HIV in the United States at the turn of the century: an epidemic in transition.
OBJECTIVE
The current status of and changes in the HIV epidemic in the United States are described.


METHODS
Surveillance data were used to evaluate time trends in AIDS diagnoses and deaths. Estimates of HIV incidence were derived from studies done during the 1990s; time trends in recent HIV incidence were inferred from HIV diagnoses and seroprevalence rates among young persons.


RESULTS
Numbers of deaths and AIDS diagnoses decreased dramatically during 1996 and 1997 but stabilized or declined only slightly during 1998 and 1999. Proportional decreases were smallest among African American women, women in the South, and persons infected through heterosexual contact, HIV incidence has been roughly constant since 1992 in most populations with time trend data, remains highest among men who have sex with men and injection drug users, and typically is higher among African Americans than other racial/ethnic groups.


CONCLUSIONS
The epidemic increasingly affects women minorities, persons infected through heterosexual contact, and the poor. Renewed interest and investment in HIV and AIDS surveillance and surveillance of behaviors associated with HIV transmission are essential to direct resources for prevention to populations with greatest need and to evaluate intervention programs.
Karon
J M
JM
National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Ga., USA. jkaron@cdc.gov
Fleming
P L
PL
Steketee
R W
RW
De Cock
K M
KM
D002423:Cause of Death; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D015528:HIV Seroprevalence / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008913:Minority Groups / Q000706:statistics & numerical data; D011159:Population Surveillance; D011203:Poverty; D012307:Risk Factors; D017678:Sex Distribution; D012725:Sexual Behavior; D014481:United States / Q000453:epidemiology