ATW1H%ASUACAD.BITNET@oac.ucla.edu (Dr David Dodell) (06/28/89)
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were treated before they got sick.
Rogers and colleagues at six New York hospitals tested the new method,
known as polymerase chain reaction, or PCR, on newborns of women infected with
the AIDS virus. They report their results in Thursday's New England Journal of
Medicine.
Ordinarily, doctors check for AIDS infections by testing the blood for
antibodies to the virus. Those who carry antibodies are presumed to be
infected.
This method is worthless for newborns. Babies whose mothers were infected
will carry their mothers' AIDS antibodies for several months, even if the
babies themselves are not infected.
Dr. Cody Meissner of New England Medical Center said doctors now typically
wait until babies are 16 months old before using standard antibody tests to
determine which ones are infected.
"This will be the key role of PCR," he said. "We will be able to do a test
on the baby's blood in the first weeks of life, and hopefully this will
differentiate between kids who are truly infected and hose who are simply born
to women who are infected."
The test locates minute bits of the genes of viruses that have gotten
inside blood cells. It then multiplies these gene fragments so they can be
detected.
In the study, the test revealed AIDS infections in five of seven newborns
who later developed AIDS. It also showed infection in one of eight newborns
who later had non-specific symptoms, such as swollen lymph glands, that could
have been caused by the AIDS virus. The test results were negative in nine
infants who remained well.
In an accompanying editorial in the journal, Drs. Samuel L. Katz and
Catherine M. Wilfert of Duke University said positive test results should be
reliable. But they cautioned that negative results are less believable,
Health InfoCom Network News Page 10
Volume 2, Number 26 June 26, 1989
because the test may miss youngsters who are truly infected.
While childhood AIDS is rare in the United States, it is becoming a major
health hazard in parts of Africa. Another report in the journal describes a
study of 475 infants who were born to infected mothers at two hospitals in
Zaire. The research, directed by Dr. Robert W. Ryder of the Department of
Public Health in Kinshasa, concludes that AIDS may already have increased
infant mortality there by as much as 15 percent.
A third study, directed by Dr. Stephane Blanche of Necker Hospital in
Paris, presented more circumstantial evidence that breast-feeding may increase
the AIDS risk for newborns. Among babies of infected mothers, they found AIDS
infections in five of six infants who were breast-fed, compared with 25 of 99
who were not.
They cautioned that further studies are necessary "before infants at risk
in developing countries are deprived of the advantages of breast-feeding."
AIDS RISING AMONG HETEROSEXUALS, BUT ONLY FRACTION OF CASES
Transmission of AIDS among heterosexuals in the United States is increasing,
but still represents only a tiny portion of all AIDS cases, according to a new
report from the U.S. Centres for Disease Control.
About five per cent of all adults with AIDS in the United States contracted
the disease by engaging in sexual activity with an infected person of the
opposite sex -- a figure which has remained constant in the past two years,
according to the report released on Thursday.
Because the number of people who have contracted the disease through
homosexual sex and intravenous drug use is vastly larger than the cases of
heterosexual transmission, even the 80 per cent increase in the number of
heterosexual cases in the last two years is not large enough to affect the
overall proportions, according to Dr. Mary E. Chamberland, a medical
epidemiologist in the CDC's AIDS programme.
The only category of new AIDS cases increasing more quickly than
heterosexual sex is intravenous drug use where new cases increased at a rate
of 109 per cent in 1987 and 1988, according to Chamberland.
In 1987 and 1988, new cases of AIDS attributed to homosexual transmission
increased only at a rate of 33 per cent.
Among the heterosexual group in the report, women were more likely than men
to become infected. Some 1,953 women have contracted AIDS by engaging in
sexual relations with infected men while only 672 men were infected in the
same way. That statistic does not include some 1,000 male and 337 female AIDS
victims who were born in Africa or Haiti and other countries where
heterosexual transmission is far more common.
Both women and men report most commonly that they had sexual relations with
an infected intravenous drug user.
"Clearly that's the single most important category of transmission,"
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Volume 2, Number 26 June 26, 1989
Chamberland said. "I think that's a very important message from this report.
More than than 70 per cent of the sex partners of this group were intravenous
drug users."
