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Poverty, joblessness, and limited education may play an important role in HIV risk among heterosexuals, the CDC reported.
In its first survey among heterosexuals, the agency found that HIV prevalence was higher among those with low socioeconomic status.
The link was independent of traditional HIV risk factors among heterosexuals, such as use of crack cocaine and exchanging sex for money or drugs, the CDC reported in the Aug. 12 issue of Morbidity and Mortality Weekly Report.
The finding comes from the National HIV Behavioral Surveillance System, which conducts a yearly cross-sectional survey of one of three groups at high risk for HIV: men who have sex with men, injection drug users, and heterosexuals at increased risk.
Heterosexuals were first surveyed between September 2006 and October 2007 and the current report reflects those numbers.
All told, 14,837 people, living in 24 metropolitan statistical areas with a high prevalence of AIDS, took part in the survey.
All participants answered a computer-based questionnaire and had an HIV test. All told, 294 participants, or 2%, tested positive for HIV and prevalence was similar among men and women, at 1.9% and 2.1%, respectively.
The rate is 10 to 20 times higher than the estimated rate among all U.S. heterosexuals who are not injection drug users, the agency noted, possibly because they were recruited from areas with a high prevalence of AIDS.
However, in a multivariate analysis, there was no difference in prevalence along racial or ethnic lines. Rates among Hispanics, whites, and other groups – 1.3%, 0.6%, and 0.9%, respectively – did not differ significantly from the 2.1% rate among blacks.
That again was at odds with the national picture, in which HIV prevalence among blacks is more than eight times that among whites and among Hispanics is three times that among whites, the CDC noted.
But the key finding was that poverty, lack of education, and unemployment were associated with significantly higher rates of HIV. Specifically, the rate was:
>2.8% among participants with less than a high school education and 1.2% among those with more than a high school education
>2.6% among those who were unemployed and 1.0% among those with jobs
>2.3% among those with annual household incomes of $9,999 or less and 1.0% among those whose incomes were $10,000 to $49,999
Taken together, the socioeconomic and racial/ethnic data imply that "poverty-related factors might account for some of the racial/ethnic disparities in HIV prevalence observed nationally," the agency suggested, since blacks and Hispanics are about four times as likely as whites to live in low-income areas like those in the survey.
The CDC study also found that traditional risk factors played a role in HIV rates, but after controlling for other factors, only a previous diagnosis of a sexually transmitted disease was significantly associated with HIV infection. In the survey, prevalence was 4% among those who had had an STD diagnosis and 1.7% for those without such a history.
The agency cautioned that the analysis took place among people living in high-risk areas, so results may not apply to all low-income heterosexuals in the U.S.
Similarly, the choice of the 24 regions with both a high rate of HIV and poverty might have led to overestimation of HIV prevalence, the CDC noted.
The authors also cited a potential for stigma in reporting male-to-male sexual behavior or injection drug use as a possible limitation in assessing incidence of other risk factors for HIV.
The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.
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