Background:  The HIV epidemic in the United States increasingly affects black, heterosexual women in the South. In North Carolina, trends in HIV prevalence among women mirror national trends in the U.S. epidemic, where black women represent 72% of new cases of HIV infection among women. In 2003, the HIV infection rate for black women in North Carolina was 14 times higher than that for white women.

Methods:  A case-control study was conducted in August 2004 to identify epidemiologic and behavioral factors associated with HIV infection among HIV⁺ and HIV^– black women residing in North Carolina. Eligible cases included all 18- to 40-year-old black women with newly reported HIV infection in North Carolina from 2003 to 2004. Controls were recruited among 18- to 40-year-old, heterosexually active black women undergoing HIV testing at local health departments and community HIV testing sites. Univariate and multivariate analyses were used to calculate odds ratios (OR) and adjusted OR. Variables that were found to be associated with HIV infection (p ≤ 1.0) were included in the multivariate analyses.

Results:  We enrolled 31 HIV⁺ and 101 HIV^– women. In univariate analyses, HIV⁺ women were significantly more likely to be unemployed (OR 4.0; 95% confidence interval 1.7, 10.0), receive public assistance (OR 5.0; CI 1.3,10.0), have 20 or more lifetime sexual partners (OR 3.8; CI 1.3, 10.7), have a history of herpes (OR 6.8; CI 2.2, 21.1), have a history of pelvic inflammatory disease (OR 3.8; CI 1.1,12.8), use crack cocaine (OR 3.7; CI 1.0, 13.7), receive money for sex (OR 3.2; CI 1.3, 7.9), and to report a partner with a history of incarceration (OR 2.8; CI 1.1, 7.6).  In multivariate analyses, HIV⁺ women were more likely to have a history of herpes infection (adjusted OR 6.1; CI 1.7, 24.0), and to receive public assistance (adjusted OR 8.1; CI 2.2, 41.6) but were less likely to have discussed sexual and behavioral histories with their male partners (adjusted OR 0.1; 95%CI 0.02, 0.4).

Conclusions:   HIV infection in black women was correlated with herpes, an ulcerative sexually transmitted disease (STD).  Therefore, biomedical research and therapeutic interventions that integrate HIV and STD treatment and prevention are warranted.  In addition, socioeconomic determinants of HIV infection highlight the need for a multi-dimensional approach to address HIV transmission in this population.

Keywords: HIV; Black Women; herpes