Health InfoCom Network News Page 12
Volume 2, Number 26 June 26, 1989
===============================================================================
Center for Disease Control Reports
===============================================================================
Morbidity and Mortality Weekly Report
Thursday June 22, 1989
Epidemiologic Notes and Reports
Multiple Outbreaks of Staphylococcal Food Poisoning
Caused by Canned Mushrooms
Recent outbreaks of staphylococcal foodborne disease have been associated
with consumption of canned mushrooms from the People's Republic of China
(PRC). These outbreaks have prompted multistate recalls of mushrooms produced
by certain canneries in the PRC and a Food and Drug Administration (FDA) order
to prohibit entry into the United States of all incoming shipments of
institution-sized cans of mushrooms from the PRC. The following reported
outbreaks in 1989 led to these actions.
Starkville, Mississippi. On February 13, 22 persons became ill with
gastroenteritis several hours after eating at a university cafeteria.
Symptoms included nausea, vomiting, diarrhea, and abdominal cramps. Nine
persons were hospitalized. Canned mushrooms served with omelets and hamburgers
were associated with illness. No deficiencies in food handling were found.
Staphylococcal enterotoxin was identified in a sample of implicated mushrooms
from the omelet bar and in unopened cans from the same lot.
Queens, New York. On February 28, 48 persons became ill a median of 3
hours after eating lunch in a hospital employee cafeteria. One person was
hospitalized. Canned mushrooms served at the salad bar were epidemiologically
implicated. Two unopened cans of mushrooms from the same lot as the implicated
can contained staphylococcal enterotoxin.
McKeesport, Pennsylvania. On April 17, 12 persons became ill with
gastroenteritis a median of 2 hours after eating lunch or dinner at a
restaurant. Two persons were hospitalized. Canned mushrooms, consumed on pizza
or with a parmigiana sauce, were associated with illness. No deficiencies were
found in food preparation or storage. Staphylococcal enterotoxin was found in
samples of remaining mushrooms and in unopened cans from the same lot.
Philipsburg, Pennsylvania. On April 22, 20 persons developed illness
several hours after eating food from a take-out pizzeria. Four persons were
hospitalized. Only pizza served with canned mushrooms was associated with
illness. Staphylococcal enterotoxin was found in a sample of mushrooms from
the pizzeria and in unopened cans with the same lot number.
Three other outbreaks possibly associated with mushrooms from the PRC have
been reported to CDC; cans associated with these outbreaks have codes similar
to those in the four confirmed outbreaks.
Reported by: RK Collins, Mississippi State University, Starkville; MN
Henderson, Oktibbeha County Health Dept; DE Conwill, MD, MM Currier, MD, FE
Thompson, MD, State Epidemiologist, Mississippi State Dept of Health. ME
Garland, Peninsula Hospital Center, Queens; S Schultz, MD, New York City
Health Department; JJ Campana, Monroe County Dept of Health; LD Budnick, MD,
JJ Guzewich, MPH, DL Morse, MD, State Epidemiologist, New York State Dept of
Health; MJ Diskin, MPH, TL Hays, JA Kail, JR Rager, MPH, RR Willenpart,
Allegheny County Health Dept; G Wells, Dept of Environmental Resources; AS
Trentini, JM Zimmerman, J Crumrine, GE Ware, M Dorman, DR Tavris, MD, State
Epidemiologist, Pennsylvania State Dept of Health. Atlanta, Buffalo,
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Volume 2, Number 26 June 26, 1989
Nashville, New Orleans, Newark, New York District Offices; Div of Emergency
and Epidemiologic Operations; Div of Food Chemistry and Technology; Div of
Microbiology; Office of Compliance, Food and Drug Administration. Div of Field
Svcs, Epidemiology Program Office; Enteric Diseases Br, Div of Bacterial
Diseases, Center for Infectious Diseases, CDC.
Editorial Note: Staphylococcal enterotoxin typically causes an acute illness
2-4 hours after ingestion; illness is characterized by severe nausea and
vomiting, often accompanied by abdominal cramps, diarrhea, and low-grade
fever, and resolves within 1-2 days. Staphylococcal enterotoxin is not
inactivated by temperatures used in canning and cooking. Finding this toxin in
cans means that staphylococci grew and produced enterotoxin in the mushrooms
before canning or that staphylococci contaminated the mushrooms after canning,
possibly through improperly formed seams. From 1982 to 1987, 75 confirmed
staphylococcal outbreaks were reported to CDC's national foodborne disease
surveillance system; none of these outbreaks were associated with deficiencies
in canning.
