Correlates of HIV Infection Among African American Women from 20 Cities in the United States

Little research has been conducted to investigate multiple levels of HIV risk—individual risk factors, sex partner characteristics, and socioeconomic factors—among African American women, who, in 2010, comprised 64 % of the estimated 9,500 new infections in women. Respondent-driven sampling was used to recruit and interview women in 20 cities with high AIDS prevalence in the United States through the National HIV Behavioral Surveillance System. We assessed individual risk factors, sex partner characteristics, and socioeconomic characteristics associated with being HIV-positive but unaware of the infection among African American women. Among 3,868 women with no previous diagnosis of HIV, 68 % had high school education or more and 84 % lived at or below the poverty line. In multivariable analysis, women who were 35 years or older, homeless, received Medicaid, whose last sex partner ever used crack cocaine or was an exchange sex partner were more likely to be HIV-positive-unaware. Developing and implementing strategies that address socioeconomic factors, such as homelessness and living in poverty, as well as individual risk factors, can help to maximize the effectiveness of the public health response to the HIV epidemic.