Heterosexually Transmitted HIV Infection Among African Americans in North Carolina

In the context of high rates of heterosexually transmitted HIV infection among African Americans in the southeastern United States, which greatly exceeds such transmission among whites, the investigators launched a study to determine risk factors for infection.

The researchers conducted a population-based case-control study of black men and women ages 18-61 who reported to the North Carolina state health department with a recent diagnosis of heterosexually transmitted HIV infection. Case subjects were matched with an age- and gender-control sample randomly selected from the state driver's license file. A lower-risk stratum of respondents was created to identify transmission risks among people who denied high-risk behaviors.

The investigators found that most case subjects reported annual household income of less than $16,000, history of sexually transmitted diseases, and high-risk behaviors including crack cocaine use and sex partners who injected drugs or used crack cocaine. However, 27 percent of case subjects, and 69 percent of control subjects, denied high-risk sexual partners or behavior. Risk factors for HIV infection in this subset of participants were less than high school education (adjusted odds ratio [OR] 5.0; 95 percent confidence interval: 2.2, 11.1), recent concern about having enough food for themselves or their family (OR 3.7; 1.5, 8.9), and having a sexual partner who was not monogamous during the relationship (OR 2.9; 1.3, 6.4).

"Although most heterosexually transmitted HIV infection among African Americans in the South is associated with established high-risk characteristics, poverty may be an underlying determinant of these behaviors and a contributor to infection risk even in people who do not have high-risk behaviors," the authors concluded.

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