Risk factors driving the emergence of a generalized heterosexual HIV epidemic in Washington DC networks at risk
Magnus, Manya. Kuo, Irene. Shelley, Katharine. Rawls, Anthony.
Peterson, James. Montanez, Luz. West-Ojo, Tiffany. Hader, Shannon.
Hamilton, Flora. Greenberg, Alan E.
The George Washington University School of Public Health and Health
Services, Washington, DC 20037, USA. email@example.com
Risk factors driving the emergence of a generalized heterosexual HIV
epidemic in Washington, District of Columbia networks at risk.
AIDS. 23(10):1277-84, 2009 Jun 19.
OBJECTIVES: Washington, District of Columbia has the highest HIV/AIDS rate
in the United States, with heterosexual transmission a leading mode of
acquisition and African-American women disproportionately affected. The
purpose of this study was to examine risk factors driving the emergence of
the local epidemic using National HIV Behavioral Surveillance data from
the District of Columbia. DESIGN: The design of the study is
cross-sectional. METHODS: Individuals at high risk for HIV based on
connection to areas with elevated AIDS and poverty were collected from
December 2006 to October 2007. Analyses characterized participants from a
respondent-driven, nonclinic-based sample; factors associated with
preliminary HIV positivity were assessed with logistic regression.
RESULTS: Of 750 participants, 61.4% were more than 30 years of age, 92.3%
African-American, and 60.0% with an annual household income of less than
$10 000; 5.2% (95% confidence interval, 2.9-7.2%) screened HIV positive;
women were more likely to screen positive than men (6.3 versus 3.9%). Of
those, 47.4% (95% confidence interval, 30.9-78.7%) did not know their
status prior to the study. Last vaginal sex was unprotected for 71.2% of
respondents; 44.9% reported concurrent sex partners, and 45.9% suspected
concurrency in their partners. Correlates of screening HIV positive were
identified. CONCLUSION: This study suggests that a generalized
heterosexual HIV epidemic among African-Americans in communities at risk
may be emerging in the nation's capital alongside concentrated epidemics
among men who have sex with men and injecting drug users. Innovation of
prevention strategies is necessary in order to slow the epidemic in
District of Columbia.