Journal of Urban Health

, Volume 90, Issue 4, pp 747–757 | Cite as

HIV Prevalence Overall and among High-HIV-Risk Behaviorally Defined Subgroups among Heterosexuals at Community-Based Venues in a Mid-Atlantic, US City

  • Sarah PolkEmail author
  • Jonathan M. Ellen
  • Caroline Fichtenberg
  • Steven Huettner
  • Jacky M. Jennings


A clear understanding of local transmission dynamics is a prerequisite for the design and implementation of successful HIV prevention programs. There is a tremendous need for such programs geared towards young African-American women living in American cities with syndemic HIV and injection drug use. In some of these American cities, including Baltimore, the HIV prevalence rate among young African-American women is comparable to that in some African nations. High-risk heterosexual sex, i.e., sex with an injection drug user or sex with someone known to have HIV, is the leading risk factor for these young women. Characterizing transmission dynamics among heterosexuals has been hampered by difficulty in identifying HIV cases in these settings. The case identification method described in this paper was designed to address challenges encountered by previous researchers, was based on the Priorities for Local AIDS Cases methodology, and was intended to identify a high number of HIV cases rather than achieve a representative sample (Weir et al., Sex Transm Infect 80(Suppl 2):ii63-8, 2004. Through a three-phase process, 87 venues characterized as heterosexual sex partner meeting sites were selected for participant recruitment in Baltimore, MD. One thousand six hundred forty-one participants were then recruited at these 87 venues, administered a behavioral risk questionnaire, and tested for HIV. The HIV prevalence was 3 % overall, 3 % among males, and 4 % among females and ranged from 1.7 to 22.6 % among high-HIV-risk subgroups. These findings indicate that attributing HIV transmission to high-risk heterosexual sex vs. other high-HIV-risk behaviors would be difficult. Moving beyond individual risk profiles to characterize the risk profile of venues visited by heterosexuals at high risk of HIV acquisition may reveal targets for HIV transmission prevention and should be the focus of future investigations.


HIV Heterosexual Prevalence Disease transmission Infectious Drug user Adult 



The authors thank the men and women who participated in this study and the staff who collected the data. The National Institute of Child Health and Human Development (grant number R21HD052438) and National Institute of Drug Abuse (grant number KO1 DA022298-01A1) are gratefully acknowledged for their support.


