Many people in this country are still inclined to see the HIV/AIDS epidemic as a problem exclusive to male homosexuals and injection drug users. But while it remains true that the majority of people with acquired immune deficiency syndrome (AIDS) in this country are men, a new review article in the Journal of the American Medical Association (March, 7, 2001) confirms that women account for an increasing percentage of AIDS cases and that heterosexual transmission is an increasingly important means of HIV acquisition. (Note: Remember that AIDS is an advanced stage of HIV infection; everyone with HIV infection does not have AIDS, but everyone with AIDS is infected with HIV.)

Dr. Shannon L. Hader and researchers at the U.S. Centers for Disease Control and Prevention (CDC) reviewed HIV/AIDS studies published from January 1981 through July 2000 and presentations made at scientific conferences between January 1999 and July 2000. Chief among their findings: In 1986, 6.7% of all people in the U.S. with AIDS were women, but by 1999, that percentage had nearly tripled, to 18%.

Hader and colleagues also found a distressing shift in the nature of the AIDS epidemic among women. By 1998, 61% of all newly reported AIDS cases among women in this country were among black women; 41% were in the South; and 38% were attributed to heterosexual transmission. According to the authors: "The HIV epidemic in women initially centered on injection drug-using women in the urban Northeast, but now centers on women with heterosexual risk in the South, traditionally a region with some of the highest sexually transmitted disease rates in the country." And further: "Black and Hispanic women have been disproportionately affected by HIV, and now account for almost three quarters of HIV infections reported among women between the ages of 13 and 24 years."

These assertions are supported by the most recent HIV/AIDS estimates from the CDC. According to those estimates, about 40,000 new HIV infections occur each year. Of those, 70% are among men, and 30% among women. When broken down by means of disease acquisition, 42% of all new cases are from male homosexual transmission; 33% from heterosexual transmission; and 25% from injection drug use (shared needles). More than half (54%) of new infections are among Blacks; 26% among Whites; 19% among Hispanics; and 1% among other miscellaneous ethnic groups including Asians, Pacific Islanders, American Indians, and Native Alaskans. Since 1986, the region of the country with the most dramatic increase in new AIDS cases has been the South.

When the CDC estimates of new HIV cases are broken down by gender, the disparities are striking: Among men, 60% of cases are from homosexual transmission; 25% from injection drug use; and 15% from heterosexual transmission. Among women, 75% of cases are from heterosexual transmission; and 25% from injection drug use. Fifty percent of newly infected males are Black; 30% White; and 20% Hispanic. Sixty-four percent of newly infected women are Black; 18% White; and 18% Hispanic.

According to the Joint United Nations Programme on HIV/AIDS, women everywhere are increasingly affected by HIV: as of the end of 2000, of the 34.7 million adults living with HIV or AIDS worldwide, 16.4 million (47%) were women. The findings of Hader and colleagues and the CDC's most recent epidemiologic estimates confirm that women in the U.S. are part of this global trend. The disproportionately large impact of HIV on Black women in this country is especially troubling and suggests at least one clear direction for intervention and future research by the U.S. public health and medical communities.