AIDS cases among women who reported sex with a bisexual man, 2000-2004--United States

INTRODUCTION: Some HIV-infected men who have sex with men also have sex with women. Additionally, some women do not know that they are or have been in a sexual relationship with a bisexual man. Knowledge of their male partner's risks for HIV infection is crucial if reductions in HIV/AIDS are to occur among women. METHODS: We examined AIDS diagnosed cases reported to CDC from the 50 states and the District of Columbia, 2000 through 2004, in women aged 13 years and older. Cases were analyzed by transmission category, race/ethnicity, age at diagnosis, and geographic region, and data were adjusted for missing risk factor information and reporting delays. RESULTS: From 2000 through 2004, an estimated 1,576 women (from a total of 35,376 women reported with HIV from heterosexual contact and diagnosed with AIDS) reported sexual contact with a bisexual man (BSXM) as their primary risk factor for HIV infection. Non-Hispanic blacks accounted for the majority (62.8%) of cases, followed by non- Hispanic whites (20.5%) and Hispanics (14.8%). The average AIDS rate attributed to sex with a BSXM differed significantly by race/ethnicity (p < 0.01), with the rate for non-Hispanic black women 13 times the rate for non-Hispanic whites and 4 times the rate for Hispanics. Sexual contact with a BSXM accounted for 6.3% of AIDS cases among non- Hispanic white women with heterosexually acquired HIV compared to 4.4% among Hispanics and 4.0% among non-Hispanic blacks. CONCLUSIONS: The proportion of AIDS cases among women attributed to sex with a BSXM was similar across races/ethnicities; however, rates were highest among non-Hispanic black women. Because some women were unaware of their male partner's risk for HIV infection, the number of women with AIDS who had a bisexual partner was probably underreported. HIV prevention programs should provide information on risks of sex with BSXM, as many women may not be fully aware of their risks for acquiring HIV infection.     

The increasing frequency of heterosexually acquired AIDS in the United States, 1983-88.

Of 88,510 cases of acquired immunodeficiency syndrome (AIDS) reported in adults in the United States from 1983 through 1988, the percentage attributed to reported heterosexual contact with persons known to be infected or at increased risk of infection with human immunodeficiency virus (HIV) has increased steadily from 0.9 percent in the first quarter of 1983 to 4.0 percent in the fourth quarter of 1988, from 0.1 (in 1983) to 1.4 percent (in 1988) among men, and from 13 (in 1983) to 28 percent (in 1988) among women. Among women, the cumulative incidence of AIDS attributable to heterosexual contact per million population is over 11 times greater for Blacks and Hispanics than for Whites. Among men, this incidence is over 10 times greater for Blacks and four times greater for Hispanics than for Whites. The pattern of distribution of heterosexually acquired AIDS parallels the distribution of other heterosexually transmitted diseases, which are also more frequent in Black and Hispanic inner-city populations. Drug use, exchange of sex for drugs or money, and early onset of sexual activity in adolescents are increasingly associated with heterosexually transmitted infections and are likely to be very important in heterosexual transmission of HIV in inner-city US populations.     

外来务工人员艾滋病知识、行为和艾滋病病毒感染状况调查

目的了解外来务工人员艾滋病相关知识知晓状况、危险行为以及艾滋病病毒感染状况。方法采用分层随机抽样的方法，对东部沿海某市18-60岁外来务工人员进行问卷调查，收集艾滋病知识和行为的信息，并采集静脉血进行艾滋病病毒抗体检测。结果1190名调查对象对艾滋病的传播途径全部回答正确的占71．9％。对于非传播途径和预防措施全部回答正确的分别占18．2％和7．1％，所有问题均能正确回答的仅占2．5％。在有过性经历者中，非婚性行为者占41．7％，有过商业性行为者占11．4％。在与固定性伴和商业性性伴发生性行为时，最近一次性行为时使用安全套的比例分别为32．9％和46．7％。多因素分析显示，正确知晓传播途径与文化程度和有性经历有关。无论与固定性伴，还是商业性性伴，最近一次性行为使用安全套的均与正确知晓传播途径有关。1125名工人艾滋病病毒抗体检测结果均为阴性。结论针对外来务工人员艾滋病知识的薄弱环节，开展宣传教育。通过艾滋病知识知晓率的提高，促进高危行为的改变。同时需要加强对该人群的监测。     

Reduction of high-risk sexual behavior among heterosexuals undergoing HIV antibody testing: a randomized clinical trial.

