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HIV transmission among black women--North Carolina, 2004.
Centers for Disease Control and Prevention (CDC).
MMWR Morb Mortal Wkly Rep
2005 Feb 4;54(4):89-94.
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PubMed entry
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Reviewed by
Susa Coffey, MD
Summary
Background
In the United States, rates of HIV infection in African Americans, and in African American women in particular, are disproportionately high. In 2003, African American women comprised 69% of women with HIV infection, and most infections were acquired via heterosexual transmission. (1) The reasons for the rising incidence rates in African American women are poorly understood. This case-control study examined epidemiologic and behavioral differences between HIV-infected (cases) and HIV-uninfected (controls) African American women in North Carolina, where the HIV infection rate for black women is 14 times higher than the rate for white women.
Summary
Study subjects were black women aged 18-40 years in 3 urban areas; they were sexually active with men and were not injection drug users. The 31 cases were recruited from among 111 patients diagnosed as HIV positive between January 2003 and August 2004. The 101 controls were recruited at HIV testing sites between August and October 2004. Interviews with the women demonstrated similarities between the 2 groups in many demographic and behavioral aspects (such as age, education, history of prior sexually transmitted diseases, prior HIV testing, rates of condom use). However, on univariate analysis, case patients had statistically significantly higher rates of unemployment, crack/cocaine use, and exchange of sex for money, drugs, gifts, or shelter. On multivariate analysis, women who received public assistance and women who had a history of genital herpes were significantly more likely to be HIV positive (adjusted odds ratio = 7.3 and 10.6, respectively), while women who were likely or very likely to discuss sexual and behavioral history with their partners were significantly less likely to be HIV positive (adjusted odds ratio = 0.6).
Strikingly, although both cases and controls appear to be at relatively high risk for acquiring HIV infection, most women in both groups believed they were unlikely or very unlikely to contract HIV (58% of cases, 71% of controls).
And, while 90-95% of women in both groups were willing to discuss condom use with their partners, only 38-39% of women in each group always asked their partners to use condoms during sex.
Comment
Although causality cannot be inferred from the data presented, as noted in the accompanying editorial, the study findings suggest the detrimental effects of poverty on risk behaviors, the disadvantages women may have in negotiating condom use with their male partners, and the protective effect of discussing sexual/behavioral history with sexual partners. Although this study examines a select group of relatively high-risk women who may not be representative of larger groups of African American women, it suggests directions for further evaluation of HIV risk factors in African American women and its authors propose multifaceted approaches to reducing these risks.
References
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Diagnoses of HIV/AIDS --- 32 States, 2000-2003.
MMWR Morb Mortal Wkly Rep
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