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Risk factors driving the emergence of a generalized heterosexual HIV epidemic in Washington, District of Columbia networks at risk

Magnus, Manyaa; Kuo, Irenea; Shelley, Katharinea; Rawls, Anthonya; Peterson, Jamesa; Montanez, Luza; West-Ojo, Tiffanyb; Hader, Shannonb; Hamilton, Florac; Greenberg, Alan Ea

doi: 10.1097/QAD.0b013e32832b51da
Epidemiology and Social: Concise Communication

Objectives: Washington, District of Columbia has the highest HIV/AIDS rate in the United States, with heterosexual transmission a leading mode of acquisition and African–American women disproportionately affected. The purpose of this study was to examine risk factors driving the emergence of the local epidemic using National HIV Behavioral Surveillance data from the District of Columbia.

Design: The design of the study is cross-sectional.

Methods: Individuals at high risk for HIV based on connection to areas with elevated AIDS and poverty were collected from December 2006 to October 2007. Analyses characterized participants from a respondent-driven, nonclinic-based sample; factors associated with preliminary HIV positivity were assessed with logistic regression.

Results: Of 750 participants, 61.4% were more than 30 years of age, 92.3% African–American, and 60.0% with an annual household income of less than $10 000; 5.2% (95% confidence interval, 2.9–7.2%) screened HIV positive; women were more likely to screen positive than men (6.3 versus 3.9%). Of those, 47.4% (95% confidence interval, 30.9–78.7%) did not know their status prior to the study. Last vaginal sex was unprotected for 71.2% of respondents; 44.9% reported concurrent sex partners, and 45.9% suspected concurrency in their partners. Correlates of screening HIV positive were identified.

Conclusion: This study suggests that a generalized heterosexual HIV epidemic among African–Americans in communities at risk may be emerging in the nation's capital alongside concentrated epidemics among men who have sex with men and injecting drug users. Innovation of prevention strategies is necessary in order to slow the epidemic in District of Columbia.

aThe George Washington University School of Public Health and Health Services, USA

bDistrict of Columbia, Department of Health, HIV/AIDS Administration, USA

cFamily and Medical Counseling Service Inc., Washington, District of Columbia, USA.

Received 19 November, 2008

Revised 21 February, 2009

Accepted 5 March, 2009

Correspondence to Manya Magnus, PhD, MPH, Department of Epidemiology and Biostatistics, The George Washington University School of Public Health and Health Services, Ross Hall Suite 120b, 2300 Eye Street NW, Washington, DC 20037, USA. Tel: +1 202 994 3024; fax: +1 202 994 0082; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.