title: HIV prevalence overall and among high-HIV-risk behaviorally defined subgroups among heterosexuals at community-based venues in a Mid-Atlantic, US City.
abstract: A clear understanding of local transmission dynamics is a prerequisite for the design and implementation of successful HIV prevention programs. There is a tremendous need for such programs geared towards young African-American women living in American cities with syndemic HIV and injection drug use. In some of these American cities, including Baltimore, the HIV prevalence rate among young African-American women is comparable to that in some African nations. High-risk heterosexual sex, i.e., sex with an injection drug user or sex with someone known to have HIV, is the leading risk factor for these young women. Characterizing transmission dynamics among heterosexuals has been hampered by difficulty in identifying HIV cases in these settings. The case identification method described in this paper was designed to address challenges encountered by previous researchers, was based on the Priorities for Local AIDS Cases methodology, and was intended to identify a high number of HIV cases rather than achieve a representative sample (Weir et al., Sex Transm Infect 80(Suppl 2):ii63-8, 2004. Through a three-phase process, 87 venues characterized as heterosexual sex partner meeting sites were selected for participant recruitment in Baltimore, MD. One thousand six hundred forty-one participants were then recruited at these 87 venues, administered a behavioral risk questionnaire, and tested for HIV. The HIV prevalence was 3 % overall, 3 % among males, and 4 % among females and ranged from 1.7 to 22.6 % among high-HIV-risk subgroups. These findings indicate that attributing HIV transmission to high-risk heterosexual sex vs. other high-HIV-risk behaviors would be difficult. Moving beyond individual risk profiles to characterize the risk profile of venues visited by heterosexuals at high risk of HIV acquisition may reveal targets for HIV transmission prevention and should be the focus of future investigations.
authors.affiliation: Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA. spolk@jhmi.edu
authors.forename: Sarah
authors.initials: S
authors.lastname: Polk
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Ellen
authors.forename: Caroline
authors.initials: C
authors.lastname: Fichtenberg
authors.forename: Steven
authors.initials: S
authors.lastname: Huettner
authors.forename: Jacky M
authors.initials: JM
authors.lastname: Jennings
mesh_terms: D000293:Adolescent; D000328:Adult; D015142:Baltimore / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D020010:Heterosexuality / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D015995:Prevalence; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012307:Risk Factors; D012737:Sex Factors; D012747:Sexual Partners; D015819:Substance Abuse, Intravenous / Q000453:epidemiology; D047568:Unsafe Sex / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult