XIX International AIDS Conference

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Correlates of undiagnosed HIV infection among African American women at increased risk of HIV: United States, National HIV Behavioral Surveillance System, 2010

W. Ivy, III, B. Le, I. Miles, G. Paz-Bailey, NHBS Study Group

Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, United States

Background: Although the rate of new HIV infections among African American women (AAW) is 15 times that of white women, few multi-site studies have characterized the sub-groups of AAW who are at greatest risk of infection.
Methods: We analyzed data from AAW who participated in the National HIV Behavioral Surveillance System among heterosexuals with low income or education in 2010. Women were recruited in 20 cities with high prevalence of AIDS and completed a survey and HIV test. Undiagnosed HIV infection was defined as a positive HIV test and no history of an HIV diagnosis. We conducted multivariable logistic regression to determine factors associated with undiagnosed HIV infection. Women who provided complete data and had a valid HIV test were included in this analysis.
Results: Of 3,951 women in the sample, 138 (4%) were HIV-positive, of whom 58 (42%) had undiagnosed HIV infection. Sixty-two percent of women had an annual income < $10,000. Women with undiagnosed infection were significantly more likely than uninfected women to be older than 34 years (adjusted prevalence ratio (APR): 9.0, 95% confidence interval (CI): 3.6-22.7), have Medicaid (APR: 2.1, CI: 1.5-3.6), reside in the Northeast (APR: 6.5, CI: 2.0-21.9) and South (APR: 3.8, CI: 1.1-12.7) compared to the West, and report unstable housing in the past year (APR: 2.0, CI: 1.2-3.4). The only significant individual risk behaviors in multivariate analysis was reporting last sex partner as exchange partner versus main partner (APR: 2.4, CI: 1.2-4.5).
Conclusions: Prevalence of HIV infection was high and many infections were undiagnosed. Social and demographic characteristics were stronger independent predictors of undiagnosed HIV infection than individual behaviors and last sex partner characteristics. High-impact prevention for this population should include increased testing and linkage to HIV care and structural interventions that address contextual factors to reduce infection among AAW.

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