Acquired immunodeficiency syndrome in Alabama: Special concerns for black women

Background. Among AIDS case reports from rural and small town areas of the United States, rates are higher in the South than in any other part of the country. Methods. For this study we analyzed AIDS surveillance statistics from the state of Alabama for trends, distributions, and populations affected. Mie aggregated Alabama AIDS surveillance data in 5-year intervals - 1981 to 1985, 1986 to 1990, 1991 to 1995 - and made comparisons based on geographic area of residence of people diagnosed with AIDS. Results, Of the 3,558 cases of AIDS reported in Alabama in the period 1981 to 1995, 86% were men and 14% were women. Among women, 69.7% were black and 29.1% were white. Among men, 48.4% were black and 50.9% were white. We compared these figures with 1995 Alabama population estimates of 26.2% black, 73.7% white, and <1% another race. The rates for black women and white women increased 170-fold and 23-fold, respectively, from the 1981 to 1985 period to the 1991 to 1995 period. For the same periods, case rates for black men and white men increased more than 80-fold and 50-fold, respectively. Black women showed a rise per 100,000 population - from 0.3 (1981 to 1985) in both northern and southern Alabama to 37 in northern Alabama and 64 in southern Alabama (1991 to 1995). Conclusions. Black women are at disproportionately high risk, particularly in the southern counties of Alabama. HIV is increasingly prevalent in rural and small town communities in Alabama and is more often transmitted heterosexually than it has been previously.