Half of Heterosexual Women With HIV Have No Risk Factors

Emma Hitt, PhD

August 24, 2011

August 24, 2011 (Atlanta, Georgia) — Nearly half of heterosexual women with HIV infection report having no identifiable risk factors, according to new surveillance data from the Centers for Disease Control and Prevention (CDC).

Stacy Cohen, MPH, from the CDC’s Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, presented the findings here during a poster session at the 2011 National HIV Prevention Conference.

Stacy Cohen

"The majority of women who report heterosexual contact may not know their partner’s risk, and they will therefore be categorized as 'no risk factor reported or identified,'" Cohen told Medscape Medical News. "However, only about one third of women reported having recent heterosexual contact, meaning that the remaining two thirds of women in this category have no identifiable risk factor at all," she said. "This might mean that they or their male partner haven’t been followed up properly post testing."

"Perhaps the indication is that more effort needs to be made to interview women who have no identifiable risk factors," Cohen said. "Women who are diagnosed with HIV are supposed to receive postdiagnosis counseling where they get linked to care."

Using data from the National HIV Surveillance System, Cohen and colleagues examined characteristics of 42,035 women from 40 states aged at least 13 years diagnosed with HIV infection during 2006-2009. They also compared categories of women of childbearing age (13 to 44 years) with those of older women.

Of the women, 69% were of childbearing age, 66% were black, and 56% resided in the South.

In addition, 37% reported that they had had sex with a high-risk person, which was the most common risk factor, and 47% had no identifiable risk factors. Of the women with no identifiable risk factors, nearly one third reported having sex with a man.

Compared with the previous survey, there were a significant increase in the number of women with unknown risk factors but significant decreases in the distribution of risk factors between older and younger women. There was a larger proportion of injection drug use as a risk factor in older women.

The distribution of risk factors by race/ethnicity and region of residence at diagnosis also significantly differed within each age group.

"Prevention planning for women should consider age group differences in HIV risk factors; for each age group, region and race/ethnicity should also be considered," the researchers conclude in their poster abstract. "Future research should evaluate the effect of late testing among injection drug users on differences in distribution of risk factors between older and younger women."

Independent commentator Irene A. Doherty, PhD, an assistant professor at the School of Medicine University of North Carolina, Chapel Hill, pointed out that coinfection with sexually transmitted diseases (STDs) is thought to increase the risk for HIV acquisition, and perhaps the CDC should change its risk categories and add "concomitant STD diagnosis (at the time of HIV diagnosis)" for future surveillance," she said.

"All clinicians, especially primary care, OB/GYN, and those working in emergency departments, should become comfortable talking to all of their patients about HIV infection regardless of perceived or known risk behaviors and then offer testing," Dr. Doherty told Medscape Medical News. "Then rapid oral tests can be done on site, and if positive, patients can receive follow-up."

The study was not commercially funded. Ms. Cohen and Dr. Doherty have disclosed no relevant financial relationships.

2011 National HIV Prevention Conference. Presented August 15, 2011.

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