All cans implicated in these mushroom-associated outbreaks were large
institution-sized (68-ounce, drained weight (#10)) cans of pieces and stems of
mushrooms produced in the PRC and shipped through Hong Kong. FDA is monitoring
the voluntary recall of shipments of cans that have codes implicated in
outbreaks. Cans from lots associated with illness have lids embossed with
three-line codes with the plant identifiers "TM" on the first line or "T3" or
"M2" on the second line. FDA is prohibiting entry into the United States of
all shipments of mushrooms from the PRC in #10 cans because the source of
contamination has not been identified and cans produced by other plants might
also be involved. FDA has begun sampling mushrooms imported from the PRC in
all can sizes, including consumer-sized cans. FDA has offered to assist the
PRC in an investigation of the sources of contamination.
The United States imports approximately 50 million pounds of processed
mushrooms from the PRC annually. Many other countries also import canned foods
from the PRC. Since the canned mushrooms are widely distributed, other canned
mushroom-associated outbreaks may have occurred. Possible outbreaks should be
reported through state health departments to the Enteric Diseases Branch,
Division of Bacterial Diseases, Center for Infectious Diseases, CDC ( FAX:
(404) 639-3296, Telex: 549571 CDC ATL).
Health InfoCom Network News Page 14
Volume 2, Number 26 June 26, 1989
International Notes
Dengue Epidemic -- Ecuador, 1988
A large dengue 1 (DEN-1) epidemic occurred in Guayaquil, Ecuador, from
late February through April 1988. The Virology Laboratory, Ecuadorian National
Institute of Hygiene, detected antidengue hemagglutination-inhibition antibody
in serum specimens from persons with viral syndromes who had visited local
health centers in Guayaquil during February and March. Dengue infection was
subsequently confirmed by CDC through serologic testing and isolation of DEN-1
virus from nine specimens.
From May 14 to May 19, 1988, a population-based cluster serosurvey was
conducted in eight of Guayaquil's 14 parishes, representing 72% of the city's
population. Serum collected from 1340 persons in 280 households was tested for
antidengue IgM antibody using an IgM-capture, enzyme-linked immunosorbent
assay (MAC-ELISA). Before DEN-1 was recognized as the infecting serotype of
the epidemic, approximately half the specimens were screened using a mixed
(DEN 1-4) antigen. Specimens from this group with equivocal results and all
subsequent samples were then tested using DEN-1 antigen. Based on the
resulting area-specific seropositivity rates, an estimated 420,000 individuals
were infected with dengue during the epidemic.
Responses to a standard clinical questionnaire from a subsample of 106
IgM-seropositive persons reflected a pattern of illness consistent with
classic dengue fever. Fever was reported by 105 (99%) of this group. More than
50% of the subsample reported one or more of the following symptoms: headache,
chills, pruritus, rash, myalgias, and arthralgias; 12 (11%) persons reported
hemorrhagic manifestations. Review of data at the National Institute of
Hygiene and discharge records from a major tertiary hospital for severe dengue
illness detected only one case of severe hemorrhagic disease and no deaths.
In an entomologic survey done concurrently with the serosurvey, the
highest Aedes aegypti indices (container, 8.1% and 8.7%; house, 13.5% and
18.7%; and Breteau, 23.1 and 26.3) were in two of the parishes with the
highest dengue attack rates. In another parish with high seropositivity,
however, low mosquito indices were detected, probably as a consequence of
intensive larval mosquito-control efforts implemented after infections had
occurred but before the entomologic survey.
Weekly surveillance data from public clinics indicated that the number of
patients with acute febrile illness increased during March and peaked during
the week ending April 2. Most onsets of illness reported by IgM-positive
persons in Febres Cordero and Letamendi parishes occurred in mid-April (Figure
1). At the time of the entomologic and serologic surveys, few persons reported
current dengue-like illness. Thus, the epidemic appeared to have subsided by
mid-May. An intradomiciliary fumigation campaign for Ae. aegypti control,
involving approximately 350,000 houses, was conducted from May 27 to July 29,
after the epidemic had subsided.
Reported by: National Institute of Hygiene, National Malaria Eradication
Service and Region II Epidemiology Office, Ministry of Health; Guayas
Provincial Health Department, Guayaquil, Ecuador. Dengue Br, Div of Vector-
Borne Viral Diseases, Center for Infectious Diseases, CDC.
Editorial Note: In 1948, an Ae. aegypti eradication program for yellow fever
control was initiated in Ecuador in collaboration with the Pan-American Health
Organization (PAHO); by 1958, the country was declared free of this mosquito.
