High HIV Seropositivity among Heterosexuals at Risk in Miami Confirmed by Two Different Sampling Methods
High HIV Seropositivity among Heterosexuals at Risk in Miami Confirmed by Two Different Sampling Methods David W. Forrest, Gabriel A. Cardenas, Marlene LaLota, Dano W. Beck, Lisa R. Metsch, Xierong Wei, Jeffrey A. Johnson, S. Michele Owen, Thomas M. Liberti National HIV Prevention Conference 2011 Atlanta, GA August 15, 2011
National HIV Behavioral Surveillance (NHBS) NHBS is a repeated, cross- sectional study of high-risk populations in US MSAs Target population rotates each year MSM IDU Heterosexuals at increased risk of HIV infection First round (2004-2007) conducted in Miami- Dade and Broward counties Second round (2008-2010) in Miami only
NHBS Objectives"Effective HIV prevention programs rely primarily on changing behavior; therefore, behavioral data are needed to inform these programs.”  NHBS provides data on trends in: Risk behaviors HIV testing behaviors Use and impact of prevention services HIV prevalence and incidence  Lansky A, Abdul-Quader AS, Cribbin M, et al. Developing an HIV behavioral surveillance system for injecting drug users: the National HIV Behavioral Surveillance System. Public Health Reports 2007; 122(suppl 1):48-55.
Target Population for NHBS-HET• The NHBS-HET1 and HET2 cycles targeted heterosexually active adults in areas with high poverty in Miami-Dade County, Florida.
NHBS-HET Eligibility Criteria Eligible for study participation 18-50 years of age for HET1, 18-60 years of age for HET2 Resident of Miami-Dade County Male or Female (not transgender) First-time participant during cycle Able to complete interview in English or Spanish
Assessing Characteristics ofPopulation X In ON-going surveillance
NHBS-HET SamplesHET-1•Data collected through venue-based sampling•March 2007 – October 2007•Miami total sample N=668 HETHET-2•Data collected through respondent-driven sampling•July 2010 – November 2010•Miami total sample N=568 HET
HET Samples for AnalysisAny NHBS-HET participants reportinginjection drug use (IDU) and any maleparticipants reporting sex with anothermale (MSM) in their lifetimes wereexcluded from this analysis. N=577 for HET1 N=456 for HET2
Demographics of HET1 & HET2 HET1 HET2 African American 80.59% 77.85% Lower income 70.72% 87.06% (<=$14,999)High school education 79% 78.73% or less No health insurance 59.34% 58.41%No visit to a health care 50.78% 46.49% provider in past 12 monthsArrested in the previous 30.16% 22.37% 12 months
Drug use and sexual risk behaviors of HET1 & HET2 HET1 HET2 Heavy alcohol use 26.9% 34.2% Illicit drug use 47.7% 56.36% Alcohol or drug treatment in 26.52% 33.77% lifetimeDepression (CES-D 10 scale) 39.17% 52.19% Unprotected vaginal 83.5% 87.5% and/or anal sexHIV testing during the previous 58.5% 55.2% 12 months
HIV among HET1 & HET2 HET1 HET2HIV positive (HIV test result) 5.7% 7.7%Previously undiagnosed HIV 42.4% 37% (self reported HIV- or unknown plus HIV+ test result)Previously undiagnosed who 85.71% 76.92%reported unprotected vaginal or anal sex in the past 12 months
HIV in NHBS-HET1HIV positive test results were associated in the HET1 sample with: • Crack use in the past 12 months 14.93% vs 4.52% (p=.001) • Self reported Hepatitis C infection 20% vs 5.5% (p=.051)
HIV in NHBS-HET2 HIV positive test results wereassociated in the HET2 sample with: • Female gender 11.6% vs 3.6% (p=.001) • Crack use in the past 12 months 19.35% vs 5.84% (p<=.001)• Self reported Hepatitis C infection 23.53% vs 6.96% (p=.011)
Recent HIV InfectionResults of tests for recent HIV infection which exclude 12 month MSM and IDU show that 4.5% of the positives in HET1 and 7.1% in HET2 were infected within the previous 12 months.
ConclusionsOur findings document the high rates of heterosexually acquired HIV infection in lower-income communities in Miami using two different sampling strategies and underscore the need to increase and optimize HIV testing and other prevention services.
Limitations Data are predominantly self-reported and subject to recall bias Data are cross sectional and time order cannot be established Findings can only be generalized to the population meeting eligibility criteria
NHBS Website Visit www.PreventHIVFlorida.org Site has links to publications, presentations, and fact sheets on findings Local and national Categorized by population (MSM, IDU, HET) Special Reports – e.g., “Out in the Open”
Credits NHBS-HET Miami Other acknowledgements:Interviewing Team: Miami-Dade County Health DepartmentEmelina Martinez, Miami Regional Roxana Bell, Laboratory, Florida Cristobal Plaza, Department of Health Cheryl Riles, Richard Walker NHBS-HET1 and HET2 participants
Contact David W. Forrest, Ph.D.University of Miami School of Medicine firstname.lastname@example.org