Academic journal article Family Relations

Advances in HIV/AIDS Education and Prevention

Academic journal article Family Relations

Advances in HIV/AIDS Education and Prevention

Article excerpt

Since the first cases of the illness were identified about 16 years ago, AIDS and the human immunodeficiency virus (HIV) infection that causes it have become the most serious infectious disease epidemic of modern times. Approximately 500,000 persons in the United States have been diagnosed with AIDS to date, and between 1 and 1.5 million Americans are believed to be infected with HIV (Centers for Disease Control, 1994). AIDS and HIV disease are now the leading causes of death among men between the ages of 18 and 45 in the United States and the fourth leading causes of death among American women of the same age group; AIDS recently became the leading killer of all Americans between the ages of 25 and 45 (National Center for Health Statistics, 1994). Between 40,000 and 80,000 Americans are believed to contract HIV infection each year (Mann, Tarantola, & Netter, 1992). Although American discussions about AIDS usually focus on the epidemiology of HIV infection in the United States, the global scope of the epidemic is alarming and remains largely out of control. Approximately 17 million people in the world presently have HIV infection, between 38 million and 110 million infections are expected worldwide by the end of the decade, and heterosexual transmission is responsible for the now-pervasive HIV infection prevalence among men, women, adolescents, and--through perinatal transmission from a mother to her fetus--children in much of the developing world (Mann et al., 1992). In areas of some developing countries, 20% to 30% of adults are already infected (Allen et al., 1992; Chin, 1990).

Within the United States, approximately 53% of AIDS cases diagnosed to date have been due to infection contracted during sex by men who have sex with men, 25% due to injected drug use, 6% due to infections occurring among injection drug users (IDUs) who also are gay or bisexual men, 7% due to heterosexual contact, and the remainder due to other risk factors (Centers for Disease Control, 1994). However, because of the long latency between initial infection and the appearance of AIDS-defining illnesses, persons diagnosed with AIDS in the present are those people who first contracted HIV infection an average of 10 years ago. Present trends in new infections and new AIDS cases diagnosed in the past year reveal evidence of increased rates of heterosexual transmission especially among the ethnic minority, inner-city poor; increased vulnerability of adolescents and young adults; strong likelihood of contracting HIV by users of crack and cocaine due to accompanying risky sex patterns; and continued high rates of new infections among men who have sex with men, especially outside original AIDS epicenters and among young and ethnic minority gay or bisexual men (Edlin et al., 1994; Hays, Kegeles, & Coates, 1990; Kelly, Murphy, et al., 1992; Massachusetts Medical Society, 1995; Peterson et al., 1992; Quinn, Groseclose, Spence, Provost, & Hook, 1992).

The risk that an individual will contract HIV during sex depends jointly on the likelihood that a sexual partner is infected (determined by the prevalence of HIV within a population segment in a given community) and the probability that HIV will be transmitted during a particular sexual practice (transmission efficiency, also known as infectivity). In AIDS epicenters such as San Francisco or New York, between 40% and 50% of gay men are already infected; comparable levels of HIV infection prevalence characterize IDUs in some large cities (Curran et al., 1988). HIV prevalence of 10% to 20% is common among both gay men and IDUs in many other American cities (Kelly, Murphy, et al., 1992). In this context, it requires very few sexual partners for a man who has sex with men, or for a person whose sexual network includes IDUs, to encounter an infected partner. Recent studies of HIV prevalence among persons being treated for "traditional" sexually-transmitted diseases (STDs) such as syphilis and gonorrhea indicate that between 1% and 8% of inner-city STD clinic patients also have HIV, although there is wide geographic variation in these rates (McCray & Onorato, 1992; Quinn et al. …

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