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Reports on Selected Racial/Ethnic Groups Special Focus: Maternal and Child Health Surveillance for AIDS and HIV Infection Among Black and Hispanic Children and Women of Childbearing Age, 1981-1989

Jacob A. Gayle, Ph.D.
Office of the Deputy Director (HIV)
Richard M. Selik, M.D.
Susan Y. Chu, Ph.D.
Division of HIV/AIDS
Center for Infectious Diseases

Summary

Surveillance systems indicate that the most documented human immunodeficiency virus (HIV) infections and acquired immunodeficiency syndrome (AIDS) cases among children and women of childbearing age in the United States occur among black and Hispanic populations. Intravenous-drug use (IVDU) is the presumptive origin of HIV infection for most of these cases, through direct IVDU, sexual contact with an intravenous (IV)-drug user, or birth to women with either mode of exposure. These data confirm the need for HIV-prevention programs directed to the racial, ethnic, age, and reproductive concerns of black and Hispanic women of childbearing age and their children. Services should be available for those who are HIV infected, as well as for those who are not infected with HIV, to prevent the further spread of HIV. Services for prevention and treatment of drug abuse are an integral part of HIV prevention and treatment for these groups.

INTRODUCTION

The incidence of reported acquired immunodeficiency syndrome (AIDS) and the prevalence of human immunodeficiency virus (HIV) infection have been greater among Hispanics and blacks than among other racial/ethnic minority groups (1-4). This report focuses on this disparity among children ( less than 15 years of age) and women of childbearing age (15-44 years of age).

METHODS

HIV/AIDS data from four sources were examined: 1) national AIDS surveillance data reported to the Division of HIV/AIDS, Center for Infectious Diseases, CDC, in 1989; 2) mortality data reported to the National Center for Health Statistics, CDC, in 1988; 3) data on HIV-antibody prevalence in specimens routinely submitted for metabolic screening of newborns from December 1987 through November 1988; and 4) data on HIV-antibody prevalence among women who applied for military service from October 1985 through December 1989.

To calculate the annual incidence of AIDS, the authors estimated the number of cases diagnosed in each year, adjusting for the delay between diagnosis and reporting. Annual incidence data for 1989 were excluded, because this adjustment is less reliable for the most recent year. To compare AIDS surveillance and mortality data with population data, the authors excluded residents of U.S. territories (e.g., Puerto Rice, Virgin Islands), because postcensus projections and population data specific for age, sex, and racial/ethnic minority group were unavailable for U.S. territories. To estimate the non-Hispanic white population, the authors assumed all Hispanics to be white (5), and their number was subtracted from the white population (Irwin R. Demo-Detail, unpublished postcensus estimates recorded on computer tape, adjusted to agree with the Census Bureau's national estimates by age, sex, and race in Current Population Reports, Series P-25, No. 1022). Asians and Pacific Islanders were assumed to represent 79% of the population other than whites and blacks, and American Indians and Alaskan Natives were assumed to represent 21% of this "other" population (the same distribution estimated for 1980). Mortality data are provisional, based on a 10% sample of death certificates for U.S. deaths in 1988 (6). Deaths due to AIDS or other HIV disease were assumed to be those in which the underlying cause of death was assigned code 042, 043, or 044, according to the International Classification of Diseases, 9th Edition (7). Hispanics were not separated from whites or other racial/ethnic groups in analysis of mortality data.

The prevalence of HIV infection among childbearing women was determined by anonymously testing blood for antibodies to HIV by the enzyme immunoassay (EIA) and Western blot methods. Blood samples were routinely collected from newborn infants for diagnosis of hereditary metabolic disorders. The prevalence of HIV antibody in these samples measures the prevalence of HIV infection among childbearing women because maternal antibody is transferred to the infants before birth, sample selection is relatively unbiased, and blood specimens are available for greater than 90% of births.

RESULTS HIV/AIDS Morbidity and Mortality

Hispanic and black children and women of childbearing age have accounted for a disproportionate share of AIDS cases compared with the proportion of the U.S. population they represent (Figures 1, 2). The annual incidence of AIDS among children and women of childbearing age in the United States has been increasing every year for most racial/ethnic groups but has been persistently higher among blacks and Hispanics than among other groups (Figures 3, 4).

Most AIDS cases among women of childbearing age have been related to intravenous (IV)-drug use, either directly (by IV-drug users sharing needles or syringes) or indirectly (by sexual contact with an IV-drug user) (Table 1). Among blacks and Hispanics, most cases among children have been indirectly related to IV-drug use (by perinatal transmission to an infant or fetus from a mother who used IV drugs or whose sex partner used IV drugs) (Table 2). The proportion of pediatric cases related to IV-drug use has been smaller among other racial/ethnic groups.

