THE CHANGING DISTRIBUTION OF HIV-INFECTION - HIV SURVEILLANCE IN LAZIO, ITALY, 1985 THROUGH 1994

Objectives. This study sought to describe the human immunodeficiency v irus (HIV) surveillance system in Lazio, Italy, and to analyze exposur e patterns and time trends of HIV serodiagnoses from January 1985 to D ecember 1994. Methods. A linkage procedure made it possible to identif y newly diagnosed HIV cases. Anonymous information was collected on de mographic and exposure factors for each individual. Results. Of 35 425 reports, 13 660 were newly diagnosed HN cases, 70.9% of them in men. The proportion of women increased at the beginning of the study period (the male:female ratio declined from 3.5 in 1985 to 2.6 in 1986) and then remained stable. The proportion of subjects reporting heterosexua l exposure, in men and women, respectively, increased from 1.5% and 2. 0% in 1985 to 21.2% and 60.8% in 1994. Starting in 1992, heterosexual contact has become the main transmission route for women. Conclusions. A changing pattern in the HIV epidemic is emerging, with a shift in t he incidence of HIV diagnosis from ''core'' high-risk groups (drug inj ectors) to the large low-risk population (the general population) expo sed through heterosexual transmission. This is probably occurring in o ther areas (e.g., large urban centers in the United States) with a sim ilar epidemiological situation.