Heterosexually transmitted HIV infection among African Americans in North Carolina.
BACKGROUND
Rates of heterosexually transmitted HIV infection among African Americans in the southeastern United States greatly exceed those for whites.


OBJECTIVE
Determine risk factors for heterosexually transmitted HIV infection among African Americans.


METHODS
Population-based case-control study of black men and women, aged 18-61 years, reported to the North Carolina state health department with a recent diagnosis of heterosexually transmitted HIV infection and age- and gender-matched controls 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.


RESULTS
Most case subjects reported annual household income < $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% of case subjects (and 69% 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% CI: 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 with the respondent (OR 2.9; 1.3, 6.4).


CONCLUSIONS
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.
Adimora
Adaora A
AA
Department of Medicine, Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, CB #7030 Bioinformatics Building, 130 Mason Farm Road, Chapel Hill, NC 27599, USA. adimora@med.unc.edu
Schoenbach
Victor J
VJ
Martinson
Francis E A
FE
Coyne-Beasley
Tamera
T
Doherty
Irene
I
Stancil
Tonya R
TR
Fullilove
Robert E
RE
D000328:Adult; D001741:Black or African American; D000367:Age Factors; D003710:Demography; D005260:Female; D015658:HIV Infections / Q000635:transmission*; D020010:Heterosexuality; D006801:Humans; D008297:Male; D009657:North Carolina; D012016:Reference Values; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors