, Volume 18, Issue 6, pp 523-544

Evolution of an urban epidemic: The first 100,000 AIDS cases in New York City

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Abstract

Between 1981 and August 1997, 100,000 AIDS cases were reported in New York City (NYC): 77,067 men, 20,818 women, 307 teenagers, and 1,808 children. This report examines AIDS trends in NYC as the epidemic evolved from a predominantly white male epidemic among men with same sex contact (MSM) mostly from a single borough to a geographically diffuse epidemic that includes injecting drug users (IDU), persons of color, and women infected heterosexually. Case data were collected by active surveillance methods augmented by electronic laboratory based reporting. Mortality data were obtained from NYC Vital Statistics. 1990 Census data were used to derive incidence rates and prevalence by neighborhood income. Rates per 100,000 adults by neighborhood ranged from 260 to 5,500. Total AIDS incidence peaked in 1993 and has subsequently declined. Among men there was a shift from MSM to IDU as the predominant risk group, and increasing incidence among men reporting heterosexual contact. IDU was the leading risk factor among women, and women increased from 8 to 30 percent of all cases between 1982 and 1997. Unlike incidence, AIDS prevalence is rising among socially and economically marginalized populations, and will remain a major public health challenge well into the next century.