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Trends In Risk Behavior
Risk Factors.
Unprotected sexual behavior and substance use behaviors, and their interactions, continue to fuel the epidemic. Through 1998, 57% of reported AIDS cases were attributed to sexual contact and 25% to injection drug use (IDU). Substance use other than injection drug use, such as alcohol and other drug use, contribute to sexual risk-taking and result in an unknown number of new infections.
Majority of Cases Among Gay/Bisexual Men.
Gay and bisexual men still represent the largest proportion of new AIDS cases and HIV infections each year. In 1998, 45% of AIDS cases and 40% of HIV infections among adult and adolescent men older than 13 were among gay/bisexual men. Men of color comprise an increasingly larger proportion of cases among gay/bisexual men. For the first time, in 1998, men of color represented the majority (52%) of total AIDS cases among men who had sex with other men. In 1989, men of color represented 31% of total AIDS cases among this same group.
Injection Drug Users Represent Large Proportion of Cases.
As of the end of 1998, injecting drug users were the second largest transmission category after gay/bisexual men, accounting for 26% of reported AIDS cases and 17% of reported HIV cases. There were large differences between men and women. Injection drug use (IDU) was the risk behavior directly attributable to 43 % of the cumulative AIDS cases in women and only to 22% of the cumulative AIDS cases in men. Recent data suggest that, particularly in the urban Northeast, IDU cases may have peaked and stabilized at a high rate. Minorities represent a significantly higher proportion of drug use-related AIDS cases than do whites. Through 1998, 35% of the 285,549 AIDS cases reported among African American and Hispanic males were associated with IDU, compared to 9% of the 278,151 AIDS cases reported among white males. More than half of IDU-associated AIDS cases are among African Americans. Capturing the full impact of IDU is difficult, however, because many individuals become HIV-infected through a partner with an unknown history of drug use.
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