Prevalence data from the serosurveillance system continue
to reflect the widespread, yet extremely varied, distribution of HIV infection across
demographic and geographic subgroups. From 1993–1997, the highest overall HIV prevalence rates
were observed among persons who engage in high-risk sexual behavior, particularly MSM, and among
IDUs entering DTCs. In all geographic regions and metropolitan areas, prevalence rates among MSM
in participating STD clinics were high (overall unadjusted rate, 26%; range, 8%–39%). In
contrast to HIV rates among MSM at STD clinics, prevalence among IDUs entering DTCs during the
5-year period were remarkably diverse by region and by metropolitan area (overall unadjusted
rate, 18%; range, 1%–37%). Among heterosexual men and women who attended the STD clinics but who
did not inject drugs, the overall unadjusted prevalence rate was 2.3%. In a pattern similar to
that for IDUs, prevalence rates for these high-risk heterosexual patients differed greatly by
region (0.3%–5.5%) (Figure 1,
Tables 2 and
3).
Figure 1. Comparison of HIV Prevalence Among Men Who Have Sex With Men at Sexually Transmitted Disease Clinics and Injection Drug Users Entering Drug Treatment Centers, by Metropolitan Area, 1993–1997
Among youth populations in the serosurveillance system, HIV prevalence remained low. For
patients at the five participating adolescent medicine clinics, the unadjusted clinic
prevalence rate for the 5-year study period was 0.4%. Among Job Corps entrants, the overall
unadjusted rate in all regions was less than 0.2%.
HIV prevalence was low among military applicants and first-time blood donors, populations in
which high-risk persons were likely to have self-deferred. The overall unadjusted prevalence
rate from 1993–1997 among military applicants was less than 0.04%. The lowest observed HIV
prevalence of all the selected populations in this report was among first-time blood donors;
prevalence for this group was 0.027% for men and 0.011% for women.
HIV prevalence continues to differ by race/ethnicity;
rates are substantially higher among blacks in nearly every serosurveillance population. For
example, overall unadjusted prevalence rates among MSM at STD clinics were 40% among blacks,
26% among Hispanics, and 21% among whites. Among heterosexual patients at these clinics,
prevalence for race/ethnicity differed by region but remained relatively high among blacks in
all regions. The highest overall prevalence for these high-risk heterosexuals was in the
Northeast for blacks (4.3%) and Hispanics (4.0%) (Table 4).
For IDUs entering DTCs, the association between HIV
prevalence and race/ethnicity differed considerably by region. In the Northeast, unadjusted
prevalence rates were higher among IDUs who were black (42%) and Hispanic (38%) than among
those who were white (17%). A similar pattern was observed in the South, where rates were
higher among black IDUs (20%) and Hispanic IDUs (24%) than among white IDUs (6%). In the
Midwest, prevalence was markedly higher among Hispanic IDUs (27%) than among black IDUs (11%)
or white IDUs (6%). In the West, prevalence among black IDUs (11%) was considerably higher
than among Hispanic IDUs (1%) or white IDUs (2%) (Table 4).
Prevalence was 6 times higher among black adolescent
medicine clinic patients (0.6%) than among Hispanic (0.1%) and white patients (0.1%). The
overall prevalence of 0.32% among black Job Corps entrants was 4 times that for Hispanics
(0.08%) and more than 6 times that for whites (0.05%). Among military applicants, the overall
prevalence among blacks (0.15%) was 5 times higher than among Hispanics (0.03%) and 15 times
higher than among whites (0.01%) (Table 4).
In general, prevalence was higher among survey participants
who were in the older age categories and, with the exception of Job Corps entrants, among
those who were male. For most of the surveillance populations included in this report,
prevalence by region, race/ethnicity, and age group either decreased or remained stable from
1993–1997.
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