title: Human immunodeficiency virus infection in a rural community in the United States.
abstract: In 1986, a population-based survey of human immunodeficiency virus (HIV) infection in a rural Florida community showed that HIV prevalence was 28/877 (3.2%, 95% confidence interval (CI): 2.0, 4.4). In 1998-2000, the authors performed a second population-based survey in this community and a case-control study to determine whether HIV prevalence and risk factors had changed. After 609 addresses had been randomly selected for the survey, 516 (85%) residents were enrolled, and 447 (73%) were tested for HIV. HIV prevalence was 7/447 (1.6%, 95% CI: 0.4, 2.7) in western Palm Beach County and 5/286 (1.7%, 95% CI: 0.2, 3.3) in Belle Glade (p=0.2 in comparison with 1986). Independent predictors of HIV infection in both 1986 and 1998-2000 were having a history of sexually transmitted disease, number of sex partners, and exchanging money or drugs for sex. A history of having sex with men was a risk factor among men in 1986 but not in 1998-2000; residence in specific neighborhoods was a risk factor in 1998-2000 but not in 1986. The authors conclude that heterosexually acquired HIV infection did not spread throughout the community between 1986 and 1998 but persisted at a low level in discrete neighborhoods. Interventions targeting HIV-endemic neighborhoods will be needed to further reduce HIV prevalence in this area.
authors.affiliation: Division of HIV/AIDS Prevention, Surveillance, and Epidemiology, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. tve1@cdc.gov
authors.forename: Tedd V
authors.initials: TV
authors.lastname: Ellerbrock
authors.forename: Sandra
authors.initials: S
authors.lastname: Chamblee
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Bush
authors.forename: Johnny W
authors.initials: JW
authors.lastname: Johnson
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Marsh
authors.forename: Pam
authors.initials: P
authors.lastname: Lowell
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Trenschel
authors.forename: C Fordham
authors.initials: CF
authors.lastname: Von Reyn
authors.forename: Linda S
authors.initials: LS
authors.lastname: Johnson
authors.forename: C Robert
authors.initials: CR
authors.lastname: Horsburgh
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000704:Analysis of Variance; D016022:Case-Control Studies; D002648:Child; D019353:Endemic Diseases / Q000517:prevention & control / Q000706:statistics & numerical data; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D005431:Florida / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control / Q000635:transmission; D015528:HIV Seroprevalence; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data*; D017678:Sex Distribution; D011477:Sex Work / Q000706:statistics & numerical data; D012747:Sexual Partners; D012959:Socioeconomic Factors