The increasing frequency of heterosexually acquired AIDS in the United States, 1983-88

Of 88,510 cases of acquired immunodeficiency syndrome (AIDS) reported in adults in the United States from 1983 through 1988, the percentage attributed to reported heterosexual contact with persons known to be infected or at increased risk of infection with human immunodeficiency virus (HIV) has increased steadily from 0.9 percent in the first quarter of 1983 to 4.0 percent in the fourth quarter of 1988, from 0.1 (in 1983) to 1.4 percent (1988) among men, and from 13 (in 1983) to 28 percent (in 1988) among women. Among women, the cumulative incidence of AIDS attributable to heterosexual contact per million population is over 11 times greater for Blacks and Hispanics than for Whites. Among men, this incidence is over 10 times greater for Blacks and four times greater for Hispanics than for Whites. The pattern of distribution of heterosexually acquired AIDS parallels the distribution of other heterosexually transmitted diseases, which are also more frequent in Black and Hispanic inner-city populations. Drug use, exchange of sex for drugs or money, and early onset of sexual activity in adolescents are increasingly associated with heterosexually transmitted infections and are likely to be very important in heterosexual transmission of HIV in inner-city US populations.