Authors 
  Magnus, Manya.  Kuo, Irene.  Shelley, Katharine.  Rawls, Anthony.
  Peterson, James.  Montanez, Luz.  West-Ojo, Tiffany.  Hader, Shannon.
  Hamilton, Flora.  Greenberg, Alan E.
Institution
  The George Washington University School of Public Health and Health
  Services, Washington, DC 20037, USA. sphmdm@gwumc.edu
Title
  Risk factors driving the emergence of a generalized heterosexual HIV
  epidemic in Washington, District of Columbia networks at risk.
Source
  AIDS.  23(10):1277-84, 2009 Jun 19.
Abstract
  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.