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
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.
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.
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.
CDC. AIDS and human immunodeficiency virus infection in the
United States: 1988 update. MMWR 1989;38(suppl. no.
S-4):3,11,29-30.
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.
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.
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.
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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