i

National HIV

Prevalence Surveys

1997 Summary

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for HIV, STD, and TB Prevention

Division of HIV/AIDS Prevention
ii

The National HIV Prevalence Surveys, 1997 Summary, is published by the Division of HIV/AIDS PreventionSurveillance and Epidemiology, National Center for HIV, STD, and TB Prevention, Centers for Disease Control

and Prevention (CDC), Atlanta, GA 30333. This report reflects the efforts of CDC, state and local health

departments, and other public health agencies and institutions.

Copyright Information

All material contained in this report is in the public domain and may be used and reprinted without special

permission; citation of source is appreciated.

Federal Recycling Program Printed on Recycled Paper

Centers for Disease Control and Prevention ........................................................... Jeffrey P. Koplan, M.D., M.P.H.

 Director

 National Center for HIV, STD, and TB Prevention ............................................ Helene D. Gayle, M.D., M.P.H.

Director

 Division of HIV/AIDS PreventionSurveillance and Epidemiology ...................... Kevin M. DeCock, M.D.

 Director

Prevention Services Research Branch .................................................. Richard W. Steketee, M.D., M.P.H.

Chief

 Clinic and Special Studies Section .............................................................. Marta Gwinn, M.D., M.P.H.

Chief

Martha S. Miller, M.P.H.

Prevalence Report Coordinator

Statistics and Data Management Branch ................................................................. Philip H. Rhodes, Ph.D.

Chief

Janet E. Royalty, M.S.

Technical Information & Communications Branch ..................................................... Sara Thrift, M.L.I.S.

Chief

Single copies of the National HIV Prevalence Surveys, 1997 Summary are available from the CDC National

Prevention Information Network (NPIN), P.O. Box 6003, Rockville, MD 20849-6003; telephone 1-800-458-5231

or 1-301-562-1098.

 The National HIV Prevalence Surveys, 1997 Summary is accessible via Internet:

 http://www.cdc.gov/nchstp/hiv_aids/pubs/hivsero.htm

 Suggested Citation: Centers for Disease Control and Prevention. National HIV Prevalence Surveys, 1997

Summary. Atlanta, GA: Centers for Disease Control and Prevention; 1998:1-25.
iii

Contents

National HIV Prevalence Surveys, 1997 Summary ....................... 1

Background ....................................................................................................................... 1

Summary of Findings ....................................................................................................... 1

Technical Notes ................................................................................................................. 2

Principles of Unlinked Surveys ............................................................................................................. 2

Collection and Interpretation of Data .................................................................................................... 2

STD Clinics ........................................................................................................................................... 3

Drug Treatment Centers ........................................................................................................................ 3

Adolescent Medicine Clinics ................................................................................................................. 4

Job Corps Entrants ................................................................................................................................. 4

Military Applicants ................................................................................................................................ 4

Tables

Table 1. HIV prevalence among patients at sexually transmitted disease clinics,

by metropolitan area, exposure category, and sex, 1997 .................................................... 5

Table 2. HIV prevalence among injection drug users entering drug treatment centers,

by metropolitan area and sex, 1997 .................................................................................... 6

Table 3. Summary of HIV prevalence among youth at adolescent medicine clinics,

by metropolitan area, 1997 ................................................................................................. 7

Figures

Figure 1. Metropolitan areas participating in CDCs national unlinked HIV prevalence

surveys in clinics, 1997 ...................................................................................................... 8

Figure 2. HIV prevalence among men who have sex with men, sexually transmitted

disease clinic surveys, 1997................................................................................................ 9

Figure 3. HIV prevalence among men who have sex with men, sexually transmitted

disease clinic surveys, by race/ethnicity, and region, 1997 ................................................ 9

Figure 4. HIV prevalence among females, sexually transmitted disease

clinic surveys, 1997 .......................................................................................................... 10

Figure 5. HIV prevalence among females, sexually transmitted disease clinic surveys,

by race/ethnicity, and region, 1997 .................................................................................. 10

Figure 6. HIV prevalence among injection drug users, drug treatment center surveys, 1997 ......... 11

Figure 7. HIV prevalence among injection drug users, drug treatment center surveys,

by race/ethnicity, and region, 1997 .................................................................................. 11

Figure 8. HIV prevalence among Job Corps entrants, by sex and race/ethnicity, 1997 .................. 12

Figure 9. HIV prevalence among Job Corps entrants, by state of residence, 1997 ......................... 12

Figure 10. HIV prevalence among applicants for military service, by sex

and race/ethnicity, 1997 .................................................................................................... 13

Figure 11. HIV prevalence among applicants for military service, by state

of residence, 1997 ............................................................................................................. 13

Suggested Readings ........................................................................................................ 14
iv

Appendix.......................................................................................... 16

Survey of Childbearing Women .................................................................................... 16

Tables

Table 4. Survey of Childbearing Women: number of specimens tested and

HIV prevalence by state or territory, 1994 .................................................................... 17

Table 5. Survey of Childbearing Women: number of specimens tested and

HIV prevalence by state or territory, 1995 .................................................................... 18

Figures

Figure 12 HIV prevalence among childbearing women, 1994 ...................................................... 19

Figure 13. HIV prevalence among childbearing women, 1995 ...................................................... 19

Figure 14. HIV prevalence among childbearing women, by race and state, 1994 ......................... 20

Suggested Readings ........................................................................................................................... 21

Sentinel Hospital Surveillance System for HIV Infection........................................... 22