BACKGROUND. We evaluated the effect of HIV antibody testing on sexual behavior and communication with sexual partners about AIDS risk among heterosexual adults at a clinic for sexually transmitted diseases. METHODS. We randomized 186 subjects to receive either AIDS education alone (the control group) or AIDS education, an HIV antibody test, and the test results (the intervention group). These subjects were then followed up 8 weeks later. RESULTS. At follow-up, mean number of sexual partners decreased, but not differently between groups. However, compared with controls, HIV antibody test intervention subjects, all of whom tested negative, questioned their most recent sexual partner more about HIV antibody status (P less than 0.01), worried more about getting AIDS (P less than 0.03), and tended to use a condom more often with their last sexual partner (P = 0.05): 40% of intervention subjects vs 20% of controls used condoms, avoided genital intercourse, or knew their last partner had a negative HIV antibody test (P less than 0.005). CONCLUSION. HIV antibody testing combined with AIDS education increases concern about HIV and, at least in the short term, may promote safer sexual behaviors. Additional strategies will be necessary if behaviors risky for HIV transmission are to be further reduced.     

Demograghic and socio-economic determinants of community and hospital services costs for people with HIV/AIDS in London.

We examined the influence of demographic, social and economic background of people with HIV/AIDS in London on total community and hospital services costs. This was a retrospective study of community and hospital service use, needs and costs based on structured questionnaires administered by trained interviewers and costing information obtained from the service purchasers and providers, based on two Genito-urinary Medicine clinics in London: the Jefferiss Wing at St. Mary's Hospital and Patric Clements at the Central Middlesex Hospital, London, England. The subjects were 225 HIV infected patients (105 asymptomatic, 59 symptomatic non-AIDS and 61 AIDS). We found that over and above well established determinants of health care costs for HIV infected people such as disease stage and transmission category, social and economic factors such as employment and support of a living-in partner significantly reduced community services costs. Private health insurance had a similar effect, though only a small proportion of HIV people had such cover. The cost of community services for HIV infected non-European Union nationals, mainly of African origin, was one quarter that for the European Union nationals. Community services costs were highest for heterosexually infected women and lowest for heterosexually infected men after adjusting for other factors. Hospital services costs were significantly higher for HIV infected people lacking educational qualifications and employment. We conclude that access to community care for HIV infected non-EU nationals appears to be very poor as the cost of their community services was one quarter that for the EU nationals after adjusting for the effects of transmission category, disease stage, living with a partner, employment and having a private health insurance. Additional incentives for informal care for HIV infected people could be a cost-effective way to improve their community health service provisions.     

Sex in Australia: selected characteristics of regular sexual relationships

OBJECTIVE: To describe selected characteristics of Australian adults' regular or ongoing sexual relationships. METHOD: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years. The overall response rate was 73.1% (69.4% men, 77.6% women). Respondents indicated how often they had sex in the past four weeks, contraceptive use, their own and their partners' expectations about having sex with other people during their relationship, whether they had discussed these expectations with their partners and whether they had an explicit agreement about sex with other people. RESULTS: 85.3% of men and 89.5% of women were in a regular heterosexual relationship, among whom 81.4% of men and 89.3% of women reported contraceptive use. Men and women who had a regular partner for the past 12 months had had sex with their partners an average of 1.84 times per week in the four weeks before interview; younger people had sex more often. Most respondents expected themselves and their partners to not have sex with other people, although men were less likely than women to have discussed these expectations with their partner. Bisexually identified men and women were significantly less likely than heterosexually identified men and women to support having sex only with their regular partner. Only 4.9% of men and 2.9% of women in regular heterosexual relationships had concurrent sexual partners in the past 12 months. CONCLUSION: Australians' attitudes to not having sex with people while in a regular relationship are highly consistent with their behaviour.     