As in many other countries in the Americas, however, surveillance declined,
and reinfestation occurred. Ae. aegypti was detected in a province north of
Health InfoCom Network News Page 15
Volume 2, Number 26 June 26, 1989
Guayaquil in 1977 and 1981 and in central Guayaquil in 1985. No dengue
transmission was reported in Guayaquil from 1958 until 1988, although
unreported transmission may have occurred before 1958 (1).
In response to the 1988 epidemic, mosquito-control efforts by the
Ecuadoran National Malaria Eradication Service included 1) vehicle-applied,
ultralow-volume (ULV) insecticide (malathion) spraying, 2) source reduction by
elimination of larval habitats, and 3) treatment of water-holding containers
with temephos insecticide. These measures may have contributed to decreasing
transmission, although their effect cannot be evaluated retrospectively. Given
the high seropositivity rates in areas heavily infested with Ae. aegypti, the
epidemic probably ended because much of the population had become immune.
This epidemic and others in Brazil (2), Bolivia, and Paraguay (PAHO,
unpublished data) illustrate the increasing problem of dengue fever in
tropical America. The epidemics also demonstrate the vulnerability of many
large urban centers in Central and South America to explosive dengue
epidemics. Increased travel between countries in the Americas and other
regions of the world heightens the risk for repeated introduction of different
virus strains and serotypes. These factors, in turn, increase the risk for
dengue epidemics, and possibly for epidemics of dengue hemorrhagic fever and
urban yellow fever.
In the absence of Ae. aegypti eradication, large dengue and yellow fever
epidemics can be prevented only through programs that combine surveillance
with integrated vector-control programs. While ground-applied ULV insecticide
has been recommended to control epidemic dengue (3), recent studies in
Trinidad (4), Suriname (5), and Puerto Rico (CDC, unpublished data) suggest
that these measures are ineffective in reducing adult Ae. aegypti densities.
Ultimately, control of this mosquito must be community-based and directed
toward larval source reduction (6).
References
1. Carbo-Noboa JM. Etiologia del dengue. Ann Soc Medico-Cirug del Guayas,
Guayaquil, Ecuador 1924;4:326.
2. Schatzmayr HG, Nogueira RM, Travassos da Rosa AP. An outbreak of dengue
virus at Rio de Janeiro-1986. Mem Inst Oswaldo Cruz 1986;81:245-6.
3. CDC. Biology and control of Aedes aegypti. Vector topics No. 4, September
1979.
4. Chadee DD. An evaluation of malathion ultralow volume spraying against
caged and natural populations of Aedes aegypti in Trinidad, West Indies. Cah
Orstom ser Ent med et Parasitol 1985;23:71-4.
5. Hudson JE. The 1982 emergency ultralow volume spray campaign against Aedes
aegypti adults in Paramaribo, Suriname. PAHO Bull 1986;20:294-303.
6. Gubler DJ. Aedes aegypti and Aedes aegypti-borne disease control in the
1990s: top down or bottom up. Am J Trop Med Hyg 1989;40 (in press).
Health InfoCom Network News Page 16
Volume 2, Number 26 June 26, 1989
Perspectives in Disease Promotion and Health Promotion Prevalence of
Overweight -- Behavioral Risk Factor Surveillance System, 1987
An estimated 34 million adults in the United States are overweight (1),
placing them at increased risk for chronic diseases such as diabetes,
hypertension, and some types of cancer (2,3). Thus, reducing the prevalence of
overweight is an important public health objective.
To examine patterns of overweight adults by geographic location, data from
the 1987 Behavioral Risk Factor Surveillance System (BRFSS) (4) were used to
obtain prevalence estimates for 32 states and the District of Columbia.
Participating states were divided into four regions (West, Northeast, South,
and Midwest) based on the 1984 census divisions (5).
In the BRFSS, state health departments collect data on behavioral risk
factors using random-digit-dialed telephone interviews of adults greater than
or equal to 18 years of age. Prevalence estimates, obtained from self-reported
weights and heights in BRFSS interviews, are adjusted to the age, sex, and
race distribution of each state's population.
Overweight was defined as a body mass index (BMI=weight(kg)/height(m)2)
greater than or equal to 27.8 for men and greater than or equal to 27.3 for
women. These values represent the sex-specific 85th percentile of BMI for U.S.
adults aged 20-29 years, estimated from the Second National Health and
Nutrition Examination Survey (NHANES II) (1).
Overall, the prevalence of overweight ranged from a high of 25.7% in
Wisconsin and Indiana to a low of 15.2% in New Mexico (Table 1). Among men,
the prevalence of overweight ranged from 26.9% in Wisconsin to 15.1% in
Arizona. For women, the prevalence ranged from 25.8% in the District of
Columbia to 13.7% in Hawaii. The median prevalence of overweight was 21.8% for
men and 21.1% for women.
The median prevalence of overweight by region was lowest in the West
(17.0%), followed by the Northeast (19.8%), the South (22.0%), and the Midwest
(23.1%). Adjusting for regional population distribution by age, sex, and race
did not change this pattern. Compared with the median prevalence of overweight
for all 33 participating units (21.1%), the median prevalence by region is
lower in the West and Northeast and higher in the South and Midwest.
Reported by: The state BRFSS coordinators: R Strickland, Alabama; T Hughes,
Arizona; L Parker, California; M Rivo, District of Columbia; S Hoecherl,
Florida; JD Smith, Georgia;E Tash, Hawaii; J Mitten, Idaho; B Steiner,
Illinois; S Joseph, Indiana; K Bramblett, Kentucky; R Schwartz, Maine; A
Weinstein, Maryland; L Koumijian Yandel, Massachusetts; N Salem, Minnesota; N
Hudson, Missouri; R Moon, Montana; R Thurber, Nebraska; K Zaso, New Hampshire;
L Pendley, New Mexico; H Bzduch, New York; C Washington, North Carolina; L
Post, South Dakota; D Riding, Tennessee; J Fellows, Texas; C Chakley, Utah; K
Tollestrup, Washington; R Anderson, West Virginia; R Miller, Wisconsin. Div of
Nutrition and Office of Surveillance and Analysis, Center for Chronic Disease
Prevention and Health Promotion, CDC.
Editorial Note: The prevalence of overweight in this report may be
underestimated because the data are based on self-reported responses. When
measured weights and heights from NHANES II were used, an estimated 24.2% of
men and 27.1% of women in the United States were overweight (1), compared with
21.8% of men and 21.1% of women from BRFSS. Assuming that the underestimation
of overweight does not differ by state or region, findings of this report can
be used to make relative comparisons of the prevalence of overweight between
states and regions.
Health InfoCom Network News Page 17
Volume 2, Number 26 June 26, 1989
State and regional variations in the prevalence of overweight may result
from differences in eating habits and exercise practices (6,7). A number of
states have reached low prevalence levels of overweight. Public health
agencies should encourage moderate but regular physical activity and caloric
restriction through decreased dietary fat consumption in weight-loss programs.
These efforts are of special importance in states with the highest prevalences
of overweight.
References
1. NCHS. Anthropometric reference data and prevalence of overweight, United
States 1976-1980. Hyattsville, Maryland: US Department of Health and Human
Services, Public Health Service, 1987; DHHS publication no. (PHS)87-1688.
(Data from the National Health Survey; series 11, no. 238).
2. National Institutes of Health Consensus Development Panel on the Health
Implications of Obesity. Health implications of obesity: National Institutes
of Health consensus development conference statement. Ann Intern Med
1985;103(6 pt 2):1073-7.
3. Office on Smoking and Health. The Surgeon General's report on nutrition and
health. Washington, DC: US Department of Health and Human Services; DHHS
publication no. (PHS)88-50210:275-309.
4. Remington PL, Smith MY, Williamson DF, Anda RF, Gentry, EM. Hogelin GC.
Design, characteristics, and usefulness of state-based behavioral risk factor
surveillance: 1981-1987. Public Health Rep 1988;103:366-75.
5. US Department of Commerce. Factfinder for the nation. Census geography --
concepts and products. Washington, DC: Bureau of the Census, 1985. (CFF No. 8
Rev.).
6. Council on Scientific Affairs. Treatment of obesity in adults. JAMA
1988;260:2547-51.
7. Black W, James WPT, Besser GM, et al. Obesity: a report of the Royal
College of Physicians. J R Coll Physicians Lond 1983;17:5-65.
