Factors Associated with HIV Seroconversion Among Women Attending an Urban Health Clinic in the South: A Matched Case–Control Study

Abstract

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.

HIV and syphilis testing for women and heterosexual men aged above 25 years in the Netherlands: possibilities for targeted testing at sexual health centres

“…For determinants of HIV and syphilis diagnoses separately the targeted populations between studies differ greatly, hampering comparison of our study results. [16][17][18][19][20][21][22][23] However, determinants in our study consistent with existing data were partner notification and lower education level, found to be determinants of both HIV and syphilis 6 9 16-18 and STI symptoms and male sex found to be determinants of syphilis only. 6 19 Yet an unexpected result in our study was that persons with two or more partners would be at decreased risk for HIV/syphilis diagnosis, as multiple partners are usually determinants of STI.…”

Frequent Cocaine Use is Associated with Larger HIV Latent Reservoir Size

“…Moreover, these differences were not examined in relation to cocaine use. Given that cocaine use is independently associated with seroconversion among women( 42 ), is more common in WLWH than their uninfected counterparts( 43 ), and use persists even among ART-adherent persons( 23 ), future studies aimed at evaluating sex differences, the contribution of hormonal effects across the life course, and cocaine use on the HLR in WLWH are warranted.…”