HIV transmission among black women ‐ North Carolina, 2004

Abstract

Background The HIV epidemic in the US increasingly affects black, heterosexual women in the South. In 2003, the HIV infection rate for black women in North Carolina was 14 times higher than that for white women. Methods A case-control study was conducted in August 2004 to identify factors associated with HIV infection among HIV-positive and HIV-negative black women residing in North Carolina. Eligible cases included all 18–40 year old black women with newly reported HIV infections from 2003–2004. Controls were recruited among women undergoing HIV testing. Univariate and multivariate analyses were used to calculate odds ratios (ORs) and adjusted ORs (aORs). Results Thirty-one HIV-positive and 101 HIV-negative women were enrolled. In univariate analyses, HIV-positive women were significantly more likely to be unemployed; receive public assistance; have 20 or more lifetime sexual partners; have a history of herpes; use crack/cocaine; have received money for sex; and to report a partner with a history of incarceration. They were less likely to have discussed sexual and behavioral histories with their male partners. In multivariate analyses, HIV-positive women were more likely to have a history of herpes infection (aOR 6.1; 95%CI 1.7, 24.0), and to receive public assistance (aOR 8.1; 95%CI 2.2, 41.6), and were less likely to have discussed sexual and behavioral histories with their male partners (aOR 0.1; 95%CI 0.02, 0.4). Conclusions Findings of both biologic and socio-economic determinants of HIV infection demonstrate the need for a multidimensional approach to address HIV transmission in this population. Low levels of communication between sexually active black women and their partners may act as a barrier to sexual and behavioral risk reduction.