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February 4, 1998

Increasing Incidence of AIDS Among Women—Reply

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(5):354-356. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-5-jbk0204

In Reply.—Mr Smith and Dr Payne express concern about the definition of heterosexual transmission. The CDC defines heterosexual transmission as sexual contact with a partner who has a primary risk factor (eg, IDU or male-male sex) or is known to have HIV or AIDS. Persons initially reported without a risk are followed up to determine into which risk group they should be classified. Of 82784 AIDS cases reported through June 1997 without risk, 38202 have been reclassified, with 67% of the 9290 women reclassified as heterosexual risk.1 For analyses of trends by mode of transmission, such as that used in our analysis, persons who remain in the not identified risk group are reclassified according to the historical distribution of reclassified persons. This reclassification should limit the extent of our underestimation of heterosexual transmission. We agree that distinguishing primary (partner with risk behavior) from secondary (partner infected heterosexually) heterosexual transmission is important. However, doing so requires risk behavior information not only for the case patient and his or her partner, but also for the partner's partners. This information is not recorded in medical charts, which are the source for most surveillance information, and would require detailed patient interviews.

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