1、AFRICAN AMERICANS AND HIV: CONTEXT AND EPIDEMIOLOGY,ADAORA A. ADIMORA, MD, MPH UNC School of Medicine 9th Annual Summer Public Health Videoconference on Minority Health June 2003,AFRICAN AMERICANS AND HIV ( Overview),Epidemiology: Distribution of AIDS among U.S. racial/ethnic minorities Heterosexual
2、 HIV infection: what factors contribute to the racial disparity in the U.S? Role of sexual networks in STI transmission,AFRICAN AMERICANS AND HIV ( Overview 2),Distribution of concurrent partnerships among women in the U.S. Concurrent partnerships among African Americans in the Southeast Potential e
3、ffects of contextual features of the environment on heterosexual HIV transmission among African Americans,The adverse social and economic environment in which many African Americans live fosters HIV transmission by interfering with stable partnering and by increasing sexual network patterns which en
4、hance population STI transmission.,20,40,60,120,100,80,0,U.S. dependencies and possessions,Midwest,Northeast,South,1995,1996,1997,1998,1994,1993,Year,Estimated Number of Persons Living with AIDS,1993 -1998, by Region, United States,West,Thousands,Reasons for Racial Disparity in HIV?,Prevalence of HI
5、V Prevalence of risk behaviors Access to and use of treatment that delays progression of HIV infection to AIDS,HETEROSEXUAL HIV: Black-White Disparity,Differences in prevalence of individual high-risk sexual behaviors not clearly established SES - likely contributes, but racial disparities in STIs p
6、ersist after controlling for SES,SEXUAL NETWORKS,Set of people linked directly or indirectly by sexual contact Pattern of linkages is of critical importance in STI transmission More mixing between high and low (sexual) activity classes among blacks (Laumann) - a pattern that facilitates STI spread P
7、revalence of concurrent partnerships?,CONCURRENT SEXUAL PARTNERSHIPS,Sexual partnerships that overlap in time Permit more rapid spread of an STI throughout a population Individual infected by 1 partner already has others to infect Earlier partners are put at risk by individuals subsequent partners,M
8、ONOGAMY,CONCURRENCY,CONCURRENT PARTNERSHIPS, WOMEN, U.S. (1995, NSFG),Adimora AA, Schoenbach VJ, Bonas DM, et al. Concurrent Partnerships among Women in the US. Epidemiology (2002;13:320-327),Marital Status by Ethnicity,Adimora AA, Schoenbach VJ, Bonas DM, et al. Concurrent Partnerships among Women
9、in the US. Epidemiology (2002;13:320-327),SEXUAL NETWORK COMPONENTS AMONG AFRICAN AMERICANS IN THE RURAL SOUTH,Hypothesis Concurrency is reported more frequently by Blacks in rural North Carolina than by the general population.,SELECTION OF SUBJECTS,Randomly selected from NC Drivers License file Afr
10、ican American men and women, aged 18-59 Resided in 13 rural Eastern NC counties Counties chosen for high proportions of African Americans and high STI/HIV rates among African Americans,Controls,STUDY PROCEDURES,Potential subjects contacted by letter, telephone Study nurse went to subjects homes Info
11、rmed consent Administered standardized interview questionnaire (1 hr) Collected blood specimen Provided financial incentive,STUDY INSTRUMENT,Standardized interview Demographic data Sexual risk behaviors Timing of sexual partnerships, including date of first and last intercourse for last 3 sexual par
12、tnerships Respondents estimate of likelihood that partner had had other sexual partners during relationship with the respondent Drug use of respondent and partners,SUBJECT RECRUITMENT,1,063 sampled from Drivers License file 697 could not be located (50% due to out of date or incorrect addresses) 101
13、 refused to participate 22 unavailable (illness or incarceration) 17 ineligible (age, not black, gay, IDU, HIV+) 226 interviewed and eligible,Controls,STUDY POPULATION,Controls,Demographic Characteristics,Controls,Sexual History,Controls,Risk Behaviors,Controls,Partner Risks,Controls,Incarceration (
14、 24 hours in past 10 years),Controls,Concurrency Prevalence (%),Controls,Concurrency Odds Ratios,Controls,Concurrency Odds Ratios,Controls,Concurrency Odds Ratios,Controls,Concurrency Odds Ratios: Men & Women, Multiple Regression,Controls,# Sexual Partners,Controls,Concurrency Prevalence (%),Summary
15、,Prevalence of reported concurrent sexual partnerships among Blacks in rural NCs general population is high. A higher proportion of black women in NC reported concurrency than did black women in the US. Rates are higher among men than women. Potential contributing factors may include: Being unmarrie
16、d Lower age of sexual debut,Summary (continued),Prevalence of concurrency is higher among those with newly acquired heterosexually transmitted HIV than among Blacks in the general population This level of concurrency may markedly facilitate HIV transmission in this population.,SOCIAL CONTEXT OF SEXU
17、AL RELATIONSHIPS AMONG RURAL AFRICAN AMERICANS,Focus group interviews re: community life and contextual factors affecting sexual behavior Pervasive economic and racial oppression, boredom, resultant substance abuse Shortage of black men (increased mortality and incarceration rates) Respondents belie
18、ved male shortage responsible for widespread concurrency among unmarried persons Adimora, Schoenbach, et al. Sexually Transm Dis 2001;28:69-76,CONTEXT AFFECTS SEXUAL NETWORKS,Low sex ratios among blacks Economic adversity Drugs - especially crack Incarceration,CONCLUSIONS,Contextual factors (sex rat
19、io, poverty, discrimination) are likely of considerable importance in influencing sexual behaviors that facilitate population HIV transmission,“The Lord looked and was displeased that there was no justice.”Isaiah 59:14,CONCURRENT PARTNERSHIPS AMONG AFRICAN AMERICANS IN THE RURAL SOUTH,Adaora A. Adimora, MD, MPH Victor J. Schoenbach, PhD Francis Martinson, MD, PhD Sevgi Aral, PhD Ward Cates, MD, MPH JoAnne Earp, PhD Robert Fullilove, EdD Amy Lansky, PhD Greg Samsa, PhD Stephanie Betran, RN Kathryn Donaldson, MPH Tonya Stancil, MPH Merritha Williams, RN NC HIV/STD Control Section,
