Urban-nonurban distribution of HIV infection in childbearing women in the United States.

Women account for an increasing proportion of AIDS cases in the United States, and the number reported from small cities and rural areas is growing. To better describe the geographic characteristics of the human immunodeficiency virus (HIV) epidemic in women, we analyzed data for more than 1.6 million newborn specimens tested for maternal antibody to HIV-1 in 35 states in 1989. To provide comparable geographic units for analysis, seroprevalence rates were calculated for state-designated health districts, which are groups of counties defined for the planning and delivery of health services. Health districts with > or = 75% of the population residing in urban areas as defined by the 1990 census were considered urban. Prevalence of HIV infection ranged from 0 to 12.2 per 1,000, with the highest rates found in urban health districts, primarily those on the East coast; however, high rates were also found in some nonurban districts, particularly in the South. Rates among black women were three to 35 times higher than in white women in nine states, regardless of urbanicity. These findings should be used to focus prevention activities and direct health care planners to urban and rural areas in need of HIV-related services for women.