The Emerging Third Stage of the AIDS Epidemic: The Low-Risk Heterosexual

Abstract

Using Centers for Disease Control (CDC) data on 420,148 adults with AIDS reported before January 1995, this article documents that certain low-risk categories of heterosexuals with AIDS (1) were likely to have been underreported by the CDC before 1993; (2) were newly emerging in the early 1990s, having had more than half of their total cases diagnosed in 1993 and 1994; (3) were growing in number by 76 percent to 92 percent per year in early 1993; and (4) between 1988 and 1996 had increased their proportion among all AIDS cases reported annually by eight times for women and by thirteen times for men. The authors propose that a third stage of the AIDS epidemic emerged among adults in the early 1990s. The first stage consisted of members of the three original high-risk groups of the 1980s (men who had had male-male sex, IV-drug users, and blood or blood-product recipients). The heterosexual, non-IV-drug-using sex partners of these individuals made up the second stage. The newly emerging third stage is composed of (1) the low-risk heterosexual sex partners of second-stage persons and (2) low-risk people who were subsequently infected with HIV through heterosexual sex with third-stage persons (third- to third-stage sexual transmission).