In the developed world, including the United States and Europe, the HIV incidence rate dropped every year until the late 1990s when it stabilized translating into about 65,000 new infections in North America and Western and Central Europe. A total of approximately 2.1 million people are living with HIV infection in these regions. The rate has not continued to decline largely in part to a rising prevalence rate among immigrants, migrants, ethnic minority groups, and men who have sex with men. Men account for 74% of HIV infections in the United States. Half of new infections in the United States in 2005 were among men who have sex with men, 32% among women, and 18% among injection drug users (17). Racial and ethnic minorities, particularly African Americans and Latinos, represent 48 and 18% of new infections, respectively. There is a particular need for improved prevention, diagnosis, and treatment services in these populations. In the United States, there has been reported evidence of resurgent risk behavior among men who have sex with men (18). In Canada and Western Europe, new infections are significantly represented by immigrants who acquire the disease heterosexually. Spain, Italy, France, and the United Kingdom continue to have the largest HIV epidemics in the region. Fewer cases of new infections are attributed to injection drug users. Subtype B viruses predominate in North America and Western Europe, but immigration of people from other parts of the world have increased representation of other subtypes (19).
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