Risk Factors Driving the Emergence of a Generalized Heterosexual HIV Epidemic in Washington, District of Columbia, Networks at Risk

Noting that Washington, D.C., 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 study authors sought to examine risk factors driving the local epidemic using National HIV Behavioral Surveillance data from the District.

In this cross-sectional study, persons at high risk for HIV were enrolled from December 2006 to October 2007. Analyses characterized participants from a respondent-driven, non-clinic-based sample. Logistic regression was employed to assess factors associated with preliminary HIV positivity.

Of 750 participants, 61.4 percent were age 30 or older, 92.3 percent were African American and 60.0 percent had an annual household income of less than $10,000; 5.2 percent (95 percent confidence interval (CI), 2.9-7.2 percent) tested HIV-positive; women were more likely to screen positive than men (6.3 vs. 3.9 percent). Of those, 47.4 percent (95 percent CI, 30.9-78.7 percent) were unaware of their positive status prior to study screening. Of respondents, 71.2 percent reported last vaginal sex was unprotected; 44.9 reported concurrent sex partners; and 45.9 percent suspected concurrency in their partners. Correlates of testing HIV-positive were identified.

"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," the authors concluded, calling for innovative prevention strategies to slow the D.C. epidemic.

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