Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor
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.
Wortley PM, Fleming PL. Increasing Incidence of AIDS Among Women—Reply. JAMA. 1998;279(5):354-356. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-5-jbk0204