Heterosexuals living below the poverty line in U.S. cities are five times as likely as the nation's general population to be HIV-positive, regardless of their race or ethnicity, the federal Centers for Disease Control and Prevention said Monday.
Their neighbors in the impoverished communities who live above the poverty line are 2.5 times as likely to be infected, according to the first comprehensive study of groups that aren't involved in risky behaviors.
Because African Americans are 4.5 times as likely as whites to live in poverty and Latinos are four times as likely to do so, the findings could account for many of the ethnic and racial disparities in human immunodeficiency virus infections in this country, said Dr. Paul Denning, a medical epidemiologist at the CDC. Denning was the lead author of the study, which was released in Vienna at the International AIDS Conference.
In the United States, the overall HIV prevalence rate for blacks is eight times that for whites, while that for Latinos is three times that for whites. "That disparity appears to disappear in very-low-income areas, at least in this study," Denning said at a news conference.
The findings, based on studies of more than 9,000 people in 23 U.S. cities, indicate that these areas now have what the United Nations defines as a generalized HIV epidemic. In the past, the United States has been said to suffer from what is known as a concentrated epidemic, confined primarily to two high-risk groups: gay men and injection drug users. Those individuals were excluded from this survey.
The new results indicate that the epidemic is now firmly established in the heterosexual population and will continue there even if it could be controlled in the high-risk groups.
"There is a powerful link between poverty, low socioeconomic status and HIV," said Dr. Kevin Fenton, director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. "In communities with a generalized epidemic, we need to reach everyone in the community with prevention information and interventions.
"We need to address larger environmental issues, such as poverty, homelessness and substance abuse, which are well beyond the traditional scope of HIV intervention. Addressing those is as essential to HIV prevention as providing condoms."
The study found that 2.1% of heterosexuals living in high-poverty urban areas were HIV-positive. That included 2.4% of those living below the poverty line as defined by the Census Bureau, and 1.2% of those living above it. More than half of the households in the survey had annual incomes below $10,000, Denning said.
Overall, the HIV prevalence rate was 2.1% among blacks, 2.1% among Latinos and 1.7% among whites. In the U.S. at large, 0.45% of the population is HIV-positive.
Because the data from all 23 cities were pooled, results for individual cities are not available. In general terms, however, Western cities had lower rates than those in the Northeast and the South.
In the United States, an estimated 1.1 million people are thought to be HIV-positive and an additional 56,000 are infected each year — a number that has remained constant for more than a decade. The new findings suggest that, by focusing prevention efforts on the high-risk groups, the government has been overlooking a crucial population.
About 18,000 Americans die of AIDS each year.