六安市艾滋病异性传播病例感染方式特征分析

目的 了解六安市艾滋病异性传播主要感染方式及不同感染方式的人群特征。方法 以国家艾滋病综合防治信息系统中现住址为六安市、传播途径为异性传播的HIV/AIDS病例为调查对象,采用自行设计的调查问卷收集调查对象的社会人口学特征及异性传播方式。结果 共调查符合纳入标准HIV/AIDS 340例,其中经商业性性行为传播占59.4%（202/340）,经配偶或固定性伴传播占18.8%（64/340）,非商业性临时性伴占21.8%（74/340）。性别、年龄、文化程度及婚姻状况是异性传播方式的影响因素。经商业性性行为传播比例始终维持在较高水平,非商业性临时性伴传播比例近几年上升趋势明显,配偶或固定性伴传播比例呈下降趋势,在3个传播方式中水平最低。结论 六安市艾滋病异性传播以经商业性性行为感染方式为主,但不同人群异性传播方式差异较大,需要采取有针对性的干预措施。     

Heterosexual transmission of human immunodeficiency virus.

Heterosexual human immunodeficiency virus (HIV) transmission accounts for most cases of HIV infection and acquired immunodeficiency syndrome worldwide. Moreover, in the developed world the proportion of individuals infected heterosexually is rising faster than the proportion infected by other routes, with an increase in the number of women infected. Defining the factors associated with heterosexual transmission may help control new infections.     

泸州市艾滋病异性传播病例高危性行为史调查分析

目的 调查了解泸州市艾滋病病毒(HIV)感染者经异性传播的具体来源。 方法 招募经异性性行为传播的HIV感染者,采用深入访谈的方式调查其诊断HIV之前高危性行为信息和方式,分析其感染HIV最可能的时间和地点。 结果 对300名经异性性行为感染HIV的感染者的调查表明,男性和女性感染HIV的方式差异有统计学意义(χ²=164.834,P<0.001),男性以商业异性性行为为主(90.8%),另外固定性伴性行为占5.1%,临时异性性行为4.1%;而女性中以固定性伴性行为为主(71.9%),商业异性性行为占17.1%,临时异性性行为11.0%。自述经过商业异性性行为感染HIV的调查对象中,25.9%的人自述曾在2个以上地市发生过商业性行为,25.0%在2个及以上的省份发生过商业性行为;64.3%的调查对象自我判断在泸州市感染,而认为自己是在户籍地以外的其他省份感染HIV的调查对象占29.3%。 结论 泸州市艾滋病经异性性传播的情况较为复杂,亟需系统而全面地在全人群和重点人群中开展健康教育和行为干预工作。     

Heterosexual and mother-to-child transmission of AIDS in the hemophilia community.

Growing awareness of the potential modes of transmission of the human immunodeficiency virus (HIV) has encouraged interest in the epidemiology of infection among sexual partners and children of HIV-infected persons. The authors reviewed data on two groups, the first being those with HIV infection acquired heterosexually from a person whose hemophilia, or other chronic bleeding disorder, was treated with blood products. The second group was children with HIV infection acquired from a mother (vertical transmission) who either had been treated for a chronic bleeding disorder or had been the heterosexual partner of a person being treated. Surveillance data were examined for cases of acquired immunodeficiency syndrome (AIDS) in the United States reported to the Centers for Disease Control and Prevention, diagnosed before January 1, 1992, and for whom the only identified risk factor was being either the heterosexual partner or the child of a parent with a chronic bleeding disorder. Of the cases examined, 107 were in persons who were heterosexual partners of persons with chronic bleeding disorders. Of the 107, 98 (92 percent) were women and 87 (81 percent) were white; all were 17 years of age or older. In addition to the 107, there were 14 children, 10 (71 percent) of whom were diagnosed with AIDS in the first year of life. The rate of increase in such cases has not been as great in recent years as that observed early in the primary epidemic of AIDS among persons with hemophilia and other chronic bleeding disorders.(ABSTRACT TRUNCATED AT 250 WORDS)     

Are HIV/AIDS Prevention Interventions for Heterosexually Active Men in the United States Gender-Specific?

