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Morbidity and Mortality Weekly Report

Characteristics Associated with HIV Infection Among Heterosexuals in Urban Areas with High AIDS Prevalence --- 24 Cities, United States, 2006--2007


In the United States, approximately one in three new human immunodeficiency virus (HIV) infections are transmitted via heterosexual contact (1). To monitor HIV risk behaviors and HIV prevalence among heterosexuals and other populations, CDC surveys persons in selected metropolitan statistical areas (MSAs), using the National HIV Behavioral Surveillance System (NHBS). This report summarizes data collected from heterosexuals in 24 MSAs with a high prevalence of acquired immunodeficiency syndrome (AIDS) that participated in NHBS during 2006--2007. Of 14,837 heterosexuals aged 18--50 years who were interviewed and tested, 2.0% were HIV infected. HIV prevalence was higher among those with lower socioeconomic status (SES). For example, HIV prevalence was 2.8% among participants with less than a high school education compared with 1.2% among those with more than a high school education, 2.6% among participants who were unemployed compared with 1.0% among those who were employed, and 2.3% among participants with annual household incomes at or below the poverty level compared with 1.0% among those with incomes above the poverty level. This association between HIV prevalence and SES could not be attributed to factors commonly associated with HIV infection risk in heterosexuals, such as using crack cocaine, exchanging sex for things such as money or drugs, or being diagnosed with a sexually transmitted disease (STD). Based on the association observed between HIV prevalence and SES, HIV prevention activities targeted at heterosexuals in urban areas with high AIDS prevalence should be focused on those with lower SES.

NHBS is an annual cross-sectional survey of three populations at high risk for HIV infection: men who have sex with men (MSM), injection-drug users (IDUs), and heterosexuals at increased risk for HIV infection. Data are collected in annual cycles from one risk group per year, with each population surveyed once every 3 years. This report describes the first NHBS survey among heterosexuals, conducted from September 2006 to October 2007. Twenty-five MSAs with high AIDS prevalence were selected for the survey. In each MSA, NHBS project staff members recruited participants using either respondent-driven sampling (15 MSAs) or venue-based sampling (10 MSAs) (2).* Recruitment efforts targeted residents of census tracts with high rates of poverty and HIV diagnoses, referred to as high-risk areas. For respondent-driven sampling, a small number of initial participants were recruited by project staff members or referred by community-based organizations. Initial and subsequent participants who lived in high-risk areas were then asked to recruit up to five other persons using a coded coupon to track their referrals. Recruitment continued for multiple waves of peer referral.

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Information in this article was accurate in August 12, 2011. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.