Tables

Table 6. Sentinel Hospital Surveillance System for HIV Infection: prevalence among

patients, by region, sex, and race/ethnicity, 1994 ......................................................... 23

Table 7. Sentinel Hospital Surveillance System for HIV Infection: prevalence among

patients, by region, sex, and race/ethnicity, 1995 .......................................................... 24

Suggested Readings ........................................................................................................................... 25
1

Background

The Centers for Disease Control and Prevention (CDC),

in collaboration with other public health agencies and

institutions, conducts standardized unlinked prevalence

surveys of human immunodeficiency virus (HIV)

infection in designated subgroups of the population as

part of a sentinel surveillance system to monitor the

HIV epidemic in the United States. This system also

includes systematically collected national data from

ongoing mass HIV screening programs, which are

periodically sent without personal identifiers to CDC.

These complementary surveys provide standardized

information to local and national public health officials

on the extent of HIV infection in geographic areas and

population subgroups so that education and prevention

programs can be developed and evaluated. The

information can also be used to estimate the number

of people who may benefit from HIV-related care

and treatment.

Of persons who know or suspect that they are infected

with HIV or who are at high risk for HIV infection,

some may be more likely to participate in studies of

HIV prevalence and others may be less likely to do so.

Unlinked surveys are conducted to obtain estimates of

HIV prevalence that are unbiased by self-selection.

Residual blood from specimens originally collected for

routine diagnostic purposes are tested for HIV antibodies after all personal identifying information has

been permanently removed. Neither HIV test results

nor risk information routinely obtained from medical

records can be linked to individuals. Thus, no interaction with survey participants can take place solely for

the purpose of the unlinked surveys. All clinic sites

that conduct unlinked surveys either provide or offer

referral for voluntary HIV counseling and testing.

In 1987, CDC began providing technical and financial

assistance to state and local health departments to

conduct unlinked HIV prevalence surveys in selected

clinics serving populations at high risk for HIV

infection. Surveys were supported in 17 metropolitan

areas during 1997 (Figure 1). Settings included

sexually transmitted disease (STD) clinics, drug

treatment centers, and adolescent medicine clinics.

Clinics were chosen for participation in the surveys by

state and local health department personnel on the basis

National HIV Prevalence Surveys, 1997 Summary

of projected sample size, client demographic and

behavioral characteristics, and the ability and

willingness of the staff to conduct surveys in

accordance with standardized protocols.

In addition to the unlinked surveys, CDC monitors

results from HIV-antibody mass screening programs.

Since 1987, the U.S. Department of Labor has provided

CDC with HIV screening results for entrants to the Job

Corps, a federally funded job training program for

economically and educationally disadvantaged youth.

The U.S. Department of Defense has provided CDC

with HIV screening results for civilian applicants to the

military service since 1985. Personal identifiers are not

sent to CDC.

This report summarizes 1997 data from unlinked

prevalence surveys in selected STD clinics, drug

treatment centers, and adolescent medicine clinics, as

well as screening results for entrants to the Job Corps

and applicants for military service in the United States

and Puerto Rico. The appendix contains 1994 and 1995

summary data from the Survey of Childbearing Women

and the Sentinel Hospital Surveillance System for HIV

Infection (both of these surveys were concluded at the

end of 1995).

Summary of Findings

Data from the surveys provide estimates of HIV prevalence for populations surveyed in 1997. Because the

results of each survey reflect different biases, the reader

is encouraged to read the Technical Notes and consult

the Suggested Readings for effective interpretation of

the data. When considered with their respective biases,

data from the surveys can contribute to an overall

picture of HIV infection in the United States.

In STD clinics, prevalence rates were highest among

the population of men who reported having sex with

men. The median clinic prevalence rate in this population was 19.3%; rates among black men who have sex

with men (MSM) were approximately twice that of

white MSM. The median clinic prevalence rate was

4.8% among injection drug users (IDUs) attending STD

clinics. Among heterosexuals attending STD clinics

and reporting no other behavioral risk category, prevalence rates were higher for males than for females in

nearly all metropolitan areas (Table 1 and Figures 2-5).
2

Prevalence surveys conducted at drug treatment centers

during 1997 continue to reflect a wide range of

estimated HIV prevalence among IDUs. The overall

median clinic prevalence rate for IDUs attending drug

treatment centers was 14.8%. The highest rates were in

the Northeast and the South . In the Northeast, South,

and West, prevalence rates were highest among black

IDUs (Table 2; Figures 6 and 7).

National patterns of HIV prevalence among youth are

provided by the CDC unlinked adolescent surveys and

the screening programs of Job Corps entrants and

applicants for military service. During 1997, HIV

prevalence ranged from 0.0% to 1.0% in the six

adolescent medicine clinics, with no consistent

geographic pattern of prevalence (Table 3). Statewide

prevalence rates ranged from 0.0% to 0.8% among Job

Corps entrants and from 0.0% to 0.1% among

applicants for military service. Prevalence rates were

substantially higher among black Job Corps entrants

and black military applicants than among other racial/

ethnic groups. Rates were particularly high among

black female entrants to the Job Corps and among black

male military applicants (Figures 8-11).

