The review of a major national population HIV study has found that the HIV infection rate among low-income heterosexuals in 24 American cities with a high prevalence of AIDS is 10 to 20 times greater than in the general U.S. population.
The link between high HIV rates and low socio-economic status couldn’t be attributed to factors typically associated with HIV infection risk in heterosexuals such as crack cocaine use, being diagnosed with a sexually transmitted disease, or having an exchange sex partner.
While major racial disparities are a feature of the HIV/AIDS epidemic in the United States, the researchers found no racial/ethnic-related differences in HIV infection rates among low-income heterosexuals in cities either.
The U.S. Centers for Disease Control and Prevention 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 and 2007.
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.
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).
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.
In summary, of 14,837 heterosexuals aged 18 to 50 years who were interviewed and tested, 2% 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% among those with incomes above the poverty level.
As mentioned above, 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.
Based on their findings, the CDC authors recommended that HIV prevention programs aimed at heterosexuals should focus on those in low-income areas.
“Characteristics Associated with HIV Infection Among Heterosexuals in Urban Areas with High AIDS Prevalence — 24 Cities, United States, 2006–2007” The U.S. Centers For Disease Control and Prevention