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Epidemiologic Notes and Reports Acquired Immunodeficiency Syndrome (AIDS) among Blacks and Hispanics -- United States
In the period June 1, 1981-September 8, 1986, physicians and health departments in the United States notified CDC of 24,576 patients meeting the AIDS case definition for national reporting (1-3). Of these, 6,192 (25%) were black and 3,488 (14%) were Hispanic, whereas these groups represent only 12% and 6%, respectively, of the U.S. population (4). The proportion of cases by racial/ethnic group has remained relatively constant over time (Figure 2), but the number of reported cases of AIDS among persons of all racial and ethnic backgrounds continues to rise (Figure 3).
Adult Patients. The race and ethnicity was known for 24,102 adult AIDS patients greater than or equal to 15 years of age*; 14,554 (60%) of these patients were non-Hispanic whites; 5,988 (25%), blacks; 3,411 (14%), Hispanics; and 149 ( 1%), members of other racial/ethnic groups. The overall cumulative incidences** for black and Hispanic adults were 3.1 and 3.4 times, respectively, that for whites (Table 1).
Black and Hispanic adults with AIDS were more likely than white adult AIDS patients to reside in New York, New Jersey, or Florida: 62% and 65% of the black and Hispanic patients, respectively, resided in these three states, as did 33% of white patients. Cumulative incidences in these states for blacks and Hispanics were from 2.5 to 9.0 times those for whites. Of the black and Hispanic patients from New York and New Jersey, approximately half were intravenous (IV) drug abusers. Of the black patients from Florida, 40% were born in Haiti.
Among men, blacks and Hispanics accounted for 23% and 14%, respectively, of the 22,468 male AIDS patients. However, among women, blacks and Hispanics accounted for 51% and 21%, respectively, of the 1,634 female patients. Cumulative incidences for black and Hispanic women were 13.3 and 11.1 times, respectively, the incidence for white women.
The distribution of AIDS cases by race/ethnicity differed by recognized transmission categories for AIDS (Table 2). Homosexual or bisexual men who had AIDS and patients who acquired AIDS from blood or blood products were predominately white, whereas patients with a history of IV drug abuse or heterosexual contact with persons at increased risk for acquiring AIDS, and persons with no identified mode of transmission were predominately black or Hispanic. The proportion of blacks or Hispanics with AIDS was relatively high (in terms of their proportions in the overall U.S. population) in all transmission categories with the exception of hemophilia.
The racial/ethnic distribution of homosexual/bisexual patients differed from that of heterosexual patients. Among homosexual/bisexual male AIDS patients, 16% were black; 11%, Hispanic; and 73%, white. Among heterosexual AIDS patients in all other transmission categories, 50% were black; 25%, Hispanic; and 25%, white.
Pediatric Patients. Of the 350 AIDS patients who were children (i.e., 15 years of age) and whose race/ethnicity was known, 204 (58%) were black and 77 (22%) were Hispanic. The overall cumulative incidences for black and Hispanic children were 15.1 and 9.1 times, respectively, the incidence for white children (Table 1).
As with black and Hispanic adult AIDS patients, black and Hispanic children with AIDS were more likely than white children with AIDS to reside in New York, New Jersey, or Florida (Table 1). Of the black and Hispanic children with AIDS, 73% and 70%, respectively, lived in New York, New Jersey, or Florida. Of the 68 white children with AIDS, 40% also lived in one of those three states.
The distribution of pediatric AIDS cases by race/ethnicity varied by transmission category. Ninety percent of the children with perinatally acquired AIDS compared with 42% of the children with hemophilia- or transfusion-associated AIDS were black or Hispanic (Table 3). The observation that children with perinatally acquired AIDS (mother-to-infant transmission) were predominately black or Hispanic (Table 3) is consistent with the high proportion (75%) of heterosexual adults who are black or Hispanic. As with adults, the proportion of pediatric patients who were black or Hispanic was highest in the transmission categories associated with IV drug abuse by at least one of the parents (Table 3). Reported by AIDS Program, Center for Infectious Diseases, CDC.
