Distribution of AIDS Cases, by Racial/Ethnic Group and Exposure Category, United States, June 1, 1981-July 4, 1988

Richard M. Selik, M.D. Kenneth G. Castro, M.D. Marguerite Pappaioanou, D.V.M., Ph.D. AIDS Program, Center for Infectious Diseases

INTRODUCTION

Of the 66,464 cases of acquired immunodeficiency syndrome (AIDS) reported to CDC in the period June 1, 1981-July 4, 1988, most (60%) occurred among non- Hispanic whites; however, blacks and Hispanics accounted for 70% of the cases in heterosexual men, 70% of those in women, and 75% of those in children. To study the association between AIDS and racial/ethnic groups, the AIDS Program, Center for Infectious Diseases, analyzed the presumed means by which each patient became infected with human immunodeficiency virus (HIV) (i.e., his or her exposure category). METHODS

CDC receives AIDS case reports from the health departments of all 50 states, the District of Columbia, and U.S. territories. This analysis included only cases meeting the CDC case definition (1). Thirty-six cases in U.S. territories other than Puerto Rico were excluded because of small numbers. The distribution of cases by racial/ethnic group and exposure category were analyzed. The racial/ethnic groups consisted of Hispanics and the following groups of non-Hispanics: whites, blacks, Asians and Pacific Islanders (Asians/PIs), and American Indians and Alaskan Natives (American Indians/ANs). AIDS patients residing in Puerto Rico (97% Hispanic) were studied separately from other Hispanics. Except for the combination of intravenous-drug abuse (IVDA) in homosexual/bisexual men, the exposure categories were hierarchically ordered so that persons with more than one possible means of acquiring HIV infection were classified only in the category listed first. RESULTS

Analysis of the AIDS cases reported in the United States was limited to the 65,133 (99.8%) cases in which racial/ethnic group was specified. U.S. AIDS patients were disproportionately black (26%) and Hispanic (13%), compared with the proportions of blacks (12%) and Hispanics (6%) in the U.S. population (2).

The proportion of AIDS cases in which the mode of HIV exposure was homosexual activity among men was lower for U.S. black, Hispanic, and American Indian/AN AIDS patients and for AIDS patients in Puerto Rico than for U.S. white or Asian/PI AIDS patients (Table 1). Heterosexual men and women constituted the majority of AIDS cases in U.S. blacks and residents of Puerto Rico.

Among men with AIDS, the proportion who were heterosexual intravenous-drug abusers or whose female sex partners were intravenous-drug abusers was 34% for U.S. black men, 35% for U.S. Hispanic men, and 52% for men in Puerto Rico, compared with 5%, 2%, and 10% for U.S. white, Asian/PI, and American Indian/AN men, respectively (Table 2). Among women with AIDS, the proportion who were intravenous-drug abusers or whose male sex partners were intravenous-drug abusers was 74% and 80% for U.S. black and Hispanic women, respectively, and 83% for women in Puerto Rico, compared with 52%, 31%, and 50% for U.S. white, Asian/PI, and American Indian/AN women, respectively (Table 3). Among children with AIDS, the proportion whose mothers or mothers' sex partners were intravenous-drug abusers was 62% and 72%, respectively, for U.S. black and Hispanic children and 81% for children in Puerto Rico, compared with 31%, 25%, and 50% for U.S. white, Asian/PI, and American Indian/AN children, respectively (Table 4). Overall, the proportion of AIDS cases associated with IVDA by heterosexuals (including sex partners and children of drug abusers) was 42% for U.S. blacks, 40% for U.S. Hispanics, and 58% for residents of Puerto Rico, compared with 7% for U.S. whites, 5% for U.S. Asians/PIs, and 19% for American Indians/ANs.

Of all U.S. AIDS cases associated with IVDA by heterosexuals, 54% occurred among blacks and 26% among Hispanics. Similarly large proportions of blacks and Hispanics were found among men, women, and children with IVDA-associated AIDS (Tables 5-7). DISCUSSION

The data presented here support the findings of earlier analyses (3-8) that AIDS patients are disproportionately black and Hispanic and that the proportion of IVDA-associated AIDS cases is substantially greater in U.S. blacks and Hispanics than in U.S. whites. The disproportionate numbers of blacks and Hispanics treated for heroin abuse (9) suggest that they may have a higher prevalence of IVDA than whites. Black and Hispanic communities in the United States and Puerto Rico should be especially targeted for measures to prevent HIV transmission by treating drug abusers and by counseling drug abusers and their sex partners on the risk of HIV infection. Recommendations for preventing HIV transmission to intravenous-drug abusers, their sex partners, and their children have been published (10-14).

References

1. Centers for Disease Control. Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome. MMWR 1987;36(suppl no. 1S).

2. Bureau of the Census. 1980 census of the population. Vol 1: Characteristics of the population. (PC80-1-B). Washington, DC: US Department of Commerce, 1981.

3. Centers for Disease Control. Acquired immunodeficiency syndrome (AIDS) among blacks and Hispanics--United States. MMWR 1986;35:655-66.

4. Rogers MF, Williams WW. AIDS in blacks and Hispanics: implications for prevention. Issues in Science and Technology 1987;3:89-94.

5. Guinan ME, Hardy A. Epidemiology of AIDS in women in the United States: 1981 through 1986. JAMA 1987;257:2039-42.

6. Bakeman R, McCray E, Lumb JR, Jackson RE, Whitley PN. The incidence of AIDS among blacks and Hispanics. J Natl Med Assoc 1987;79:921-8.

7. Friedman SR, Sotheran JL, Abdul-Quader A, et al. The AIDS epidemic among blacks and Hispanics. Milbank Q (in press).

8. Selik RM, Castro KG, Pappaioanou M. Racial/ethnic differences in the risk of AIDS in the United States. Am J Public Health (in press).

9. National Institute on Drug Abuse. SMSA statistics l98l: data from the client oriented data acquisition process (CODAP): statistical series E, administrative report. Rockville, Maryland: National Institute on Drug Abuse, l983.

10. Centers for Disease Control. Public Health Service guidelines for counseling and antibody testing to prevent HIV infection and AIDS. MMWR 1987;36:509-15.

11. Centers for Disease Control. Additional recommendations to reduce sexual and drug abuse-related transmission of human T-lymphotropic virus type III/lymphadenopathy- associated virus. MMWR 1986;35:152-5.

12. Centers for Disease Control. Recommendations for assisting in the prevention of perinatal transmission of human T-lymphotropic virus type III/lymphadenopathy-associated virus and acquired immunodeficiency syndrome. MMWR 1985;34:721-32.

13. Francis DP, Chin J. The prevention of acquired immunodeficiency syndrome in the United States: an objective strategy for medicine, public health, business, and the community. JAMA 1987;257:1357-66.

14. Drotman DP. Now is the time to prevent AIDS (Editorial). Am J Public Health 1987;77:143.

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