Risk factors driving the emergence of a generalized heterosexual HIV epidemic in Washington, District of Columbia networks at risk.
OBJECTIVE
Washington, District of Columbia 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 purpose of this study was to examine risk factors driving the emergence of the local epidemic using National HIV Behavioral Surveillance data from the District of Columbia.


METHODS
The design of the study is cross-sectional.


METHODS
Individuals at high risk for HIV based on connection to areas with elevated AIDS and poverty were collected from December 2006 to October 2007. Analyses characterized participants from a respondent-driven, nonclinic-based sample; factors associated with preliminary HIV positivity were assessed with logistic regression.


RESULTS
Of 750 participants, 61.4% were more than 30 years of age, 92.3% African-American, and 60.0% with an annual household income of less than $10 000; 5.2% (95% confidence interval, 2.9-7.2%) screened HIV positive; women were more likely to screen positive than men (6.3 versus 3.9%). Of those, 47.4% (95% confidence interval, 30.9-78.7%) did not know their status prior to the study. Last vaginal sex was unprotected for 71.2% of respondents; 44.9% reported concurrent sex partners, and 45.9% suspected concurrency in their partners. Correlates of screening HIV positive were identified.


CONCLUSIONS
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. Innovation of prevention strategies is necessary in order to slow the epidemic in District of Columbia.
The George Washington University School of Public Health and Health Services, Washington, DC 20037, USA. sphmdm@gwumc.edu
Manya
M
Magnus
Irene
I
Kuo
Katharine
K
Shelley
Anthony
A
Rawls
James
J
Peterson
Luz
L
Montanez
Tiffany
T
West-Ojo
Shannon
S
Hader
Flora
F
Hamilton
Alan E
AE
Greenberg
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D004196:Disease Outbreaks; D004219:District of Columbia / Q000453:epidemiology; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission; D020010:Heterosexuality / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012309:Risk-Taking; D012737:Sex Factors; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D047568:Unsafe Sex / Q000706:statistics & numerical data; D055815:Young Adult