Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Division of Medical and Preventive Services, Fulton County Board of Health, Atlanta, Georgia.
AIDS Patient Care STDS. 2020 Mar;34(3):124-131. doi: 10.1089/apc.2019.0259. Epub 2020 Feb 28.
Compared to knowledge about HIV risk factors among men in the south, less is known about risk factors for women. We conducted an individually matched case-control study to identify factors associated with HIV seroconversion among women. Cases had a clinician-assisted visit (CAV) between 2011 and 2016 at an Atlanta-based public health clinic before HIV diagnosis. Controls were women who visited the clinic but remained HIV negative. Controls were matched to cases in a 2:1 ratio on race, age at first CAV, and date of first CAV. Conditional logistic regression was used to develop a best-fitting model for characterizing HIV risk. Of 18,281 women who were HIV negative at their first visit, 110 (0.6%) seroconverted before 2019. Of these, 80 (73%) had a CAV before HIV diagnosis. Having multiple gonorrhea episodes, a syphilis episode, a greater number of sex partners in the past 2 months, anal sex, history of drug use, history of exchanging drugs or money for sex, and heterosexual sex with >1 sex partner in the last month were individually associated with HIV seroconversion. In multivariate analyses, having a syphilis episode [odds ratio (OR) = 4.7, 95% confidence interval (CI): 1.3-16.3], anal sex (OR = 2.8, 95% CI: 1.0-8.1), and injection drug or crack cocaine use (OR = 33.5, 95% CI: 3.6-313.3) remained associated with HIV. Women having all three risk factors were six times more likely to seroconvert compared to women without these factors. Our results offer insights into which women in a southern HIV "hotspot" may be at greatest risk for HIV.
与南部男性的 HIV 风险因素知识相比，人们对女性的风险因素知之甚少。我们进行了一项个体匹配的病例对照研究，以确定与女性 HIV 血清转换相关的因素。病例是在亚特兰大一家公共卫生诊所进行的临床辅助访问（CAV），时间在 2011 年至 2016 年之间，然后在 HIV 诊断之前。对照组是在诊所就诊但 HIV 检测仍为阴性的女性。对照组按照种族、首次 CAV 年龄和首次 CAV 日期与病例以 2:1 的比例进行匹配。条件逻辑回归用于建立一个最佳拟合模型，以描述 HIV 风险。在首次就诊时 HIV 检测阴性的 18281 名女性中，有 110 人（0.6%）在 2019 年之前发生 HIV 血清转换。其中，80 人（73%）在 HIV 诊断前有 CAV。有多个淋病发作、梅毒发作、过去 2 个月有更多性伴侣、肛交、吸毒史、有过用毒品或金钱换取性的经历以及过去一个月与>1 个性伴侣发生异性性行为，这些因素单独与 HIV 血清转换有关。在多变量分析中，梅毒发作[比值比（OR）=4.7，95%置信区间（CI）：1.3-16.3]、肛交（OR=2.8，95%CI：1.0-8.1）和注射毒品或可卡因（OR=33.5，95%CI：3.6-313.3）仍然与 HIV 相关。与没有这些因素的女性相比，具有所有三种危险因素的女性发生血清转换的可能性高六倍。我们的研究结果为了解南部 HIV“热点”地区哪些女性感染 HIV 的风险最大提供了线索。