Technical Notes

Principles of Unlinked Surveys

Methods. Unlinked surveys are conducted by using

residual specimens collected from eligible survey

participants for routine clinical purposes. There is no

contact between persons in the surveys and the

investigators conducting the surveys. Before HIV

testing, demographic and risk information abstracted

from routine medical records and intake forms are

linked to the residual specimens through a unique study

number. The specimens, which otherwise would be

discarded, are anonymously tested for antibodies to

HIV after the permanent removal of all personal

identifiers. Neither the HIV test results nor the

information obtained from medical records and intake

forms can be linked to individuals. The results of HIV

testing provide prevalence data that are unbiased by

test-seeking behavior. This information is used to track

HIV infection in the population but gives no

information on individuals. The surveys are conducted

in settings that either provide or offer referral for

voluntary counseling and testing so that each person

included in the survey has the opportunity to learn his

or her HIV status and receive appropriate services for

care and counseling for behavior changes.

Ethical considerations. The Office for Protection from

Research Risks (OPRR), to which the Secretary of

Health and Human Services has delegated the

protection of the rights and welfare of human research

subjects, has determined that anonymous unlinked

surveys are ethical if (1) no interaction takes place with

the survey participant solely for the purpose of the

surveys and (2) information that may inadvertently

identify a person is not retained. In June 1998, the

Office of the Director of CDC and the Division of HIV/

AIDS PreventionSurveillance and Epidemiology,

National Center for HIV, STD, and TB Prevention,

convened an external panel to conduct an ethical review

of anonymous unlinked surveys for HIV in order to

address questions that have arisen in recent years

concerning the ethics of these surveys. The members

of the panel felt that the unlinked surveys are ethical

and are necessary to provide unbiased, accurate data on

the current status and direction of the HIV epidemic in

specific populations and also to provide reliable

information for prevention planning and the allocation

of resources.

CDC protocols for unlinked surveys are submitted to

the CDC Institutional Review Board (IRB) for review

and approval. State and local health departments

consult with, and submit their protocols for approval

to, their local IRBs before conducting the surveys.

Collection and Interpretation of Data

Standardized protocols and laboratory procedures are

used for each of the surveys. Data are summarized by

geographic area, sex, age, race/ethnicity, and, when

possible, by major behavioral risk groups. The

participating states and the District of Columbia are

divided into four geographic regions as defined by the

United States Bureau of the Census: Northeast,

Midwest, South, and West. Data for Puerto Rico are

included in the state and territory analyses, but not in

the regional analyses. All rates in this report are

reported as percentages.

Because participating clinics represent a convenience

sample rather than a probability sample, clinic data are

presented as medians. Ranges of rates are given for

each clinic type. Prevalence data from a single site

should be interpreted with caution because persons

who attended participating clinics and hospitals may

not be representative of all persons attending clinics

and hospitals in the area. However, the collective

data from these surveys suggest geographic patterns

of HIV infection.
3

Laboratory methods. In the unlinked surveys, residual

specimens collected for routine medical purposes are

tested for HIV type 1 (HIV-1) antibodies by using an

HIV-1 or HIV-1/HIV-2 enzyme immunoassay (EIA)

screening kit licensed by the Food and Drug

Administration (FDA) after all personal identifiers have

been removed. Sera that are reactive according to the

manufacturers instructions are retested in duplicate by

using fresh samples from the original unlinked

specimen. Repeatedly reactive sera are tested with an

FDA-licensed Western blot assay. Software provided

to the sites by CDC automatically generates Western

blot interpretations from recorded band patterns

according to the recommendations of the Association of

Public Health Laboratories and CDC.

Behavioral risk categories. Limited information on

demographic characteristics and major behavioral risk

categories is abstracted from client medical records and

intake forms only. For the purpose of this report,

behavioral risk groups for HIV infection are classified

into three mutually exclusive categories. Men whose

medical records indicate that they have had homosexual

or bisexual contact are categorized as MSM. Clients

who are not MSM and whose medical records indicate

that they have ever injected drugs are categorized as

IDUs. Persons for whom neither of the previous risk

categories is recorded are classified as others.

STD Clinics

STD clinics serve large numbers of persons at increased

risk for HIV infection due to unprotected sex and other

high-risk behaviors, such as having multiple sex

partners or using drugs. They are important sites for

evaluating HIV prevention programs and for

monitoring emerging patterns and trends in the

epidemic. These STD clinic surveys provide

comprehensive HIV prevalence data for MSM and

high-risk heterosexuals in the United States. Persons at

greatest risk for the sexual transmission of HIV are

likely to be those also at risk of acquiring other STDs;

thus, surveys in STD clinics provide useful information

on the sexual transmission of HIV infection.

Patients are eligible for inclusion in the survey if they

have not visited the clinic since initiation of the survey

during the current calendar year and if blood is drawn

for routine syphilis testing. The annual survey period

in each clinic ranged from 3 months to 1 year,

depending on clinic size. To ensure statistical validity,

Table 1 includes only data from clinics that reported at

least 500 eligible specimens collected and tested

according to CDC protocol or the clinics that reported

at least 200 MSM. Subgroups were analyzed for clinics

that collected and tested at least 50 specimens per

group. Median percentage positive is reported for each

metropolitan area, and ranges are included for those

areas with more than one clinic.

Persons attending STD clinics may not be

representative of all persons with STDs. Because the

prevalence of HIV is very high among MSM and IDUs,

the misclassification of only a few of these patients

could greatly elevate the measured prevalence among

patients who reported heterosexual contact as their only

risk. Therefore, prevalence rates among heterosexual

persons who reported no other risk must be interpreted

with caution.

Drug Treatment Centers

The HIV transmission associated with injection drug

use occurs either directly through the sharing of drug

injection equipment or indirectly through sexual and

perinatal transmission from IDUs. Drug users entering

treatment are a subgroup of all drug users that is easily

accessible for unlinked prevalence surveys because

blood specimens are routinely obtained as part of the

medical assessment. Of the 21 drug treatment centers

in this analysis, 18 were primarily methadone

maintenance or methadone detoxification centers, and

3 were primarily drug-free programs.

Clients eligible for the unlinked prevalence surveys

are those entering treatment for illicit drug use who

have a routine blood test for purposes other than for

HIV testing and who have used illicit drugs at least

once during the past 12 months. The data in Table 2

are for eligible clients who reported having ever

injected drugs. Only data from centers that reported

at least 100 eligible specimens collected and tested

according to the CDC protocol are included in the

tables. Subgroups were analyzed for centers that

collected and tested at least 25 specimens per group.

Median percentage positive is reported for each

metropolitan area, and ranges are included for those

areas with more than one center.

Although the prevalence rates obtained from this survey

may represent HIV infection rates within the population

of IDUs in treatment, they may not reflect HIV

prevalence among all IDUs. If IDUs who are not in

treatment programs engage in high-risk behaviors more

frequently than those who enter treatment, the

prevalence rates obtained from this survey may be an

underestimate of HIV in the entire population of IDUs.
4

However, because in-treatment IDUs are in general

older than IDUs who are not in treatment, the prevalence rates could be an overestimate of HIV prevalence

among all drug users.

Adolescent Medicine Clinics

The HIV prevalence rates among adolescents likely

reflect recent infections. Clinics specifically for

adolescents and young adults are of special interest

because they serve a population that may not be seen at

other health-care facilities. These clinics offer a wide

range of services, including general primary care,

family planning, prenatal care, counseling, STD

treatment, and sports physicals. Of the six adolescent

clinics in four metropolitan areas that participated in the

1997 survey, three were hospital-based and three were

community-based.

Eligible clients are those 13 through 24 years of age

who initially visit the clinic during the survey year and

from whom a blood specimen is drawn as part of

routine clinic procedures. Clients who visit the clinic

for HIV testing, for evaluation or treatment of HIV

infection, or for follow-up visits are excluded from the

survey.

Data from these surveys provide important prevalence

information for selected clients in a given clinic.

However, it is not possible to generalize those

prevalence rates to all adolescents and young adults in

the surrounding areas.

Job Corps Entrants

The Job Corps, administered by the U.S. Department

of Labor, is an occupational training program for

socially and economically disadvantaged youth from

rural and urban areas of all 50 states and U.S.

territories. Data sent to CDC from the Job Corps

provide a system for monitoring the HIV epidemic in

this population, which may be at increased risk for

HIV infection.

The Job Corps recruits high school dropouts or high

school graduates in need of additional education or

training in order to obtain and hold meaningful jobs.

The results in this report are for Job Corps entrants in

the United States and Puerto Rico who were 16 through

21 years of age. All entrants residing at Job Corps

centers during their training are counseled and tested

for HIV within the first 2 days of residency. Those

who test positive for HIV are allowed to continue as

residential trainees and receive both medical care and

social support. The entrants reported home state is the

basis of the state-specific rates in this report.

Job Corps entrants may not fully represent the larger

population of disadvantaged youth. Although sexual

orientation or history of illicit drug use does not

constitute a basis for exclusions, current illicit drug

users, persons with severe medical or behavioral

problems, and persons on supervised probation or

parole or incarcerated are excluded. Because HIV

testing is mandatory, self-selection for enrollment in the

program could either decrease or increase the number

of HIV-infected entrants.

Military Applicants

CDC monitors HIV prevalence data provided by the

U.S. Department of Defense (DOD) from their

screening program for military applicants. Because of

the large number of male and female applicants from all

areas of the country, this population provides valuable

information about the HIV epidemic.

All persons applying for active duty or reserve military

service, the service academies, or the Reserve Officer

Training Corps must have high school diplomas or the

equivalent. Applicants are screened for HIV infection

as part of their entrance examinations. HIV-positive

applicants are informed of their test results and

counseled by a physician and are excluded from

military service. On a quarterly basis, DOD sends CDC

HIV test results and limited demographic information

on all applicants tested. No information is available on

behavioral risk factors for HIV infection. The

applicants reported home state is the basis for the statespecific rates.

In July 1993, the military ended the screening exclusion

of MSM. However, because HIV-positive applicants

and drug users are not accepted into the military,

associated self-selection bias among persons in highrisk categories may occur. Therefore, MSM, IDUs, and

others who were already aware or suspected that they

were infected with HIV are likely to be underrepresented in the population of military applicants.
5

Table 1. HIV prevalence among patients at sexually transmitted disease clinics,

by metropolitan area, exposure category, and sex, 1997

Others All Clinics

Clinics Specimens

analyzed1 tested MSM IDUs Male Female Median3 Range

Northeast

Boston 1 985 19.7  3.2 2.9 4.4 

New York City 5 7,771 24.0 16.4 4.9 2.4 6.3 3.36.6

Newark 1 2,352 19.6  4.3 3.8 4.8 

Midwest

Chicago 1 2,393 18.6 4.8 1.8 1.5 3.8 

Detroit 1 3,302 17.0  0.5 0.3 0.8 

South

Atlanta 2 3,086 35.6  2.5 1.7 4.0 2.95.1

Baltimore 2 3,167  15.4 3.2 3.6 6.0 4.97.1

Houston 4 6,614 18.0 5.3 2.1 1.3 2.2 2.09.7

Miami 2 1,862   5.8 6.4 7.3 5.69.1

New Orleans 1 2,034 19.0  1.3 1.1 1.8 

Washington, D.C. 2 1,835 8.2  5.9 3.3 8.3 5.211.4

West

Denver 1 3,020 13.9 2.3 0.3 0.1 1.3 

Los Angeles 4 11,234 17.9 0.0 1.1 0.5 1.7 0.83.9

Phoenix 1 2,362 20.2  0.6 0.2 2.2 

San Francisco4       

Seattle 1 1,639 3.6 0.0 0.1 0.2 0.5 

Total 29 53,656 19.3 4.8 2.7 1.6 3.9 0.511.4

1 Includes only clinics reporting at least 500 eligible specimens collected and tested according to CDC protocol or clinics reporting at least

200 MSM.

2 Subgroups analyzed for clinics reporting at least 50 specimens per group. IDU subgroup does not include MSM. Others subgroup does

not include MSM or IDUs.

3 Median rate for clinics in the metropolitan area.

4 Data not available.

Median % positive2
6

Table 2. HIV prevalence among injection drug users entering drug treatment

centers, by metropolitan area and sex, 1997

Median % positive2

All centers

Centers Specimens

analyzed1 tested Male Female Median3 Range

Northeast

Boston 2 340 11.5 9.8 10.6 6.414.8

New York City 5 2,302 29.5 27.9 28.8 25.433.0

Newark 1 191 33.9 43.9 37.7 

Midwest

Chicago 1 301 18.0 14.4 16.6 

Detroit 1 406 5.7 5.5 5.7 

South

Baltimore 1 135 19.7 22.0 20.7 

Washington, D.C. 1 157 15.1 18.9 15.9 

West

Denver 2 352 0.0 0.0 0.0 0.00.0

Los Angeles 3 777 0.7 1.0 0.8 0.71.9

San Francisco 1 444 8.3 9.6 8.8 

Seattle 2 524 1.9 1.8 1.8 1.52.2

Other

San Juan 1 500 19.5 23.7 20.0 

Total 21 6,429 15.1 11.6 14.8 0.037.7

1 Includes only centers reporting at least 100 eligible specimens collected and tested according to CDC protocol.

2 Subgroups analyzed for centers reporting at least 25 specimens per group.

3 Median rate for centers in the metropolitan area.
7

Table 3. Summary of HIV prevalence among youth at adolescent medicine

clinics, by metropolitan area, 1997

 % Positive

Median Range

Northeast

 New York City

South

 Baltimore

 Houston

West

 Los Angeles

Clinics analyzed

1

1

3

1

Specimens tested

2,552

 932

1,907

 207

0.3 

0.3 

0.1 0.00.4

1.0 
Boston

Sexually transmitted disease clinics

Drug treatment centers

Adolescent medicine clinics

New York City

Newark

Atlanta

Baltimore

Miami

Houston

New Orleans

Washington, D.C. Denver

Seattle

Phoenix

San Juan

Los Angeles

Chicago

Detroit

San Francisco

Figure 1. Metropolitan areas participating in CDC’s national

unlinked HIV prevalence surveys in clinics, 1997

8
Figure 3. HIV prevalence among men who have sex with men, sexually

transmitted disease clinic surveys, by race/ethnicity

and region, 1997

0

5

10

15

20

25

30

35

Northeast Midwest South West

White

Black

Hispanic

Figure 2. HIV prevalence among men who have sex with men,

sexually transmitted disease clinic surveys, 1997

Boston

Median % positive

New York City

Newark

Atlanta

Houston

New Orleans

Washington, D.C. Denver

Seattle

Phoenix

0

10

20

30

40

Los Angeles

Chicago

Detroit

Includes only areas with sufficient data for analysis.

HIV prevalence (% positive)

9
Figure 5. HIV prevalence among females, sexually transmitted

disease clinic surveys, by race/ethnicity and region, 1997

0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

Northeast Midwest South West

White

Black

Hispanic

Figure 4. HIV prevalence among females, sexually transmitted disease

clinic surveys, 1997

Boston

Median % positive

New York City

Newark

Denver Washington, D.C.

Seattle

Baltimore

0

1

2

3

4

5

Atlanta

Houston

Miami

New Orleans

Phoenix

6

7

Los Angeles

Chicago

Detroit

Includes only areas with sufficient data for analysis.

10

IDUs not included.

HIV prevalence (% positive)
Figure 7. HIV prevalence among injection drug users, drug treatment

center surveys, by race/ethnicity and region, 1997

0

5

10

15

20

25

30

35

40

Northeast Midwest South West

White

Black

Hispanic

Figure 6. HIV prevalence among injection drug users, drug treatment

center surveys, 1997

Boston

Median % positive

New York City

Newark

Washington, D.C. Denver

Seattle

0

10

20

30

40

Baltimore San Francisco

San Juan

Los Angeles

Chicago

Detroit

Includes only areas with sufficient data for analysis.