Although gender-specific theories are often deployed in interventions to reduce women''s HIV risks, the same is often not true for interventions among men. Theories of masculinity are not guiding most US research on the risky sexual behavior of heterosexual men or on what can be done to intervene.We first assess the extent to which evidence-based HIV-prevention interventions among heterosexually active men in the United States draw upon relevant theories of masculinity. Next, we introduce a useful framework within masculinity and gender studies that can be applied to HIV-prevention interventions with heterosexually active men.Finally, we make suggestions to improve the gender specificity of HIV-prevention interventions for heterosexually active men in the United States.ALTHOUGH THE FIRST AIDS cases in the United States were attributed to men who had sex with men, more than 70% of HIV infections worldwide are now estimated to occur as a result of heterosexual sex.¹ Most HIV-positive women were infected through heterosexual sex.²Despite wide regional variation in the percentage of cases attributable to heterosexual transmission, it is clear that the proportion of women with HIV is rising in many parts of the world. In Asia, 30% of adults living with HIV are women, and in Sub-Saharan Africa, 60% of adults living with HIV are women.² Globally, increases in the proportion of women infected with HIV have occurred in a relatively short period of time: in 1985, 30% of infected persons were women; this percentage now stands at approximately 50%, and the absolute numbers of infected women, as well as the percentages, are increasing in many parts of the world.²In the United States, where the main subgroup affected by HIV/AIDS is men who have sex with men, heterosexual transmission is the primary means of transmission among women.³ Among women diagnosed in the United States, heterosexual transmission as the identified source of transmission more than tripled from 1985 to the present, and the Centers for Disease Control and Prevention has reported that 80% of cases of HIV infection among women are diagnosed as being heterosexually transmitted.^3,4 Of this 80%, approximately one third are the result of having sex with a male partner who is an injection drug user.^3,4 Combined, these facts suggest that sexual behavior change among heterosexually active men will be key to controlling the HIV epidemic for both heterosexual men and women.Analyses of why these trends are occurring have come to the same conclusions: gender and gender inequality in particular have been identified as a major “root cause” of what shapes and exacerbates the course of the epidemic.^5–8 Some argue that these findings underscore how HIV studies need to “adequately address the contextual issues of heterosexual relationship dynamics”^6(p873) on a domestic and global level. It seems clear that the structure of gender relations needs to be examined and challenged for both women and men.To what extent has this examination already occurred? Very little, it appears. Indeed, HIV-prevention interventions for heterosexually active adults have largely targeted women, as they are said to need structural, cultural, institutional, and technologically based empowerment and protection. But what do heterosexually active men need? What do gender relations have to do with HIV prevention? Because women and men are equally shaped by gender, how can we use theories of masculinity to understand what puts men at risk for HIV infection and to guide researchers in creating effective prevention interventions?Ten years ago, Exner et al. underscored that:

While many HIV risk reduction interventions have been focused among women, heterosexual men have less frequently been the focus of such efforts … yet it is imperative that heterosexually-active men be included in strategic efforts to reduce heterosexual transmission because sexual behavior is dyadic and men are the partners of women.^9(p348)