  1. 1.
    Weir SS, Tate JE, Zhusupov B, Boerma JT. Where the action is: monitoring local trends in sexual behaviour. Sex Transm Infect 2004; 80(Suppl 2): ii63–ii68.PubMedCrossRefGoogle Scholar
  2. 2.
    The HPTN 064 (ISIS study)—HIV incidence in women at risk for HIV: US. 2012.Google Scholar
  3. 3.
    Centers for Disease Control and Prevention. HIV surveillance in adolescents and young adults.; Updated 2011–2012. Accessed July 6, 2012.
  4. 4.
    Denning P, DiNenno E. Communities in crisis: is there a generalized HIV epidemic in impoverished urban areas of the United States? 2010.Google Scholar
  5. 5.
    Towe VL, Sifakis F, Gindi RM, Sherman SG, Flynn C, Hauck H, et al. Prevalence of HIV infection and sexual risk behaviors among individuals having heterosexual sex in low income neighborhoods in Baltimore, MD: the BESURE study. J Acquir Immune Defic Syndr 2010; 53(4): 522–528.PubMedCrossRefGoogle Scholar
  6. 6.
    Magnus M, Kuo I, Shelley K, Rawls A, Peterson J, Montanez L, et al. Risk factors driving the emergence of a generalized heterosexual HIV epidemic in Washington, District of Columbia networks at risk. AIDS. 2009; 23(10): 1277–1284.PubMedCrossRefGoogle Scholar
  7. 7.
    Jennings JM, Taylor R, Iannacchione VG, Rogers SM, Chung SE, Huettner, et al. The available pool of sex partners and risk for a current bacterial sexually transmitted infection. Ann Epidemiol. 2010; 20(7): 532–538.PubMedCrossRefGoogle Scholar
  8. 8.
    Jackson L. Baltimore's HIV/AIDS epidemic, a unique challenge. Poster exhibition: the XV International AIDS Conference: abstract no. MoPeE4266Google Scholar
  9. 9.
    Simon D, Burns E. The corner: a year in the life of an inner-city neighborhood. 1st ed. New York: Broadway; 1997. Accessed June 20, 2012.Google Scholar
  10. 10.
    Agar M, Reisinger H. Numbers and trends: heroin indicators and what they represent. Hum Organization. 1999; 58: 365–374.Google Scholar
  11. 11.
    Gleghorn AA, Jones TS, Doherty MC, Celentano DD, Vlahov D. Acquisition and use of needles and syringes by injecting drug users in Baltimore, Maryland. J Acquir Immune Defic Syndr Hum Retrovirol. 1995; 10(1): 97–103.PubMedCrossRefGoogle Scholar
  12. 12.
    United States Census Bureau. Census 2000, summary file 3 (SF 3). 2003. <>. Updated 2003. Accessed February 12.
  13. 13.
    Doherty MC, Garfein RS, Monterroso E, Brown D, Vlahov D. Correlates of HIV infection among young adult short-term injection drug users. AIDS. 2000; 14(6): 717–726.PubMedCrossRefGoogle Scholar
  14. 14.
    Mehta SH, Galai N, Astemborski J, Celentano DD, Strathdee SA, Vlahov D, et al. HIV incidence among injection drug users in Baltimore, Maryland (1988–2004). J Acquir Immune Defic Syndr. 2006; 43(3): 368–372.PubMedCrossRefGoogle Scholar
  15. 15.
    Vlahov D, Anthony JC, Munoz A, Margolick J, Nelson KE, Celentano DD, et al. The ALIVE study, a longitudinal study of HIV-1 infection in intravenous drug users: description of methods and characteristics of participants. NIDA Res Monogr. 1991; 109: 75–100.PubMedGoogle Scholar
  16. 16.
    Craig T. Drugs worsen in city, U.S. says: traffic in cocaine, heroin, ecstasy assessed by DEA. Baltimore Sun. 2000.Google Scholar
  17. 17.
    Associated Press. Baltimore leads in ER cases tied to drugs. Baltimore Sun. 1998.Google Scholar
  18. 18.
    United States. National Drug Intelligence Center. Heroin in the northeast. 2003.Google Scholar
  19. 19.
    Centers for Disease Control and Prevention. Diagnoses of HIV infection among adults and adolescents, by sex and age group, 2008-37 states and 5 U.S. dependent areas.
  20. 20.
    MacKellar DA, Gallagher KM, Finlayson T, Sanchez T, Lansky A, Sullivan PS. Surveillance of HIV risk and prevention behaviors of men who have sex with men—a national application of venue-based, time-space sampling. Public Health Rep. 2007; 122(Suppl 1): 39–47.PubMedGoogle Scholar
  21. 21.
    Centers for Disease Control and Prevention. HIV prevalence estimates—United States. MMWR Morb Mortal Wkly Rep. 2008; 57(39): 1073–1076.Google Scholar
  22. 22.
    Strathdee SA, Stockman JK. Epidemiology of HIV among injecting and non-injecting drug users: current trends and implications for interventions. Curr HIV/AIDS Rep. 2010; 7(2): 99–106.PubMedCrossRefGoogle Scholar
  23. 23.
    Vlahov D, Robertson AM, Strathdee SA. Prevention of HIV infection among injection drug users in resource-limited settings. Clin Infect Dis. 2010; 50(Suppl 3): S114–S121.PubMedCrossRefGoogle Scholar
  24. 24.
    Metzger DS, Navaline H. HIV prevention among injection drug users: the need for integrated models. J Urban Health. 2003; 80(4 Suppl 3): iii59–iii66.PubMedGoogle Scholar
  25. 25.
    Gindi RM, Sifakis F, Sherman SG, Towe VL, Flynn C, Zenilman JM. The geography of heterosexual partnerships in Baltimore city adults. Sex Transm Dis. 2011; 38(4): 260–266.PubMedGoogle Scholar
  26. 26.
    Wohl DA, Khan MR, Tisdale C, Norcott K, Duncan J, Kaplan AM, et al. Locating the places people meet new sexual partners in a southern US city to inform HIV/STI prevention and testing efforts. AIDS Behav. 2011; 15(2): 283–291.PubMedCrossRefGoogle Scholar
  27. 27.
    Woodhouse DE, Rothenberg RB, Potterat JJ, Darrow WW, Muth SQ, Klovdahl AS, et al. Mapping a social network of heterosexuals at high risk for HIV infection. AIDS. 1994; 8(9): 1331–1336.PubMedCrossRefGoogle Scholar

Copyright information

© The New York Academy of Medicine 2012

Authors and Affiliations

  • Sarah Polk
    • 1
    Email author
  • Jonathan M. Ellen
    • 1
    • 2
    • 3
  • Caroline Fichtenberg
    • 2
  • Steven Huettner
    • 1
  • Jacky M. Jennings
    • 1
    • 2
  1. 1.Division of General Pediatrics and Adolescent Medicine, Department of PediatricsJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  3. 3.Children’s Hospital, Johns Hopkins University School of MedicineBaltimoreUSA

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