HIV prevalence (% positive)

11
Figure 9. HIV prevalence among Job Corps entrants, by state of residence, 1997

.00 - .04

.05 - .19

.20 - .39

.40+

% Positive

Source: Department of Labor

Figure 8. HIV prevalence among Job Corps entrants, by sex and

race/ethnicity, 1997

0

0.1

0.2

0.3

0.4

0.5

0.6

White, not

Hispanic

Black, not

Hispanic

Hispanic American

Indian/Alaska

Native

Asian/Pacific

Islander

All races

Race/Ethnicity

Male

Female

Source: Department of Labor

HIV prevalence (% positive)

12
Figure 10. HIV prevalence among applicants for military service by

sex and race/ethnicity, 1997

0

0.1

0.2

Race/Ethnicity

Male

Female

Source: Department of Defense

White, not

Hispanic

Black, not

Hispanic

Hispanic American

Indian/Alaska

Native

Asian/Pacific

Islander

All races

HIV prevalence (% positive)

13

.00

.01 - .03

.04 - .06

.07+

% Positive

Figure 11. HIV prevalence among applicants for military service, by state

of residence, 1997

Source: Department of Defense
14

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the levels and trends of HIV infection: the Public

Health Services HIV Surveillance Program. Public

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Karon JM, Rosenberg PS, McQuillan G, Khare M,

Gwinn M, Petersen LR. Prevalence of HIV infection in

the United States, 1984 to 1992. JAMA 1996;276:

126-31.

National Commission for the Protection of Human

Subjects of Biomedical and Behavioral Research.

Belmont Report: Ethical Principles and Guidelines for

the Protection of Human Subjects of Research.

Washington DC, Government Printing Office, 1988.

Publication GPO 887-890.

Pappaioanou M, Dondero TJ, Petersen LR, Onorato IM,

Sanchez CD, Curran JW. The family of HIV

seroprevalence surveys: objectives, methods, and uses

of sentinel surveillance for HIV in the United States.

Public Health Rep 1990;105:113-9.

Sexually Transmitted Disease Clinics

McCray E, Onorato IM. Sentinel surveillance of

human immunodeficiency virus infection in sexually

transmitted disease clinics in the United States. J Sex

Transm Dis 1992;19:235-41.

Onorato IM, McCray E, Pappaioanou M, et al. HIV

seroprevalence surveys in sexually transmitted disease

clinics. Public Health Rep 1990;105:119-24.

Weinstock HS, Sidhu J, Gwinn M, Karon J, Petersen

LR. Trends in HIV seroprevalence among persons

attending sexually transmitted disease clinics in the

United States, 1988-1992. J Acquir Immune Defic

Syndr Hum Retrovirol 1995;9:514-22.

Drug Treatment Centers

Allen DM, Onorato IM, Green TA. HIV infection in

intravenous drug users entering drug treatment, United

States, 1988 to 1989. Am J Public Health 1992;82:

541-6.

Jones TS, Allen DM, Onorato IM, Petersen LR,

Dondero TJ, Pappaioanou M. HIV seroprevalence

surveys in drug treatment centers. Public Health Rep

1990;105:125-30.

Prevots DR, Allen DM, Lehman JS, Green TA,

Petersen LR, Gwinn M. Trends in human

immunodeficiency virus seroprevalence among

injecting drug users entering drug treatment centers,

United States, 1988-93. Am J Epidemiol 1996;

143:733-42.

Adolescent Medicine Clinics

Lindegren ML, Hansen C, Miller K, Byers RH, Onorato

IM. Epidemiology of human immunodeficiency virus

infection in adolescents, United States. Pediatr Infect

Dis J 1994;13:525-35.

Sweeney P, Lindegren ML, Buehler JW, Onorato IM,

Janssen RS. Teenagers at risk of human immunodeficiency virus type 1 infection. Arch Pediatr Adolesc

Med 1995;149:521-8.

Wendell DA, Onorato IM, McCray E, Allen DM,

Sweeney PA. Youth at risk: sex, drugs, and human

immunodeficiency virus. Am J Dis Child 1992;146:

76-81.

Job Corps Entrants

Conway GA, Epstein MR, Hayman CR, et al. Trends

in HIV prevalence among disadvantaged youth: survey

results from a national job training program, 1988

through 1992. JAMA 1993;269:2887-9.

St. Louis ME, Conway GA, Hayman CR, Miller C,

Petersen LR, Dondero TJ. Human immunodeficiency

virus infection in disadvantaged adolescents: findings

from the US Job Corps. JAMA 1991;266:2387-91.
15

Valleroy LA, MacKellar DA, Karon JM, Janssen RS,

Hayman CR. HIV infection in disadvantaged out-ofschool youth: prevalence for U.S. Job Corps entrants,

1990 through 1996. J Acquired Immune Defic Syndr

Hum Retrovirol 1998;19:67-73.

Applicants for Military Service

Burke DS, Brundage JF, Goldenbaum M, et al. Human

immunodeficiency virus infections in teenagers:

seroprevalence among applicants for military service.

JAMA 1990;263:2074-7.

Brundage JF, Burke DS, Gardner LI, et al. Tracking

the spread of the HIV infection epidemic among young

adults in the US: results of the first four years of

screening among civilian applicants for military

service. J Acquir Immune Defic Syndr 1990;3:1168-80.
16

Survey of Childbearing Women

The Survey of Childbearing Women (SCBW) was

conducted from 1988 through 1995 in collaboration

with CDC, the National Institute of Child Health and

Human Development, and state and territorial health

departments. This unlinked survey, which was

concluded at the end of 1995, measured the prevalence

of HIV infection among women who gave birth to live

infants in participating states and territories of the

United States.

