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No Time to Lose: Getting More from HIV Prevention
FIGURE A.1 Estimated AIDS incidence, deaths, and prevalence in adults, quarter-year of diagnosis or death, 1985–1999, United States. SOURCE: CDC, 2000c.
portion of AIDS cases linked to sex between men declined from approximately 65 percent in 1985 to 40 percent in 1998 (CDC, 2000b; CDC, 2000c) (Figure A.2). In contrast, the proportion of AIDS cases linked to heterosexual transmission accounted for less than 5 percent in 1985 but increased to 15 percent in 1999. The proportion of cases linked to injection drug use rose through the early 1990s, but has declined in recent years. Injection drug use accounted for 22 percent of new AIDS cases in 1999 (CDC, 2000b).4
Perinatal transmission is the primary route of HIV infection among children under 13 years of age. With the exception of children infected through transfusions and blood products, which occurred mostly in the early 1980s, the vast majority of children with AIDS (92 percent) were infected in the course of pregnancy, delivery, or breast feeding (IOM, 1999). In the early 1990s, roughly 1,000 children were diagnosed with
Since the surveillance system is hierarchical, any admission by an HIV-infected person of injection drug use after 1977 will result in assignment to that risk exposure category, even if a given individual might be much more likely to have acquired HIV through heterosexual routes. Furthermore, the “no identified risk” persons are often reassigned to the heterosexual risk exposure category if resources are applied for re-interviews. Thus, this hierarchical scheme could minimize the magnitude of the heterosexual epidemic.