The mortality rate from HIV/AIDS per 1,000,000 population for black and white women, respectively, was 1.8 and 0.4 among those 15-24 years of age, 15.1 and 1.5 among those 25-34 years of age, and 16.9 and 1.7 among those 35-44 years of age. Among women 25-34 years of age, HIV-related deaths accounted for 11% and 3% of all deaths among black and white women, respectively. Overall, 1,010 deaths (6.4/100,000) occurred among black females and 880 deaths (0.8/100,000) among white females for all ages combined (6).

In 1988, HIV infection accounted for 360 deaths among children in the United States. Although HIV infection is not a major cause of infant mortality, it is now among the 10 leading causes of death for children 1-4 years of age. In 1988, the death rate for black children (2.1/100,000) was five times higher than the rate for white children (0.4/100,000) (6).
HIV-Seroprevalence Data
Published data were available from a survey for maternal HIV antibody conducted in New York State by using specimens submitted for metabolic screening of newborns (8). Blood specimens were submitted for an estimated 99% of all infants born in the state during the period November 30, 1987-November 30, 1988. Statewide HIV-seroprevalence rates were 0.13% for whites, 1.82% for blacks, and 1.31% for Hispanics; 1,816 births to HIV-seropositive mothers occurred during the 1-year study period, including 982 (54%) among blacks and 539 (30%) among Hispanics. From October 1985 through December 1989, a total of 358,584 civilian female applicants for military service were tested for antibody to HIV as part of the entrance medical examination; 225 (0.06%) were seropositive. Among the women tested, seroprevalence rates were 0.02% for whites, 0.15% for blacks, and 0.08% for Hispanics (U.S. Department of Defense, unpublished data). Fifty-four of the HIV-seropositive applicants were from New York, where seroprevalence rates were 0.06% for whites, 0.54% for blacks, and 0.34% for Hispanics.

DISCUSSION

Current trends in the ongoing surveillance of HIV seroprevalence and AIDS incidence document the special needs of black and Hispanic communities for prevention of HIV infection and treatment of HIV disease among women of childbearing age and their children. Specific public health needs include education and development of skills pertaining to the prevention of HIV, HIV-antibody testing and counseling, information related to early interventions for HIV-seropositive individuals, access to these interventions, and provision of social services related to management and prevention of HIV infection.

Public health surveillance indicates that IV-drug use represents the primary route of HIV transmission among black and Hispanic women and children. Programs for preventing HIV infection among blacks and Hispanics should focus on drug-related issues in addition to precautions regarding heterosexual and homosexual contact. Drug-prevention and rehabilitation programs should include HIV-related services, and drug-treatment services should be more available within black and Hispanic communities. State and local health agencies should provide prevention and care services through multiple sources, recognizing the socioeconomic barriers and the diverse patterns of culture and communication represented within these two racial/ethnic minority groups.

References

  1. Selik RM, Castro KG, Pappaioanou M. Racial/ethnic differences in the risk of AIDS in the United States. Am J Public Health 1988;78:1539-45.
  2. Selik RM, Castro KG, Pappaioanou M. Birthplace and the risk of AIDS among Hispanics in the United States. Am J Public Health 1989;79:836-39.
  3. Gwinn M, Selik R, Allen D, Petersen L, St. Louis M, Dondero T. Racial and ethnic differences in HIV seroprevalence in selected United States populations. Abstract W.D.P.24. In: Abstracts, V International Conference on AIDS. Montreal, June 4-9, 1989:746.
  4. CDC. AIDS and human immunodeficiency virus infection in the United States: 1988 update. MMWR 1989;38(suppl. no. S-4):3,11,29-30.
  5. Spencer G. Projections of the Hispanic population: 1983 to 2080. Washington, DC: Bureau of the Census, 1986; Current population reports, series P-25, no. 995.
  6. National Center for Health Statistics. Annual summary of births, marriages, divorces, and deaths: United States, 1988. Monthly vital statistics report; vol 37, no. 13. Hyattsville, Maryland: Public Health Service, 1989.
  7. CDC. Human immunodeficiency virus (HIV) infection codes: official authorized addendum ICD-9-CM, effective January 1, 1988. MMWR 1987;36(no. S-7):1-24.
  8. Novick LF, Berns D, Stricof R, Stevens R, Pass K, Wethers J. HIV seroprevalence in newborns in New York State. JAMA 1989;261:1745-50.


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