Maternal antibodies, including antibodies to HIV, cross

the placenta during pregnancy and are present in the

blood of a newborn at approximately the same concentration as in the mother. In the SCBW, residual dried

blood specimens that are routinely collected on filter

paper from newborn infants for metabolic screening

programs were tested for HIV antibody after the

removal of all personal identifiers. Data from the

population-based SCBW can be compared with other

national health data, such as acquired immune

deficiency syndrome (AIDS) surveillance data, to

describe the dynamics of the HIV epidemic among

women of reproductive age.

The last full year of data collection for the SCBW was

1994; partial data were available for 1995. Prevalence

rates were generally higher in the Northeast and in the

South for both years (Tables 4 and 5; Figures 12 and

13). The collection of race/ethnicity data differed by

state. For states that reported race/ethnicity data for

1994, prevalence rates were consistently higher among

blacks than among whites or Hispanics (Figure 14).

Appendix
17

State of birth

Alabama

Alaska

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

District of Columbia1

Florida

Georgia

Hawaii

Idaho2

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska2

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota2

Ohio

Oklahoma

Oregon

Pennsylvania

Puerto Rico

Rhode Island

South Carolina

South Dakota2

Tennessee

Texas

Utah

Vermont2

Virginia

Washington

West Virginia

Wisconsin

Wyoming

Months data collected

12

12

12

12

3

12

12

12

12

6

12

12



3

6

12

12

12

12

12

12

12

12

12

12

12

12



12

12

4

12

12

12



6

12

12

6

12

12

12



12

9

12



12

12

12

12

12

Specimens tested

57,710

10,255

64,758

32,682

141,983

52,195

44,201

10,807

14,184

85,026

126,248

15,406



46,195

39,564

36,062

36,096

48,949

62,153

14,299

68,576

81,511

134,486

62,626

37,061

74,902

10,634



23,603

13,983

28,390

26,990

272,058

95,123



78,976

43,963

43,194

72,234

61,179

14,096

48,236



70,519

213,241

36,631



88,283

70,442

21,509

65,100

5,670

% Positive

0.12

0.01

0.04

0.06

0.07

0.05

0.21

0.26

0.75

0.46

0.20

0.06



0.10

0.05

0.03

0.03

0.04

0.24

0.02

0.35

0.20

0.04

0.04

0.15

0.05

0.02



0.05

0.07

0.35

0.01

0.52

0.16



0.08

0.02

0.03

0.16

0.47

0.09

0.22



0.10

0.11

0.02



0.12

0.04

0.05

0.04

0.00

1 Data for fourth quarter of 1994 are incomplete.

2 Not in Survey of Childbearing Women.

Table 4. Survey of Childbearing Women: number of specimens tested and HIV

prevalence, by state or territory, 1994
18

Table 5. Survey of Childbearing Women: number of specimens tested and HIV

prevalence, by state or territory, 1995

State of birth1

Alabama

Alaska

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

District of Columbia

Florida

Georgia

Hawaii

Idaho2

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska2

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota2

Ohio

Oklahoma

Oregon

Pennsylvania

Puerto Rico

Rhode Island

South Carolina

South Dakota2

Tennessee

Texas

Utah

Vermont2

Virginia

Washington

West Virginia

Wisconsin

Wyoming

Months data collected

4

12

12

12

3

12

9

12

0

6

5

8



3

6

12

3

12

12

12

12

8

4

12

7

2

12



12

12

4

0

12

2



6

3

12

3

5

12

12



7

4

3



8

6

4

6

5

Specimens tested

18,248

8,798

74,541

32,241

135,991

48,062

32,432

10,809



65,220

45,070

8,494



45,468

41,272

34,611

8,570

45,761

51,257

10,634

63,751

46,087

65,689

61,243

16,001



10,529



22,081

13,906

28,562



265,347





75,239

10,478

39,393

33,664

22,975

13,430

49,276



30,441

88,658

8,621



58,708

23,505

6,725

18,454

2,297

% Positive

0.09

0.02

0.03

0.07

0.07

0.05

0.18

0.25



0.41

0.19

0.06



0.13

0.06

0.01

0.05

0.02

0.25

0.02

0.30

0.15

0.04

0.04

0.15



0.01



0.05

0.01

0.30



0.46





0.07

0.04

0.05

0.15

0.34

0.12

0.22



0.14

0.09

0.01



0.10

0.05

0.00

0.04

0.00

1 States with less than 3 months of collected data not analyzed.

2 Not in Survey of Childbearing Women.
District of Columbia

Figure 13. HIV prevalence among childbearing women, 1995

No data or <3 months

of data

.00 - .04

.05 - .19

.20 - .39

.40+

% Positive

District of Columbia

19

Figure 12. HIV prevalence among childbearing women, 1994

No data or <3 months

of data

.00 - .04

.05 - .19

.20 - .39

.40+

% Positive
Figure 14. HIV prevalence among childbearing women,

by race and state*, 1994

0

0.5

1.0

1.5

2.0

Michigan

Kansas

Mississippi

Alabama

Tennessee

California

South Carolina

Minnesota

Texas

Connecticut

New Jersey

New York

Florida

White

Black

Hispanic

*States meeting criteria for completeness of race/ethnicity data HIV prevalence (% positive)

20
21

Suggested Readings

Davis SF, Byers RH Jr., Lindegren ML, Caldwell MB,

Karon JM, Gwinn M. Prevalence and incidence of

vertically acquired HIV infection in the United States.

