This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Magnitude and Trends in the District of Columbia

Pnilip S. Rosenberg, PhD; Martin E. Levy, MD, MPH; John F. Brundage, MD, MPH; Lyle R. Petersen, MD; John M. Karon, PhD; Thomas R. Fears, PhD; Lytt I. Gardner, PhD; Mitchell H. Gail, MD, PhD; James J. Goedert, MD; William A. Blattner, MD; Caitlin C. Ryan, MSW; Sten H. Vermund, MD, PhD; Robert J. Biggar, MD

JAMA. 1992;268(4):495-503.

Abstract
Objective.
—To assess the extent of the human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS) epidemic in the District of Columbia and demonstrate an approach to monitoring HIV infection and projecting AIDS incidence at a community level.

Design.
—Backcalculation methods to reconstruct HIV incidence from AIDS incidence in subgroups. Results were compared with directly measured HIV seroprevalence in selected sentinel populations: childbearing women, civilian applicants for military service, and hospital patients admitted for conditions unrelated to HIV infection.

Results.
—Between the start of the epidemic in 1980 and January 1,1991, one in 57 District of Columbia men aged 20 to 64 years was diagnosed with AIDS. Unlike the plateau projected for the nation, AIDS incidence for the District of Columbia was projected to increase by 34% between 1990 and 1994. Models of HIV infection incidence suggested two broad epidemic waves of approximately equal size. The first occurred in men who have sex with men and peaked during the period from 1982 through 1983. The second began in the mid-1980s in injecting drug users and heterosexuals. We estimated that among District of Columbia residents aged 20 to 64 years, 0.3% of white women, 2.9% of white men, 1.6% of black women, and 4.9% of black men were living with HIV infection as of January 1,1991. These estimates are broadly consistent with survey data: among black childbearing women in their 20s, HIV prevalence doubled to 2% between the fall of 1989 and the spring of 1991; from military applicant data, we estimated that over 5% of black men born from 1951 through 1967 were HIV-positive; in the sentinel hospital, HIV prevalence rates among male patients aged 25 to 34 years were 11.3% in white men and 16.9% in black men.

Conclusion.
—Backcalculation and surveys yielded quantitatively consistent estimates of HIV prevalence. Many injecting drug users and heterosexuals in the District of Columbia were infected after January 1,1986. Similar monitoring of the epidemic in other localities is needed to focus efforts to reduce the incidence of HIV transmission.

(JAMA. 1992;268:495-503)

Author Affiliations
From the Epidemiologic Methods Section, Biostatistics Branch (Drs Rosenberg, Fears, and Gail), and the Viral Epidemiology Section, Environmental Epidemiology Branch (Drs Goedert, Blattner, and Biggar), National Cancer Institute, Rockville, Md; District of Columbia Commission of Public Health, Preventive Health Services Administration, Washington, DC (Dr Levy); Division of Preventive Medicine, Walter Reed Army Institute of Research, Washington, DC (Drs Brundage and Gardner); Population Studies Section (Dr Petersen) and the Statistics and Data Management Branch (Dr Karon), Division of HIV/AIDS, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Ga; Agency for HIV/AIDS, District of Columbia Commission of Public Health, Washington, DC (Ms Ryan); and Vaccine Trials Epidemiology Branch, Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, Md (Dr Vermund).

Footnotes
Reprint requests to National Cancer Institute, 6130 Executive Blvd, EPN/403, Rockville, MD 20892 (Dr Rosenberg).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Exploring a Model of Symbolic Social Communication: The Case of 'Magic' Johnson
Flora et al.
J Health Psychol 1996;1:353-366.
ABSTRACT  

Rising HIV-Related Mortality in Young Americans
Vermund
JAMA 1993;269:3034-3035.
ABSTRACT  

HIV Prevalence Among Washington, DC, Residents Having Abortions
Wolter
JAMA 1993;269:472-472.
ABSTRACT