title: Human immunodeficiency virus infection in Alabama women: sociodemographic, behavioral, and reproductive health characteristics and factors associated with lack of human immunodeficiency virus-1 viral control.
abstract: BACKGROUND
  Human immunodeficiency virus (HIV) infection among women in the southern United States is on the rise. This study examined sociodemographic profile and behavioral risk factors for HIV and sexually transmitted infections and assessed factors associated with HIV-1 viral control in a cohort of 280 HIV-infected Alabama women aged 17 to 66 years.
  
  
  METHODS
  Women receiving care for HIV infection at a university outpatient HIV clinic were enrolled in the study. Women completed a self-administered questionnaire on demographics and behavioral risk factors at enrollment. They were followed up with appointments at least every 6 months with Papanicolaou smears, cervicovaginal lavages, cervical and vaginal swabs, and blood specimens collected at each visit.
  
  
  RESULTS
  Of the women in the study, 69% were black, had mean age of 36 years, and approximately three fourths were mothers with annual household income <$20,000. White women were likely to have been HIV infected for a longer period (50.2 versus 36.3 months; P = 0.02) and had significantly lower viral loads at enrollment (P = 0.04) than black women. Factors associated with lack of HIV-1 control (> or =10,000 RNA copies/mL) at enrollment included black race/ethnicity (odds ratio [OR]: 2.8; 95% confidence interval [CI]: 1.2-6.8), CD4+ T-cell count <200 cells/microL (OR: 20.1; CI: 8.6-47.0), being diagnosed with HIV <6 months (OR: 3.5; CI: 1.4-8.9) and not being on any antiretroviral therapy (OR: 2.5; CI: 1.1-5.7).
  
  
  CONCLUSIONS
  Poorer HIV-1 viral control in black women at enrollment may indicate suboptimal access to HIV testing, delays in receipt of medical care after HIV-1 diagnosis, and/or some underlying biologic or social race-related influence.
authors.affiliation: Department of Biostatistics, Epidemiology and Environmental Health Science, Kent State University, OH 44242, USA. mbhatta@kent.edu
authors.forename: Madhav P
authors.initials: MP
authors.lastname: Bhatta
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Hoesley
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D000407:Alabama / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology*; D015497:HIV-1; D006801:Humans; D008875:Middle Aged; D012307:Risk Factors; D012725:Sexual Behavior; D012959:Socioeconomic Factors; D044465:White People; D055815:Young Adult