One in 300 US Women in High-Risk Group Infected With HIV Yearly

One in 300 high-risk women in 10 US communities become infected with HIV every year, according to results of a 2000-woman longitudinal study conducted in 2009 and 2010. This HIV incidence is more than 6 times higher than the rate reported by the Centers for Disease Control and Prevention in a general population of US black women of similar age.

Women now account for nearly one quarter of new HIV infections in the United States every year. But there are few well-characterized cohorts of US women that describe behavioral traits associated with HIV acquisition. HIV Prevention Trials Network (HPTN) study 064 seeks to address that issue in a longitudinal cohort of women recruited in 10 urban and periurban communities with high HIV prevalence and poverty rates in the northeastern and southeastern United States.

Women from 18 to 44 years old were recruited via venue-based sampling. All recruited women recently had unprotected sex and had one or more additional personal or partner risk factors and no previous HIV diagnosis. Women received a rapid HIV test and completed an audio computer-assisted self-interview upon entering the study then every 6 months for a year.

Of the 2099 women enrolled, 85.9% were black and 11.7% Hispanic. While 30.4% of women were married or living with a partner, 59.9% were single, separated, divorced, or widowed. Almost half of women (46.3%) reported being concerned about having enough food.

Thirty-two women (1.5%) were diagnosed with HIV infection upon enrollment. The researchers calculated an annual HIV incidence of 0.32% (95% confidence interval 0.14% to 0.74%). Ten women (0.61% per year) died during the study.
Univariate analysis identified five factors associated with prevalent HIV infection at the following relative risks (RR) (and 95% confidence intervals):

• At least weekly substance use: RR 2.52 (1.22 to 5.21), P = 0.013
• At least weekly drug use (except cannabis): RR 2.71 (1.33 to 5.33), P = 0.006
• Age 27 to 33 versus 18 to 26: RR 5.83 (1.22 to 27.96), P = 0.028
• Age 34 or older versus 18 to 26: RR 11.54 (2.71 to 49.05), P = 0.028
• Partner with HIV: RR 8.19 (2.64 to 25.42), P = 0.007

The 0.32% estimated annual incidence was substantially higher than a 2009 estimate of 0.05% in a general population of African-American women of similar age. Incidence in the new study is similar to that of the general adult population in Congo (0.28%), Nigeria (0.38%), and Kenya (0.53%).

At their initial study visit, 20% of women reported that they could not get needed health care in the preceding 6 months. Among women who could not access care, 61% said they could not get care because they could not afford it.

The HPTN team concludes that “enhanced risk for HIV infection [among high-risk US women] occurs in the setting of increased mortality rates and inability to obtain needed medical care, suggesting that prevention strategies addressing a broader agenda than just HIV are needed.”

Source: Sally L. Hodder, Jessica Justman, James P. Hughes, Jing Wang, Danielle F. Haley, Adaora A. Adimora, Carlos Del Rio, Carol E. Golin, Irene Kuo, Anne Rompalo, Lydia Soto-Torres, Sharon B. Mannheimer, LeTanya Johnson-Lewis, Susan H. Eshleman, Wafaa M. El-Sadr, for the HIV Prevention Trials Network 064; and the Women's HIV SeroIncidence Study Team. HIV acquisition among women from selected areas of the United States: a cohort study. Annals of Internal Medicine. 2013;158: 10-18.

For the study abstract
(Downloading the complete article requires a subscription to Annals of Internal Medicine or an online payment; the abstract is free.)

Written by Mark Mascolini on behalf of the International AIDS Society