To examine the state of the field, Exner et al. reviewed HIV-prevention interventions from 1981 to 1998 that focused on reducing risky heterosexual behavior among North American men. Intervention programs were described as “informational” (e.g., providing HIV/AIDS, alcohol, and sexuality information), “condom skills” (e.g., ensuring consistent and correct condom use), “relational skills building” (including negotiating safer sex, assertiveness, and communication), and “individual risk counseling” and “community street outreach” (for injection drug users). Of the 20 interventions they found to meet rigorous methodological standards, seven were for injection drug users. Of the remaining 13 interventions, three targeted men exclusively, whereas the remainder focused on both women and men. At that time, the authors made a call to bolster prevention efforts for heterosexually active men.How far have we come since then? Lyles et al.¹⁰ carried out a systematic review of the intervention literature from 2000 to 2004 and detailed 18 interventions that met rigorous criteria for best evidence. Of the six best-evidence interventions that were designed for sexual risk reduction among heterosexually active HIV-negative adults, four were for women, two were for both women and men (of which one focused on those receiving outpatient psychiatric care and the other on couples communication), and none were designed for heterosexually active men only. Although one of the two interventions among both women and men focused on issues of gender norms and gender power, all of the women-only interventions focused on these topics. The women-only interventions also emphasized the need to infuse women with more safer-sex negotiating power vis-à-vis a male partner.Notably, in both of the previously mentioned reviews—and even in a third review from 2002 that focused on interventions with heterosexually active men¹¹—despite the large number of interventions, the word masculinity was not mentioned once. The reviews included no overt discussion about the ways in which men have gender or are affected by a system of gender inequality. There was also no mention of how masculinity and gender relations should be a guiding theoretical framework to understand—and intervene about—what puts heterosexually active men at risk for HIV infection.     

河南省HIV配偶间性传播流行病学调查

目的了解河南省报告的艾滋病配偶间性传播者的流行病学特征,为制定更有针对性的干预措施提供依据。方法采用自行设计的调查问卷,对2011年1月至2012年6月,河南省189个县区通过国家艾滋病网络直报系统报告的感染途径是“异性传播”且接触史是“配偶HIV阳性”的配偶间性传播者进行面对面调查。结果共调查557例HIV配偶间性传播感染者,其中男性占37．7％,女性占62．3％,70．7％的HIV感染者是40岁以上;49．7％的感染者感染前配偶间性生活频次在2～3次／月,得知配偶感染后73．4％的感染者性行为次数减少;46．9％的感染者从未使用过安全套;58．3％的感染者不习惯使用安全套,13．3％的感染者由于不知道配偶感染而没有使用安全套;38．4％的配偶间性传播者其配偶属于异性传播,59．3％的配偶间性传播者的配偶因既往采供血或输血感染HIV;50．3％的感染者是由医务人员告知其配偶感染HIV,73．6％的配偶双方HIV检测确认时间差值在3个月内。结论报告的HIV配偶间性传播者中属于配偶双方同时检测确认的比例较高,应采取定期随访检测、早期抗病毒治疗等综合干预措施预防HIV配偶间性传播。     

云南省2015年新报告988例非婚异性传播HIV/AIDS病例性行为及影响因素分析

目的 了解人类免疫缺陷病毒（human immunodeficiency virus,HIV）感染者/获得性免疫缺陷综合征（acquired immunodeficiency syndrome,AIDS）患者经非婚异性性接触感染的高危性行为特点及其影响因素,为控制艾滋病经性传播策略制定提供科学数据。方法 连续抽取云南省2015年新报告非婚异性传播HIV/AIDS病例,进行问卷调查,了解调查对象获知感染HIV前后危险行为等情况。结果 调查男性498人、女性490人。获知感染HIV前一年内有商业性行为的比例为39.88%（男性占68.67%,女性占10.61%）,性别差异有统计学意义（χ2=352.797,P<0.001）,地点集中在路边店/街头,坚持使用安全套比例仅为8.38%;71.36%有临时性伴间性行为（男性占64.46%,女性占78.37%）,且性别差异有统计学意义（χ2=23.379,P<0.001）,临时性伴主要是朋友/熟人（占82.52%）;存在多种性行为交叉和叠加。获知感染HIV后仍有12.96%发生高危性行为,仅31.86%愿意告知性伴自身的感染状况。结论 异性传播影响人群扩大,控制异性传播的策略应转为在强化高危人群干预工作基础上,倡导全民推广使用安全套的普遍防护,宣传教育时增加风险行为识别和安全性行为警示性教育,艾滋病感染者随访管理工作中应评估其传播风险并采取相应措施。     

