDC, 1996b; Ventura et al., 1998). In contrast to their concentration in the Northeast, perinatal AIDS cases are less common in most geographical areas. In 1997, 39 states had fewer than ten perinatally transmitted AIDS cases (CDC, 1997e).
Figure 3.3 displays pediatric AIDS incidence rates (perinatal AIDS cases as a proportion of births) by state for 1996 as an illustration of this great variability, ranging from 30.9 per 10,000 births in the District of Columbia to zero in 14 states. The District of Columbia. Florida (6.3 per 10,000). New York (6.1 per 10,000), New Jersey (4.3 per 10,000), Connecticut (3.8 per 10,000), and Maryland (3.0 per