The social epidemiology of HIV transmission among African American women who use drugs and their social network members

Abstract

Despite 15 years of prevention efforts, recent increases in HIV infection have been documented for Black women in the US. Little is known about the role played by HIV status disclosure in high HIV prevalence communities. 180 Black women who used drugs in the past 30 days were recruited between May 2002 and May 2004 in New York City. Women were administered a structured network questionnaire and HIV serotested. Risk practices, HIV status disclosure within networks and mixing patterns by known HIV status are examined. Most (85%) women had used crack in the past 30 days; 48 (27%) had injected drugs, 65 (36%) reported anal sex, and 99 (55%) reported sex work at some time. Forty (22%) women were HIV-seropositive; 29 (16%) knew their seropositive status. Of high risk individual behaviours, only a history of sex work was associated with an HIV-seropositive status [(aOR=3.0; 95%CI: 1.3–7.3), p=.01]. Few (7%) of 600 network members disclosed an HIV positive status, although 73% were sex or drug use partners. Women who knew themselves to be HIV-infected were more likely than other women to report HIV-infected network members [(OR=1.5; 95%CI: 1.1–6.4), p=.03]. However, only 51% of network members disclosed an HIV status and women disclosed to 50% of their network members. In a context of high background HIV prevalence and low levels of HIV status disclosure, serodiscordant mixing patterns likely facilitate transmission.

Acknowledgements

Funding for this project was provided by the National Institutes of Health grant DA14523 awarded to Maureen Miller. We would like to acknowledge Malin Serner for her help with the manuscript; the Bed Stuy West staff, including Delysha D'Mellow, Niki Cunningham, Anu Manchikanti, Marcia Morris and other members of the research staff who have worked on this study; Peter Vavagiakis; and all of the participants who generously shared their time and life histories. This research was conducted when Dr. Miller was with the Department of Epidemiology at the Mailman School of Public Health, Columbia University.