萍乡市男男同性恋性病艾滋病哨点监测结果分析

目的了解男同人群的性相关危险因素特点,找出有效的途径或策略,进一步有效控制艾滋病的流行。方法问卷调查与实验室检测。结果总共监测310名男同,其中酒吧会所监测占30.97%,网络监测占69.03%;90%被监测男同是高中以上文化程度;最近一年患性病的占14.19%;310人当中HIV感染者8例,感染率为2.58%;网络招募人中HIV感染为3.27%。艾滋病知识知晓率为98.71%;有将近15%的感染者有过商业性行为(包括3名感染者);有商业性行为的男男同性恋艾滋病感染率与没有商业性行为的男男同性恋的艾滋病感染率两者比较有明显差异;与女性发生性关系的时候有三分之一不使用安全套,每次都会使用的不到一半,最近一次与女性发生性关系有三分之一没有使用安全套。结论男同容易将艾滋病性病进行婚内、外传播;男同存在掌握相关HIV防治知识与实际防范结果背离现象;网络加大了男同交往的频率和范围,也加大了艾滋病传播风险;同性商业性行为风险性更高;男同的双性性关系及无保护性性交在艾滋病传播中起到一个非常重要的桥梁作用;今后要把宣传干预重点放在双性恋、男性性商业服务人群、男同配偶或性伴、甚至青年妇女、青年学生身上。     

台州市男男性行为者艾滋病相关知识、行为和感染率调查

[目的]了解台州地区男男性行为人群(MSM)艾滋病相关知识、性行为及艾滋病病毒(HIV)和梅毒感染率。[方法]在台州市区以方便抽样法招募MSM接受问卷调查、HIV和梅毒感染检测。[结果]共调查106名MSM,平均年龄(27.9±6.0)岁;对于艾滋病传播途径的认知率分别为血液传播83.5%、性传播86.6%和母婴传播74.2%;81.7%的对象愿意接受自愿咨询检测;81.9%的对象曾与其他城市MSM约会;72.9%的对象有1名或多名女性性伴;94.6%的对象发生过肛交,且安全套使用率较低,其中22.1%有过群交行为;38.9%曾召过女性性服务,35.5%曾召过男男性服务,15.3%曾提供过男男性服务;HIV抗体阳性率为3.9%,梅毒抗体阳性率为24.7%。[结论]台州地区MSM人群存在着多性伴、安全套使用率低、商业性行为普遍等高危行为,艾滋病、梅毒感染率较高,与周边城市MSM人群联系密切,是台州地区艾滋病防控的重点人群。     

艾滋病高流行区农村留守妇女艾滋病高危行为分析

目的 了解云南省艾滋病高流行区留守妇女艾滋病高危行为现况及影响因素。方法 于2015年3~5月,采用按规模大小成比例抽样法（probability proportionate to size sampling,PPS）抽样法对云南省德宏州、临沧市的500名留守妇女进行一对一问卷调查,收集相关信息。结果 留守妇女艾滋病知晓率为71.0%,35岁以上年龄、初中以下文化水平、在婚、汉族、现居临沧市、未曾接受艾滋病干预服务者知晓率较低。近一年28.6%留守妇女有过丈夫以外的性伴。多性伴行为危险因素:年龄35岁以上、少数民族、丧偶、现居住德宏州、未曾接受艾滋病相关服务、配偶有吸毒行为。临时性行为、商业性行为安全套使用率分别为20.7%、58.3%。1.4%留守妇女吸毒。67.4%接受过艾滋病干预服务。结论 云南省艾滋病高流行区留守妇女艾滋病知识认知程度较低,多性伴比例较高且安全套使用率较低,今后应加大对艾滋病高流行区农村留守妇女的干预力度,尤其是少数民族、低文化水平、未曾接受过相关干预服务者的干预,重点关注多性伴、有吸毒行为留守的妇女。     

