Where exactly is this problem concentrated in Philadelphia? According to the Philadelphia AIDS Statistical Update, the two zip codes with the highest number of total AIDS cases are 19140, with 1099 cases, and 19143, with 1229 cases [Table 1].[4] The rates of AIDS for these two zip codes, 1,924 and 1,727 (respectively), are considerably high compared with the national rate of 340. More alarming, however, is that 40 of Philadelphia’s 48 zip codes have cumulative AIDS rates (per 100,000 people) that are greater than the national average (Table 1). Undoubtedly, these areas have a problem, but why? The reasons become apparent when examined in an article in The Triangle, a newspaper of Drexel University (a college a few miles away from the zip code 19143: Kingsessing). The reporter interviewed the director of AIDS Fund, Robb Reichard, concerning the AIDS issue in the immediate Philadelphia area. Reichard said that, “AIDS is increasingly becoming the disease of the poor.”[5] He elaborates by indicating another issue with the AIDS crisis in the city. A high-risk demographic, the poor, are the ones who can’t afford consistent treatment, and, thus, they pass on the disease that they either don’t know about or unable to treat.

The high AIDS prevalence may also correspond to racial demographics. In an article entitled, “The changing face of area AIDS cases,” Dawn Falik states that, “Overall, 78 percent of all Philadelphia residents diagnosed with AIDS in 2002 belonged to those minority groups [black, Latino, or Asain].”[6] In another article, Marie McCullough quotes that, “in 2004 alone, half of AIDS diagnoses were among blacks, even though they represent only 13 percent of the U.S. population.”[7] Philadelphia, on the other hand, has an abundant African American population. The black population of Nicetown, for instance, is 60.7%.[8] In Kingsessing, the black population reaches 90.2%.[9] On the whole, the average AIDS rates among blacks in Philadelphia are dramatically greater than those on a state and national level. As noted on Table 2, even the rate of AIDS among Whites in Philadelphia, 615, is more than three times higher than the national rate and over six times higher than the state rate. But the true problem is in the rates for black AIDS cases. Compared with the national rate of 1,117, Philadelphia’s rates for cumulative Black AIDS cases is 1,803 [Table 2]. The rates for cases among Hispanics are equally as dismal. Fallik, a reporter for the Inquirer, noted in 2004 that, “About 15,400 people are living with AIDS in Pennsylvania, about half of them in Philadelphia.”[10] Clearly, the numbers of cases in Philadelphia are not merely a result of a city environment; they are problem on a state and national level.  In fact, Figure 3 on page 17 of the PA HIV/AIDS Biannual Summary for 2005 indicates that there are roughly 835 new cases of AIDS each year in Philadelphia. Whereas the next highest county, Allegheny (in which Pittsburg is located), has merely 70-120 new cases per year.[11]

Another legitimate concern in Philadelphia is the spread of AIDS in new populations: to females and youths. Many officials are fearful that AIDS is not being taken seriously by Americans. Several articles express the need to eradicate a certain aloofness that people have, an “it’s not going to happen to me” attitude. The disinterest becomes a particular issue in making this disease known to a new generation: particularly high school- and college-aged students. In an article in The Triangle, Diana Stow hoped to diminish misconceptions about AIDS. She interviewed Tiffiany Gallagher, a Health Counselor at Drexel, who said, “A lot of people think it is most prevalent in Africans and gay guys, when in fact...approximately 40 million individuals globally are infected, 50 percent of which is represented by women.”[12] This statistic is a startling reminder that AIDS is, in fact, a sexually transmitted disease, and that women are equally (or in fact more*) likely to contract it as men.[13]  The articles in the Inquirer suggest several reasons for the increase in AIDS cases in females. One theory is the “down low” phenomenon in which married men have sexual affairs with gay men.[14] Zahira Soto, who works for a Latino organization in Northeast Philadelphia, believes that an urban woman has little time to care about her own health concerns in the face of social and economic pressures.[15] Statistically, 51% of cumulative female AIDS cases are result of heterosexual sex, and 47% of cumulative cases are from drug use. On the other hand, the data shows that of women living with AIDS, 56% received it through heterosexual sex and 43% received it through drug use.[16] This indicates a fairly recent increase of female AIDS cases due to sex. Perhaps this is due to a feeling of remoteness or apathy towards AIDS among the next generation of women.

Yet, the cumulative statistics for AIDS don’t reflect this new surge in the disease. Table 3 displays the percent of cumulative AIDS cases among women. The percent of cases in Pennsylvania indicate an increase from the national average, but the percent of cases in Philadelphia is only slightly higher. Still, all are below 30% which is inconsistent with the quote that 50% of women represent all cases globally. This fact is understandable because the cumulative AIDS rates include all cases historically, most of those which began in all-male gay communities in the 1980s. The increase in female infections has only become an issue in the last decade; therefore, this demographic is underrepresented in cumulative AIDS data. The increase in female cases is evident on a state level. The number of female cases in Pennsylvania rose from 18% of all cases 1980-1999 to 29% in 2000-2005.[17] At the Philadelphia level, the percent of female cases living with AIDS is 27% compared to the cumulative 22%.[18] It may take a keen eye to realize it, but there is a problem with AIDS among women. In fact, the most recent high risk group in Philadelphia combines the prevalence of AIDS in both black and female demographics: African American woman. Fallik states in an Inquirer article that, “87 percent of the women diagnosed with AIDS in 2002 were black, Latino, or Asian”.[19] Ultimately, it makes sense that this new group would comprise those that live in areas of high risk but consider themselves immune to or simply too busy to confront this disease.

What makes the problem in Philadelphia so complex is the wide spread of the disease. Although the two zip codes with the highest numbers of cases explain part of the problem, they do not account for the entire AIDS epidemic in the city. While the rates for these two zip codes hover under 2,000, the rate for the zip code 19107 is 4,806 [Table 1]. This number, 12 times greater than the national rate, indicates a particular issue. John Bell, a member of Philadelphia’s Project TEACH, identifies this area as Philadelphia’s “gayborhood.”[20] The high rates in this area help explain why MSM, men having sex with men, is the leading mode of transmission of AIDS in Philadelphia [Table 4]. It is most likely that these cases account for the initial outbreak of AIDS in Philadelphia. This percentage, 37%, is roughly consistent with MSM at the state and national levels. Since that time, however the AIDS demographic has sifted. In an extensive article entitled “Kevin’s Journey,” reporter Leonard Fleming follows the story of Kevin Holloman who became dangerously involved in the Philadelphia drug scene before contracting AIDS. In this article, Fleming states that, “At least a third of the…people living with AIDS in the Philadelphia region also have an addiction problem.”[21] In fact, 35.2% of the cases in Philadelphia are a result of IDU [Table 4]. Compared to 14% at the national level, this number is staggering. This becomes a particular problem in state and federal prisons. Jane Shull, the director of Philadelphia FIGHT (an AIDS program that runs Project TEACH), said 7% of inmates in Philadelphia test positive for HIV, a figure that surpasses the positive tests at any other health clinics in the city.[22] Therefore, although the problem in Philadelphia began in the gay community, it has since spread to other demographics. Drug users and those that practice unsafe sex seem to be at the highest risk.

*In an article from the Philadelphia Inquirer, Kathleen Bradley (HIV epidemiologist for the Philadelphia Department of Public Health) stated that, “women have a greater chance than men of being infected during sex.” [Fallik, Dawn. A changing face for area AIDS cases. The Philadelphia Inquirer. June 23, 2004. A01.]