Ellerbrock T V, Lieb S, Harrington P E, Bush T J, Schoenfisch S A, Oxtoby M J, Howell J T, Rogers M F, Witte J J
Division of HIV/AIDS, Centers for Disease Control and Prevention, Atlanta 30333.
N Engl J Med. 1992 Dec 10;327(24):1704-9. doi: 10.1056/NEJM199212103272402.
In the United States, an increasing proportion of women infected with the human immunodeficiency virus (HIV) live in nonmetropolitan areas. Little is known, however, about the risk factors for HIV transmission in women outside large cities.
We interviewed and tested 1082 (99.8 percent) of 1084 consecutive pregnant women who registered for prenatal care at a public health clinic in western Palm Beach County, Florida. This rural agricultural area of about 36,000 people is known to have a high prevalence of HIV infection.
The seroprevalence of HIV was 5.1 percent (52 of 1011 women). Black women who were neither Haitian nor Hispanic had the highest rate of infection (8.3 percent [48 of 575]). Only 4 of 1009 women (0.4 percent) reported ever injecting drugs, and the 4 were HIV-seronegative; however, 14 of 43 users of "crack" cocaine (33 percent) had HIV infection. At prenatal registration, 131 of 983 women (13 percent) tested positive for gonorrhea, chlamydial infection, or syphilis. By multivariate logistic-regression analysis, HIV infection was found to be independently associated with having used crack cocaine (odds ratio, 3.3; P < 0.001), having had more than two sexual partners (odds ratio, 4.6; P < 0.001), being black but neither Hispanic nor Haitian (odds ratio, 11; P < 0.001), having had sexual intercourse with a high-risk partner (odds ratio, 5.6; P < 0.001), and testing positive for syphilis (odds ratio, 3.1; P = 0.015). Nevertheless, 11 of the 52 HIV-infected women (21 percent) reported a total of only two to five sexual partners and no known high-risk partners, had never used crack cocaine, and had no positive tests for sexually transmitted disease.
In the rural community we studied, most of the women with HIV infection acquired it through heterosexual contact. The increasing seroprevalence of HIV and the increasing incidence of syphilis and use of crack cocaine mean that other women may be at similar risk of acquiring heterosexually transmitted HIV infection.
在美国，感染人类免疫缺陷病毒（HIV）的女性中，居住在非大都市地区的比例日益增加。然而，对于大城市以外女性的HIV传播危险因素，人们了解甚少。
我们对在佛罗里达州棕榈滩县西部一家公共卫生诊所登记进行产前护理的1084名连续孕妇中的1082名（99.8%）进行了访谈和检测。这个约有36000人的农村农业地区，已知HIV感染率很高。
HIV血清阳性率为5.1%（1011名女性中的52名）。既非海地人也非西班牙裔的黑人女性感染率最高（8.3%[575名中的48名]）。1009名女性中只有4名（0.4%）报告曾注射过毒品，这4名HIV血清反应均为阴性；然而，43名使用“快克”可卡因的人中，有14名（33%）感染了HIV。在产前登记时，983名女性中有131名（13%）淋病、衣原体感染或梅毒检测呈阳性。通过多变量逻辑回归分析，发现HIV感染与使用快克可卡因（比值比，3.3；P<0.001）、有两个以上性伴侣（比值比，4.6；P<0.001）、是黑人但既非西班牙裔也非海地人（比值比，11；P<0.001）、与高危伴侣发生性行为（比值比，5.6；P<0.001）以及梅毒检测呈阳性（比值比，3.1；P=0.015）独立相关。然而，52名感染HIV的女性中有11名（21%）报告总共只有两到五个性伴侣且没有已知的高危伴侣，从未使用过快克可卡因，性传播疾病检测也没有呈阳性。
在我们研究的农村社区，大多数感染HIV的女性是通过异性接触感染的。HIV血清阳性率不断上升以及梅毒发病率上升和快克可卡因的使用表明，其他女性可能有类似的感染异性传播HIV的风险。
