Geographical Patterns of AIDS in the United States

Abstract

Data on incidence of AIDS between 1981 and 1986 from the U.S. Centers for Disease Control are analyzed geographically. Nationwide and regional patterns by source groups, gender, race, age cohorts, and survival rates in the United States are emphasized. Some elements like association of AIDS incidence by source display distinct regional variations, while others like incidence by age cohort have uniform patterns. A CQUIRED immune deficiency syndrome (AIDS) is the bubonic plague of the twentieth century. Both diseases were initially incurable, and, as was the case with the plague, almost everyone who contracts AIDS eventually dies of it. Contrastingly the cause of AIDS was discovered and isolated shortly after the disease was identified.1 In this article we offer a spatial analysis of the disease in the United States by region, by patient, gender, and age groups of the victims, and by country of birth and death. This analysis is both tentative and speculative. Because of the current status of data collection and reporting for AIDS, definitive conclusions are virtually impossible. However, the problem has such contemporary enormity and future implications that it cannot be ignored or withheld from geographical analysis. The deadliness of AIDS is unquestioned. According to the World Health Organization, more than 500,000 AIDS cases had been reported globally by mid-1987, and five to ten million persons in all parts of the world had been infected by the virus.2 By the end of 1986, 32,560 cases had been reported in the Western Hemisphere, and 90 percent of them were in the United States. From the initial four diagnoses in 1978, the number of new cases in the United States increased to nine in 1979 and to forty-four in 1980.3 In 1986 alone, 9,877 new cases were reported by the U.S. Centers for Disease Control (CDC). The origin of the AIDS virus has several possible explanations. Most researchers believe that the retrovirus responsible for AIDS originated in * Margaret Geib, cartographer for the Department of Geography, University of Akron, prepared the graphics. Bani Bose, librarian at Akron City Hospital, Swati Sinha, and Karen Schauri are thanked for their help in the research for this article. I Colin Norman, AIDS Priority Fight Goes to Court, Science 231 (3 Jan. 1986): 11-13; Colin Norman, AIDS Virology: A Battle on Many Fronts, Science 230 (29 Nov. 1985): 518-521. 2 Jean L. Marx, Probing the AIDS Virus and Its Relatives, Science 230 (19 June 1987): 1523. 3A. M. Hardy, James R. Allen, W. Meade Morgan, and James W. Curran, The Incidence Rate of Acquired Immune Deficiency Syndrome in Selected Populations, Journal of American Medical Association 253, No. 2 (1985): 215-220. * DR. DUTT and DR. MONROE are members of the geography faculty at the University of Akron, Akron, Ohio 44325, where MRS. PRINCE is a graduate student in urban studies. DR. DUTTA is an associate professor of biological sciences at Kent State University, Kent, Ohio 44242. This content downloaded from 157.55.39.135 on Sun, 03 Jul 2016 04:14:23 UTC All use subject to http://about.jstor.org/terms AIDS IN THE UNITED STATES 457 Africa.4 The disease has been recognized in central Africa at least since 1972, six years before its identification in the United States. The large number of cases recognized in central Africa earlier than in other regions of the world suggests an African origin and the spread of the AIDS virus from there. This explanation of the origin of AIDS emanates from the isolation of a retrovirus, similar to the AIDS virus, from West African wild green monkeys. The virus may recently have crossed the species barrier and infected humans, although the green monkeys with the virus remained devoid of AIDS. Thus the monkey virus may be mutated in humans and may have acquired some destructive properties.5 Two other explanations have been postulated.6 The AIDS virus may have been present in a small number of humans for a long time, but only recently did the number become large enough for the disease to be identified. The recent increase in cases may result from various factors such as changing migration patterns and rises in intravenous drug abuse and homosexuality. Another possibility is that the AIDS virus is a variant of a retrovirus that has always infected humans. The data for this study come from AIDS-case reports received by the U.S. Centers for Disease Control as of January 1987. These data are reported voluntarily by state and local health departments and are compiled on a Public Information Data Tape by the CDC. Information for each victim includes age at and date of first diagnosis; race; large SMA region (Northeast, Central, West, South, Mid-Atlantic) or small SMA; country of birth and, if patient is deceased, of death; and gender (male, subdivided into homosexual, bisexual, or heterosexual, and female). Information is also available for relevant patient groups: homosexual/bisexual male, intravenous drug user, a combination of these two, hemophiliac, heterosexual contact with an AIDS victim, or transfusion recipient. Through January 1987, the total sample included 29,137 AIDS patients. These data were cross-tabulated to examine relationships among the characteristics of each AIDS victim. The annual incidence rates of AIDS victims per 100,000 persons for the years 1981 to 1985, 1986, and 1987 appear on figures 1 and 2. Because statewide data were not available for individual years from 1981 to 1985, the five-year total for each state was divided by five to obtain an average for the period. Although the disease was primarily concentrated in large cities, only statelevel data were available nationwide. Hence choropleth maps were based on states. Incidence in the District of Columbia was also included on these figures. The initial appearance of AIDS in the United States had three foci-the metropolitan areas of New York City, San Francisco, and Los Angeles. Prior to 1983, 67 percent of the AIDS victims in the country were confined to these 4 Colin Norman, Africa and Origins of AIDS, Science 230 (6 Dec. 1985): 1141. 5 Ronald C. Desrosiers, Origins of the Human AIDS Virus, Nature 319 (27 Feb. 1986): 728. 6 Desrosiers, footnote 5 above. This content downloaded from 157.55.39.135 on Sun, 03 Jul 2016 04:14:23 UTC All use subject to http://about.jstor.org/terms 458 THE GEOGRAPHICAL REVIEW