Health InfoCom Network News Page 18
Volume 2, Number 26 June 26, 1989
Current Trends
Update: Heterosexual Transmission of
Acquired Immunodeficiency Syndrome and
Human Immunodeficiency Virus Infection -- United States
This report updates data for acquired immunodeficiency syndrome (AIDS) and
human immunodeficiency virus (HIV) infection associated with heterosexual
transmission and is based on national AIDS surveillance, HIV seroprevalence
surveys, and studies of populations at varying levels of risk for heterosexual
transmission. HETEROSEXUALLY ACQUIRED AIDS CASES
By March 31, 1989, 89,501 AIDS cases in persons greater than or equal to
13 years of age had been reported to CDC; 3962 (4%) of these were attributed
to heterosexual transmission. Forty-one percent of heterosexual transmission
cases were reported in the preceding 12 months, compared with 36% of all other
AIDS cases. Of the heterosexualtransmission cases, 1337 (34%) persons were
born in countries where heterosexual transmission is a major route of HIV
infection; 2625 (66%) persons reported heterosexual contact with a partner
with or at increased risk for HIV infection (Table 1, page 429). These
heterosexual contacts included intravenous-drug users (IVDUs) (72%), bisexual
men (10%), recipients of blood or clotting factor concentrates (3%), persons
born in countries where heterosexual contact is the major route of
transmission (2%), and persons with HIV infection or AIDS and an unreported
risk (13%). Men were proportionately more likely than women to report partners
from countries where heterosexual contact is the major route of transmission
(5%, compared with 1%) or partners with an unreported risk (19%, compared with
11%).
While the number of heterosexually acquired AIDS cases reported each year
has increased, the overall proportion has remained relatively stable--from
5.2% of adult AIDS cases reported in 1983 to 4.9% in 1988. However, the
composition of the group has changed over time; since 1986, persons reporting
sexual contact with a partner at risk have outnumbered HIV-infected persons
born in countries with predominantly heterosexual HIV transmission (Figure 1).
>From 1987 to 1988, the percentage increase for heterosexually transmitted AIDS
among persons born in countries where heterosexual contact is the major route
of transmission was 41%, compared with a 97% increase for persons with an "at-
risk" partner.
Of the 2625 persons with an "at-risk" partner, 672 (26%) were men and 1953
(74%) were women, representing 0.8% and 25% of AIDS cases in all males and
females, respectively. Men were older than women (mean age: 40, compared with
34 years, respectively). Forty-seven percent were black, 29% white, 23%
Hispanic, 0.6% Asian Pacific Islander, and 0.2% American Indian/Alaskan
Native. In the 12 months before March 31, 1989, blacks and Hispanics had the
highest incidences of heterosexually acquired AIDS per 100,000 population: 3.1
and 3.5, respectively, for women and 1.9 and 0.8, respectively, for men,
compared with 0.3 and 0.2 cases per 100,000 for white women and men,
respectively. Overall, rates for blacks and Hispanics were 12 and 10 times,
respectively, the rate for whites.
Forty-six states, the District of Columbia, Puerto Rico, and the Virgin
Islands have reported AIDS cases in persons who had heterosexual contact with
an "at-risk" partner. The geographic distributions of women who were sex
partners of bisexual men or men who used IV drugs were similar to those of men
with AIDS from these two groups (Table 2A and 2B). In contrast, the geographic
distribution of men who reported heterosexual contact with a woman who used IV
drugs was different from that of women with AIDS who were IVDUs (Table 2C).
For example, New York accounted for 40% of female IVDUs with AIDS but for only
Health InfoCom Network News Page 19
Volume 2, Number 26 June 26, 1989
4% of men who reported sexual contact with a female IVDU, and Florida
accounted for 25% of men reporting IV-drug-using partners but for only 9% of
female IVDUs with AIDS.
HETEROSEXUAL TRANSMISSION OF HIV IN SURVEYED POPULATIONS
Risk for HIV transmission from infected persons to their steady
heterosexual partners without other risks varied in 26 studies that included
at least 20 couples each; in heterosexual partners, HIV seroprevalence ranged
from 0 to 58% (median: 24%) (1,2).
Female prostitutes are at increased risk for acquisition and potential
transmission of HIV infection. In the United States, HIV infection in
prostitutes is strongly associated with IV-drug use. In a multicity study, HIV
antibody was detected in 180 (13%) of 1378 female prostitutes; 80% of the
infected prostitutes reported using IV drugs (3). In prostitutes with no
histories or findings suggestive of IV-drug use, HIV seroprevalence was 5%;
HIV seropositivity in this group was greater among blacks and Hispanics and
among those with greater than 200 lifetime nonpaying sex partners.
Seroprevalence data are limited for heterosexuals who are not sex partners
of persons known to be infected or at increased risk. Data on heterosexuals
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