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[Analysis of the AIDS epidemic in The Netherlands, 1982-1993]
H Houweling1, S H Heisterkamp, J K van Wijngaarden
1Centrum voor Infectieziekten Epidemiologie, Rijkinstituut voor Volksgezondheid en Milieuhygiëne, Bilthoven.
Objective:
Description of the epidemiology and transmission categories of AIDS in the Netherlands.
Design:
Descriptive.
Setting:
The Netherlands.
Method:
Analysis of all registered AIDS patients until 31 December 1993. Trends in the composition of this population were studied with respect to age and sex, risk groups, geographic distribution across the country, heterosexual transmission, AIDS-defining diseases and reporting pattern.
Results:
From the first patient in 1982 until December 31, 1993, a cumulative total of 2912 patients was diagnosed and reported in the Netherlands (2995 when corrected for reporting delay). The numbers of reported AIDS cases in the Netherlands are smaller than previously predicted by mathematical models. The proportion of homosexual men in the incidence of AIDS dropped from 89 to 73 per cent, the proportions of intravenous drug users and heterosexual transmission rose to 11 per cent each. Patients in the category of heterosexual transmission are mainly individuals from countries where heterosexual contact is the dominant mode of transmission and their sex partners, and to a lesser extent the sex partners of intravenous drug users (whether or not in relation to prostitution). The proportion of women is rising (229 patients or 8 per cent by December 1993), with most cases transmitted initially by intravenous drug use but later by heterosexual contact.
Conclusion:
The number of AIDS cases in all risk groups combined is levelling off. However, more detailed analysis shows that the numbers of cases of heterosexual transmission and those in young homosexual men are still rising. For a better quantitation of the quality of the AIDS data, specific research into underreporting and non-diagnosis of AIDS cases in the Netherlands is warranted.