Background: Since the first AIDS cases were reported in 1981, the portrait of the HIV pandemic in the United States has become increasingly female and increasingly black. By the end of 2005, women in the United States comprised 19% of the 956,019 cumulative reported AIDS cases, 36% of reported AIDS deaths, and 23% of the estimated 421,873 people living with HIV. Of the 181,769 AIDS cases among women, 60% have been black. Among women of all racial and ethnic groups, heterosexual contact is the most common transmission category. Numerous factors contribute to women's increasing representation in the U.S. HIV pandemic; foremost among them are racism, poverty, and gender inequity. These distal determinants foster sexual network characteristics and patterns of HIV distribution that promote differential transmission among subpopulations in the United States.

Conclusions: Slowing the HIV epidemic among minority women will require addressing not only individual-level behavioral factors, but also the distal societal determinants that support and maintain HIV transmission.