HIV transmission risks of females and males in paired partner relationships

As the HIV/AIDS epidemic has evolved, heterosexual behaviors have come to be an increasingly important mode of transmission and rates of infection have increased faster among women generally and minority women in particular. Most of what we known about heterosexual risk taking is based on survey data collected from either women or men. These data have been useful for helping to understand different levels and types of risk taking by women and men. However, they provide little information about the levels of risk taking that exist for paired partners in main partner relationships, the types of risks each partner brings to the relationship and how the contribution of partner risks varies. Using data from the pretest of a pilot project designed to test a behavioral intervention to reduce HIV/AIDS transmission among main sex partners, the authors developed four subscales of sexual risk taking for each partner. The association between subscales within and between genders are examined and the subscales are combined to obtain measures of couple risks. Particular attention is given to the gender contribution of partners to couple risk and the differential contribution of types of risk to total risk. The data suggest that, even though men bring relatively higher risks to their main partner relationship than women, this varies inversely with the level of couple risk.     

Dogma disputed: potential endemic heterosexual transmission of human immunodeficiency virus in Australia

Abstract: The concept of tertiary sexual transmission of human immunodeficiency virus (HIV) has been central to government efforts to communicate notions of risk to heterosexuals in Australia. Data on heterosexually transmitted acquired immune deficiency syndrome (AIDS) and HIV for Australia are reviewed with emphasis given to the probability of misclassification bias in the heterosexually acquired and ‘other/undetermined’ categories. Tertiary cases are almost certainly rare in Australia, with little evidence of any increase in their incidence since the first cases were recorded. Three factors (low probability of exposure, the infectivity of HIV and a comparatively low rate of sexual partner change) make it improbable that Australian heterosexuals with no risk factors will experience endemic HIV infection, with a caveat to this conclusion lying in the potential of Australian sex tourism to Southeast Asia for introducing HIV into the Australian heterosexual population. Four hegemonic factors which have acted to suppress any serious debate of the notion that HIV in Australia is unlikely to become endemic among heterosexuals are discussed: the political ‘democratisation’ of risk inspired by concerns that gay men should not be further vilified as a victim group; the preventive imperative; a reluctance among health educators to question the very foundations of the message they are employed to deliver; and a reluctance to curtail ‘Trojan horse’ benefits to sexually transmissible disease prevention engendered by HIV education promoting safe sex messages.     

A method for classification of HIV exposure category for women without HIV risk information.

An increasing number of cases of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) among women is reported to state and territorial health departments without exposure risk information (i.e., no documented exposure to HIV through any of the recognized routes of HIV transmission). Because surveillance data are used to plan prevention and other services for HIV-infected persons, developing methods to accurately estimate exposure risk for HIV and AIDS cases initially reported without risk information and assisting states to analyze and interpret trends in the HIV epidemic by exposure risk category is important. In this report, a classification model using discriminant function analysis is described. The purpose of the classification model is to develop a proportionate distribution of exposure risk category for cases among women reported without risk information. The distribution was estimated based on behavioral and demographic data obtained from interviews with HIV-infected women; the interviews were conducted in 12 states during 1993-1996. Variables used in the analysis were alcohol abuse, noninjection-drug use, and crack use; year of HIV/AIDS diagnosis; age; employment; and region. As a result of the classification procedure, nearly all cases among women with no reported risk were classified into an exposure risk category: 81%, heterosexual contact; and 16%, injection-drug use. These proportions are higher than the current redistribution fractions (calculated from risk reclassification patterns and weighted by demographic characteristics) and reflect the increasing proportion of cases among women attributable to heterosexual contact with an infected partner. This report provides one method that could be applied to HIV surveillance data at the national level to estimate the proportion of cases in exposure risk categories. However, because the study in this report is limited in sample size and geographic representativeness, other models are also needed for adjusting risk exposure data at the national, state, and local levels.