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HIV in a Rural Community in the United States in Florida
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American Journal of Epidemiology (09.15.04) Vol. 160; No. 6: P. 582-588::Tedd V. Ellerbrock; Sandra Chamblee; Timothy J. Bush; Johnny W. Johnson; Bryan J. Marsh; Pam Lowell; Robert J. Trenschel; C. Fordham von Reyn; Linda S. Johnson; C. Robert Horsburgh, Jr.
An increasing proportion of US persons with HIV live in the South, and the region accounts for most cases of AIDS among rural residents. In 1986, a population-based survey of HIV infection in Belle Glade, a rural community in western Palm Beach County, Fla., found HIV prevalence was 3.2 percent (28/877). A history of STDs and sex with men were independent predictors of HIV infection in men, while predictors in women included a positive rapid plasma reagin test and microhemagglutination-Treponema pallidum test and having a male sex partner known to engage in sex with prostitutes. In 1998-2000, researchers performed a second population-based study and case-control study to determine if prevalence and risk factors had changed.
Of 609 randomly chosen addresses selected for the study, 516 residents (85 percent) were enrolled and 447 (73 percent) were tested for HIV. The 69 who were interviewed but not tested were similar to testers in terms of sex, age, current employment, annual income, and Haitian origin, as well as history of transfusion, crack use, any STD, and exchanging sex for money or drugs. However, non-testers had more lifetime sex partners and were more likely to be black but not Haitian. Participants were less likely to be male and children under 12 years of age than the local US Census population.
Seven total HIV infections were identified in the sample, for an HIV prevalence of 1.6 percent (7/447) in western Palm Beach County and 1.7 percent (5/286) in Belle Glade. Age- and gender-adjusted HIV prevalence was 1.5 percent each for Belle Glade and West Palm Beach County. Those testing positive were ages 28-64 (median=46); five were male; all were black; and three were Haitian. The decline in prevalence in Belle Glade was more pronounced among women (12/436 in 1986 vs. 1/161 in 1998-2000) than among men (16/441 vs. 4/124), though this was of borderline statistical significance.
Independent predictors of HIV infection in both 1986 and 1998-2000 were having a history of STDs, number of sex partners, and exchanging money or drugs for sex. A history of having sex with men was a risk factor for males in 1986 but not in 1998-2000; residence in specific neighborhoods was a risk factor in 1998-2000 but not in 1986.
HIV prevalence did not increase between study periods and probably decreased, the authors concluded, but "remained a heterosexually transmitted infection in this community, facilitated by other sexually transmitted infections and crack cocaine use." Heterosexually acquired HIV infection did not spread throughout the community between 1986 and 1998 but persisted at low levels in discrete neighborhoods. "Further reduction in HIV prevalence may require a better understanding of the social networks that exist in these endemic neighborhoods and ethnographic studies focusing on the identification of factors affecting heterosexual HIV transmission," the authors concluded.
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