Sex Seen as Source of Most New AIDS Cases in Women : Health: Prior to 1992, intravenous drug use was the leading cause, CDC says. The trend indicates spread of the disease away from primary risk groups.

By MARLENE CIMONS

July 23, 1993 12 AM PT

TIMES STAFF WRITER

WASHINGTON —

For the first time since the start of the AIDS epidemic, more American women were infected with the human immunodeficiency virus through sexual contact than through intravenous drug use, federal health officials reported Thursday.

Although not unexpected, the trend indicates the continuing spread of the disease away from primary risk groups, such as homosexual men and intravenous drug users, and toward more mainstream populations, health officials said.

“This is a signal that this movement is occurring and we shouldn’t be complacent,” said Dr. John Ward, chief of the Centers for Disease Control and Prevention’s HIV/AIDS surveillance branch. “Heterosexual transmission is becoming more common, and this is a reflection of what the data are telling us.”

Most of the women were one step removed from HIV exposure through drug use. While they did not inject drugs themselves, they had sexual contact with someone who did, meaning that heterosexual transmission among women continues to be greatest in communities with high rates of intravenous drug use, the CDC said in its Morbidity and Mortality Weekly Report.

Although the statistics reflect AIDS cases reported in 1992--the latest year for which complete figures are available--they represent infections that are likely to have taken place as many as 10 years ago.

“More than half of the women who acquired the infection through heterosexual contact reported having sex with an injecting drug user,” Ward said.

Overall, new AIDS cases in the United States increased 3.5% in 1992, with 47,095 cases reported, compared with 45,499 in 1991, the CDC said.

As in previous years, the majority of cases--nearly 51%--were among homosexual and bisexual men, although the number of cases in that group decreased during 1992, continuing a trend begun the year before, the CDC said.

But women accounted for the biggest increase in new cases, recording an increase of 9.8% last year, compared to the 2.5% increase among males. There were 6,642 new cases reported among women and 40,453 new cases among men, the Atlanta-based federal agency said.

Although the cases among women do not reflect “an abrupt jump,” they are “consistent with the trends of the last few years,” Ward said, indicating “the continued evolution of the epidemic away from injecting drug users and homosexual and bisexual men.”

Women still make up about 15% of the total caseload, Ward said.

The latest findings “demonstrate a continuing trend of increased HIV infection among women and the growing risk of contracting HIV through heterosexual contact,” said Christine Lubinski, associate director of programs for AIDS Action Council, a lobbying organization.

Growing numbers of women with HIV “are in desperate need of health and support services that respond to their particular needs,” she added. “Biomedical research, as well, must pay far more attention to the specifics of how HIV disease progresses in women.”

The CDC report “underscores the tremendous need for highly specific education aimed at sexually active women,” said David Kirby of the American Foundation for AIDS Research.

The CDC said that the steady increase in heterosexually acquired cases emphasizes “the need to improve understanding of . . . safer sexual practices among heterosexuals.”

Surveys among the general heterosexual population have “found low rates of condom use for persons with multiple partners and for persons with partners at risk for HIV infection, indicating that behavioral changes sufficient to decrease HIV transmission may not yet have occurred,” the CDC said.

AIDS cases attributable to intravenous drug use were about 25% of all cases last year, a slight increase over the previous year, the CDC said.

Cases acquired through heterosexual contact accounted for the largest proportionate increase in reported cases, the agency said. The proportionate increase in heterosexual cases was greater for men than for women; however women accounted for most people infected through that means, the CDC said.

One serious consequence of growing infections among women was an increase of transmission of HIV to their offspring; the second-largest proportionate increase was recorded among infants infected during pregnancy by their mothers, the CDC said.

Most of the new cases among women were concentrated in 10 metropolitan areas, with New York City reporting the greatest number, 1,581 new cases. In the Los Angeles metropolitan area, 163 new cases among women were reported, the CDC said.

L.A. 10th in AIDS Rates for Women

The 10 metropolitan areas in the United States and its territories with the highest rates of AIDS among women:

Cases per 100,000 women

* New York: 42

* West Palm Beach, Fla.: 38

* Ft. Lauderdale, Fla.: 34

* Newark, N.J.: 30

* Miami: 29

* San Juan, Puerto Rico: 27

* Baltimore: 19

* Washington: 10

* Chicago: 8