HIV/AIDS Epidemiology

Case studies in the United States in the 1980s initially suggested

a high AIDS prevalence among men who have sex with men
and intravenous drug abusers. This indicated a transmissible
agent, presumably transferred during sexual activity or by bloodcontaminated
needles. Individuals receiving blood or blood products
were also at high risk: Hemophiliacs who required infusions
of blood products, usually pooled from multiple donors, acquired
AIDS, as did a small number of individuals who received blood
transfusions or tissue transplants before 1982 (when bloodscreening
procedures were implemented). Today the incidence
of HIV in hemophiliacs and in blood transfusion and organ
Table 28.9 HIV/AIDS infections worldwide, 2011a
Location HIV/AIDS infections
The Americas 3.0 million
Western and Central Europe 0.9 million
Eastern Europe and Central Asia 1.4 million
Africa 23.8 million
East Asia and Pacific 0.9 million
South and Southeast Asia 4.0 million
Oceania 53,000
aThe total number of individuals living with HIV/AIDS is estimated to be about 34
million.
About 1.7 million people died from AIDS in 2011. Data are from the World Health
Organization.
Figure 28.14 Annual new cases of human immunodeficiency virus/acquired
immunodeficiency syndrome (HIV/AIDS) in the United States. Cumulatively, there
were about 1.1 million cases of HIV/AIDS through 2010. In 2009, the HIV/AIDS
case definition changed to include all new HIV infections and AIDS diagnoses.
Data
are from the HIV/AIDS Surveillance Report and Division of HIV/AIDS Prevention
Surveillance and Epidemiology, CDC, Atlanta, Georgia, USA.
1985 1990
80,000
70,000
60,000
50,000
40,000
30,000
20,000
10,000
AIDS incidence, United States
Year
1980 1995 2000 2005 2010

recipients has been virtually eliminated through rigorous screening

of blood and biological products.
Soon after the discovery of HIV, laboratory immunosorbent assays
and immunoblot tests ( Section 27.9) were developed to detect
antibodies to the virus in a blood sample. Extensive surveys of HIV
incidence and prevalence defined the spread of HIV and ensured
that new cases would not be transmitted by blood transfusions. The
pattern illustrated in Figure 28.15 is typical of an agent transmissible
by blood or other body fluids. The identification of defined highrisk
groups implied that HIV was not transmitted from person to
person by casual contact, such as the respiratory route, or by contaminated
food or water. Instead, body fluids, primarily blood and
semen, were identified as the vehicles for transmission of HIV.
Figure 28.15 shows that in the United States the number of AIDS
cases is disproportionately high in men who have sex with men, but
the patterns in women and in certain racial and ethnic groups indicate
that male-to-male sex is not the only risk factor for acquiring
AIDS. Among women, for example, heterosexuals are the largest
risk group, whereas in African American and Hispanic men, intravenous
drug use as well as sexual activity is linked to HIV infection.
Racial differences in HIV incidence rates in the United States
indicate that social and economic factors also contribute to infection
risk. African Americans acquired 44% of all new HIV infections
in 2010, but made up only about 14% of the U.S. population.
Black men accounted for 70% of these infections; the incidence
of new HIV infections for black men was seven times as high as
that for white men.
The study of individuals who are at high risk for acquiring AIDS
indicates that virtually all who acquire HIV today share two specific
behavior patterns. First, they engage in activities (sex or drug
use) in which body fluids, usually semen or blood, are transferred.
Second, they exchange body fluids with multiple partners through
sexual activity, needle-sharing drug activity, or both. With each encounter they
have a probability of receiving body fluids from an
HIV-infected individual and therefore a chance of being infected
with HIV.
HIV can be transmitted to the fetus by infected mothers and
also in mothers milk; in 2010, there were 162 new cases of perinatal
HIV infection in the United States. Infants born to HIVinfected
mothers have maternally derived antibodies to HIV in
their blood. However, a positive diagnosis of HIV infection in
infants must wait a year or more after birth because about 70% of
infants showing maternal HIV antibodies at birth show no signs
of being infected later on.
Heterosexual transmission of HIV is the norm in Africa. In
some regions, fewer men than women are infected with HIV. The
identification of high-risk groups such as prostitutes has led to the
development of health education campaigns that inform the public
of HIV transmission methods and define high-risk behaviors.
Because no cure or proven immunization for AIDS is available,
public health education remains the most effective approach to
the control of HIV/AIDS. We discuss the pathology and therapy
of HIV/AIDS in Section 29.14.