Increasing use of emergency department services by HIV-infected persons is due in part to changes in the demographic distribution of HIV cases and AIDS-related illnesses.4 In homosexual and bisexual men, rates of newly acquired HIV, HIV progression to AIDS, and AIDS-related deaths have all declined (largely due to access to antiretroviral therapy and, in part, to effective prevention strategies). Meanwhile, rates of new HIV infection have continued to rise among young, disadvantaged, minority populations who utilize the emergency department for both primary and emergency care. During the past several years, the highest percentages of increase in reported AIDS cases have occurred among women, minority populations, and children. These changes are principally due to an increase in HIV prevalence among injected drug users and their women partners. Seroprevalence studies in one inner-city emergency department reflect these trends, with rates of HIV infection among unselected adult patients rising from 6 to 11.4 percent over a 4-year period. 4
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