title: The unexpected movement of the HIV epidemic in the Southeastern United States: transmission among college students.
abstract: BACKGROUND
  Approximately 16 million people are enrolled in institutions of higher learning in the United States. However, college students have not been perceived as at high risk for HIV infection. In early 2003, acute HIV infection was diagnosed in 2 men attending college in North Carolina. We describe an epidemiologic investigation of newly diagnosed HIV infection in men attending college in North Carolina.
  
  
  METHODS
  We reviewed state surveillance records examining new HIV diagnoses in men 18-30 years old between January 1, 2000 and December 31, 2003, living in 69 North Carolina counties. Risk behavior and demographic information for HIV-infected men enrolled in college were compared with HIV-infected male nonenrollees.
  
  
  RESULTS
  Of the 735 records available for review, 84 (11%) were college men. Eighty-seven percent of college men were African American and 92% were men who have sex with men (MSM) or men who have sex with men and women (MSM/W). Compared with noncollege men, college men were more likely to be African American (odds ratio 3.70, 95% CI = 1.86-7.54), to report meeting sex partners at bars or dance clubs (odds ratio 3.01, 95% CI = 1.77-5.10) or on the Internet/chat lines (odds ratio 4.95, 95% CI = 2.53-9.64), or to report use of "ecstasy" or club drugs (odds ratio 4.51, 95% CI = 1.15-15.40). Newly diagnosed HIV infection was found in men in 37 colleges located in North Carolina or surrounding states and a sexual partner network investigation linked 21 colleges, 61 students, and 8 partners of students.
  
  
  CONCLUSIONS
  We describe an epidemic of HIV infection occurring in North Carolina college students, primarily involving African American MSM and MSM/W. College students represent an at-risk, accessible population, which deserves further HIV prevention interventions.
authors.affiliation: Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. lisa_hightow@med.unc.edu
authors.forename: Lisa B
authors.initials: LB
authors.lastname: Hightow
authors.forename: Pia D M
authors.initials: PD
authors.lastname: MacDonald
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Pilcher
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Kaplan
authors.forename: Evelyn
authors.initials: E
authors.lastname: Foust
authors.forename: Trang Q
authors.initials: TQ
authors.lastname: Nguyen
authors.forename: Peter A
authors.initials: PA
authors.lastname: Leone
mesh_terms: D000293:Adolescent; D000328:Adult; D044383:Black People; D015897:Comorbidity; D018562:Disease Transmission, Infectious; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission; D006630:Hispanic or Latino; D006801:Humans; D013287:Illicit Drugs; D008297:Male; D009657:North Carolina / Q000453:epidemiology; D012309:Risk-Taking; D012725:Sexual Behavior; D013334:Students; D013587:Syphilis / Q000453:epidemiology; D014495:Universities; D044465:White People; D001741:Black or African American
chemical_list: D013287:Illicit Drugs