Editorial Note: The incidence of AIDS is rising for all racial/ethnic groups, and in all geographic regions of the country. However, cumulative incidences of AIDS among blacks and Hispanics are over 3 times the rate for whites. Seroprevalence studies of military recruit applicants and of potential blood donors also indicate a higher prevalence of infection with human T-lymphotropic virus type III/lymphadenopathy-associated virusP (HTLV-III/LAV) among blacks than whites (separate values for Hispanics are not available since ethnicity was not recorded). Antibody seroprevalence rates were over 4 times higher for black military recruit applicants and over 7 times higher for black potential blood donors in one city than for whites (6,7). However, the population of individuals volunteering for military service or blood donation may not be representative of the U.S. population at large.
Several factors may contribute to the elevated incidence of AIDS and HTLV-III/LAV infection among these racial/ethnic groups. The racial/ethnic distribution of AIDS cases may reflect, to some degree, the racial/ethnic distribution of the populations at risk in the high-prevalence areas. Persons at risk become so as a result of underlying risk factors, not because of their race/ethnicity. Reported AIDS patients who are IV drug abusers are predominately black (51%) or Hispanic (30%). Children with AIDS whose parents abuse IV drugs are also predominately black (51%) or Hispanic (31%). Population-based estimates of the racial/ethnic distribution of IV drug abusers in the United States are unknown. However, in September 1982, the National Institute on Drug Abuse (NIDA) surveyed all known drug abuse treatment facilities in the United States to determine the racial/ethnic composition of the client populations using those facilities (8). The racial/ethnic distribution of clients in the surveyed clinics was 32% white, 40% black, 28% Hispanic, and 1% "other race" for clients in the New York City standard metropolitan statistical area (SMSA), and 41% white, 50% black, and 9% Hispanic in the Newark, New Jersey, SMSA. This survey indicates that in these SMSA's, which have reported two-thirds of the IV drug abusers with AIDS, a disproportionate number of IV drug abusers attending these clinics were black or Hispanic.
Economic and cultural factors may also be associated with the observed differences in incidence for racial/ethnic groups. For example, education and economics may play a role in the observed difference in needle-sharing practices and, therefore, in the HTLV-III/LAV infection rates among white, black, and Hispanic IV drug abusers. In a study of HTLV-III/LAV infection among IV drug abusers in New York City, the prevalence of antibody to HTLV-III/LAV was higher for black (42%) and Hispanic (42%) patients than for white patients (14%) who were drug abusers (9). Preliminary analysis of data from the same study indicates that a higher proportion of white patients (18%) than black or Hispanic patients (8%) reported using new needles at least half the time when they injected drugs. Black and Hispanic participants in the study reported having substantially fewer years of education and were more likely than white patients to receive public assistance. Further analysis of data from this study and further study of HTLV-III/LAV infection involving other IV-drug-abusing populations are needed to fully understand the reasons black and Hispanic drug abusers have higher rates of AIDS and HTLV-III/LAV infection.
Education and prevention programs may be less effective in reaching minority populations unless specifically designed for those groups. Targeted programs are needed for black and Hispanic men who engage in homosexual activity, and for blacks and Hispanics of either sex who are engaging in other high-risk behavior. One report has suggested that many blacks who engage in homosexual activity are bisexual, and that these men may not benefit from educational programs designed for homosexuals (10). Programs to prevent transmission of HTLV-III/LAV infection through heterosexual contact and perinatal exposure also need to consider that approximately 75% of heterosexual patients, 73% of women with AIDS, and 92% of children with perinatally acquired infection are black or Hispanic.
Until an effective therapy or vaccine is available, prevention of HTLV-III/LAV infection depends on education and behavioral modification of persons at increased risk (11,12). The U.S. Public Health Service has assisted and encourages involvement of minority professional and community organizations in providing education about AIDS and its prevention in black and Hispanic communities. Additional health-education/risk-reduction projects are needed to actively involve minority communities in the accomplishment of overall community AIDS risk-reduction activities.
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