Suburbs see jump in AIDS

April 17, 1994|By Holly Selby | Holly Selby,Maryland AIDS Administration and the federal Centers for Disease Control and Prevention.Sun Staff Writer

In a clinic in the suburbs, Brian Scott sees daily evidence that AIDS is not just a city problem.

He and his staff encounter all kinds of people at all stages of the progressive disease: ailing drug abusers, gay men with full-blown AIDS, pregnant women who have tested positive for HIV and can't afford care.

The clinic is in Prince George's County, which last year had Maryland's highest percentage increase (20.3) in AIDS cases, higher even than Baltimore City's (15.9).

"People will say, 'HIV is a city disease, and it doesn't affect me,' " says Mr. Scott. "But we see people every day not from the cities."

His remarks are echoed by other health workers and specialists when they discuss shifts in the demographics of acquired immune deficiency syndrome.

The epidemic has served notice, via statistics, that it will spare neither cities nor their suburbs. An increase in AIDS cases caused by heterosexual transmission is partly responsible for growing caseloads beyond city borders.

According to preliminary totals for 1993, the number of cases in four Baltimore metropolitan counties -- Anne Arundel, Baltimore, Harford and Howard -- grew by larger percentages than in the city. Only Carroll County's was smaller.

For example, Baltimore County had 82 new cases in 1993, an increase of 19.7 percent over the 416 cases reported from 1981 through 1992.

The corresponding figures for the city were 543 new cases, an increase of 15.9 percent over the 1981-1992 caseload of 3,421.

"We see a tremendous escalation in the number of women [who are diagnosed with AIDS], a general increase in heterosexual transmission and a general decrease in homosexual transmission," says Eileen Foster, human services coordinator in the Baltimore County AIDS division.

The large caseload in Prince George's County -- 244 new patients last year -- may be influenced by the county's proximity to Washington, D.C., say health officials. A hub of the epidemic nationally, Washington had 1,534 new cases in 1993, a 36.7 percent increase over the 1981-1992 total.

For more than a year, Mr. Scott has run the Whitman-Walker Clinic of Suburban Maryland, a satellite in Hyattsville of the Whitman-Walker AIDS clinic of Washington.

During that time, more than 330 people infected with the human immunodeficiency virus or AIDS have come for medical referrals, a Spanish interpreter's services, financial aid or counseling. Most are from Prince George's County or Montgomery County.

Three waves of infection

Although the majority of AIDS cases nationally still occur among gay men and substance abusers, the epidemic is viewed by some doctors and researchers as three overlapping "waves" of infection.

The first came from unprotected sex among male homosexuals, the second from needle sharing among intravenous drug users, and the third may come from heterosexual contact.

"The bulk of AIDS -- as a percentage of the total -- is still largely urban and is focused in Newark, New York City, Baltimore, Washington, L.A., Miami," says Dr. Alfred Saah, an epidemiologist at the Johns Hopkins School of Hygiene and Public Health. "These are all the places you'd expect large populations of gay men or large groups of drug users.

Recent statistics from the national Centers for Disease Control and Prevention in Atlanta also paint a changing picture of AIDS. In the mid-1980s, gay men accounted for about 67 percent of all AIDS cases. Last year, they constituted less than half.

The percentage of cases of AIDS caused by heterosexual contact increased more than in any other category of transmission. In 1985, 2 percent of all cases nationwide were caused by heterosexual contact. Last year, the figure was 9 percent, and two-thirds of those new cases were women, according to the CDC.

The agency also found that most cases of AIDS caused by vTC heterosexual sex were attributed to sexual contact with an intravenous drug user (42 percent) or with a partner whose risk for AIDS was unknown (49 percent).

In Maryland, the percentage of AIDS cases attributed to heterosexual sex has more than tripled since 1987. Last year, 12.3 percent of the 1,102 new cases reported were transmitted by heterosexual contact, up from 3.7 percent of 923 cases in 1987, according to the state AIDS Administration.

Within the gay community, many factors affect the spread of AIDS, health officials say. For example, they point out that HIV infection apparently has slowed among white gay men, but not among African-American gay or bisexual men.

"African-American gay men are not as easy to identify as a group and are not as easy to target with outreach [education] efforts," says Maureen McCleary, director of the Prince George's County division of HIV/AIDS.

In 1993, Maryland had the nation's eighth-highest rate of AIDS cases -- 47.6 documented cases of AIDS per 100,000 residents, according to the CDC. About 50 percent of all Marylanders diagnosed with AIDS -- 3,964 out of 7,844 people -- live or lived in Baltimore.

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