JAMA 1995;274:952-5.

Davis SF, Rosen DH, Steinberg S, Wortley PM, Karon

JM, Gwinn M. Trends in HIV prevalence among

childbearing women, United States, 1989-1994.

J Acquir Immune Defic Syndr Hum Retrovirol

1998;19:158-64.

Gwinn M, Pappaioanou M, George R, et al. Prevalence

of HIV infection in childbearing women in the United

States. JAMA 1991;265:1704-8.

Pappaioanou M, George RJ, Hannon WH, et al.

HIV seroprevalence surveys of childbearing women:

objectives, methods, and uses of the data. Public

Health Rep 1990;105:147-52.

Wortley PM, Fleming PL. AIDS in women in the

United States. JAMA 1997;278:911-6.
22

Sentinel Hospital Surveillance

System for HIV Infection

The Sentinel Hospital Surveillance System was

established in 1986 to detect and monitor HIV

prevalence in populations at acute-care hospitals in

metropolitan areas of the United States. The survey

focused on persons treated at participating hospitals,

including outpatient and emergency services, for

medical conditions unrelated to HIV infection or major

HIV risk behaviors. The sentinel hospital study

concluded at the end of 1995.

Hospitals participated in the Sentinel Hospital

Surveillance System on the basis of responses to a

request for proposals issued by CDC and thus were not

a representative sample of all hospitals in the United

States. Hospitals had participated in a previous phase

of the Sentinel Hospital Surveillance System for HIV

infection and met the definition for high HIV prevalence among hospital patients in 1990-1991 (one or

more cases of newly diagnosed AIDS per 1000 patients

discharged per year). Serum specimens that remained

after clinical testing of inpatients and outpatients were

systematically selected to meet quotas based on the

distribution of age and sex in the U.S. population. The

data presented in this report exclude results of tests of

blood specimens from persons whose hospital visits

were specifically for conditions associated with HIV

infection, such as AIDS, or related to considerably

increased risk for exposure to HIV infection, such as

hemophilia or drug overdose.

HIV prevalence rates were higher among males than

among females for whites, blacks, and Hispanics at

hospitals that participated in the survey during 1994.

For males and females, overall rates were higher for

blacks than for whites. HIV prevalence differed by

region (Table 6).

These patterns persisted during 1995. Prevalence rates

among males were higher at nearly all participating

hospitals. Rates increased in the Northeast from 1994

to 1995 for all race/ethnicity groups for males and also

for white and black females (Tables 6 and 7).
23

 % Positive

Male Female

Hospitals

by region White Black Hispanic White Black Hispanic

Northeast

1  11.7 8.0  5.8 5.1

2 2.4 5.6 1.4 0.0 3.4 1.2

3 3.0 5.7 1.5 2.2 5.1 2.3

4 6.1 4.3 5.8 2.4 2.0 2.9

5 0.9 1.4 0.2 0.2 1.2 

Midwest

6 0.9 1.6  0.4 0.5 

7 0.0 3.4  0.8 1.6 

8 3.4 5.9 0.9 1.0 1.3 1.8

South

9 1.0 5.3  0.9 3.7 

10 0.9 4.5  0.4 4.1 

11 3.0 5.7 3.0 1.6 6.4 1.4

12 1.2 6.1  1.0 2.7 

13 4.3 9.2  0.3 3.4 

West

14 1.2 4.0 1.8 0.2 1.2 0.0

Table 6. Sentinel Hospital Surveillance System for HIV Infection: prevalence

among patients, by region, sex, and race/ethnicity, 1994
24

Table 7. Sentinel Hospital Surveillance System for HIV Infection: prevalence

among patients, by region, sex, and race/ethnicity, 1995

 % Positive

Male Female

Hospitals

by region White Black Hispanic White Black Hispanic

Northeast

1  11.7 9.6  6.8 5.9

2 2.9 4.0 3.3 5.9 2.8 0.0

3 4.3 9.1 9.5 4.3 5.1 0.9

4 5.4 6.2 6.7 1.7 3.8 2.5

5 0.9 4.5  0.6 2.1 

Midwest

6 1.0 2.0  0.0 1.0 

7 1.5 4.0  1.4 1.2 

8 1.9 6.1 4.0 1.3 1.9 1.5

South

9 1.2 6.5  0.5 3.1 

10 1.0 5.7  0.6 2.2 

11 2.2 4.0 2.5 1.8 5.9 1.5

12 2.0 5.7  0.6 3.6 

13 1.5 5.2 1.1 0.0 2.0 0.0

West

14 0.7 5.5 1.0 0.2 0.8 0.2
25

Suggested Readings

Chin KM, Sidhu JS, Janssen RS, Weber JT. Invasive

cervical cancer in human immunodeficiency virusinfected and uninfected hospital patients. Obstet

Gynecol 1998;92:83-7.

Janssen RS, St Louis ME, Satten GA, et al. HIV

infection among patients in U.S. acute care hospitals:

strategies for the counseling and testing of the hospital

patients. N Engl J Med 1992; 327:445-52.

St Louis ME, Olivo N, Critchley S, et al. Methods of

surveillance for HIV infection at U.S. sentinel hospitals.

Public Health Rep 1990;105:140-6.

Trepka MJ, Davidson AJ, Douglas JM Jr. Extent of

undiagnosed HIV infection in hospitalized patients:

assessment by linkage of seroprevalence and

surveillance methods. Am J Prev Med 1996;12:

195-202.