Background The Miami-Fort Lauderdale metropolitan statistical area has one of the highest rates of HIV in the US and 29% of cases are among women. We explored STD history as an HIV risk factor for women.
Objective To determine if reported gonorrhoea (GC), chlamydia (CT), early syphilis (ES) or demographic factors predict the risk of subsequent HIV infection among women.
Methods We linked STD surveillance data (2000–2006) and HIV report data (2000–2009) to identify HIV infection rates among females >10 years of age, who acquired HIV >60 days after an STD diagnosis. Census data were used to estimate HIV infection rates for women without an STD diagnosis. Multivariate analysis was used to identify correlates of HIV-infection in women with an STD diagnosis.
Results Of 46 318 women diagnosed with an STD from 2000 to 2006, 534 (1.2%) were subsequently reported to be HIV-infected by 2009 (median time to diagnosis 3.0 years, mean 3.5 years). Most, 446 (83.5%), were Black. Of the 604 Black women aged 20–24 years diagnosed with HIV, 167 (27.6%) had been diagnosed with at least one STD. However, 9187 Black women aged 20–24 had an STD in 2000–2006, so the risk of HIV following an STD diagnosis was relatively low for these women. Of 371 181 Black female area residents, 6077 with no STD were reported HIV-positive in the time frame (0.16% per person-year). Risks for Black women with STD were: CT 0.23% per person-year; GC 0.54% per person-year; and ES 1.70% per person-year. In multivariate analysis, among women with an STD, HIV risk factors were: Black race (adjusted prevalence rate ratio (PRR) 4.8, 95% CI 3.1 to 7.3); age at STD diagnosis <15 years (PRR 2.1, 95% CI 1.4 to 3.3) or between 35and 49 years (minimal PRR 1.9, 95% CI 1.4 to 2.5) compared to 20–24 years; residence in a high morbidity zip code (PRR 2.1, 95% CI 1.8 to 2.5); and diagnosis of GC (PRR 2.0, 95% CI 1.8 to 2.5) or ES (PRR 7.9, 95% CI 5.7 to 10.9) compared with CT.
Conclusion STDs are common in young women. However, these data demonstrate that STDs in younger and older women, particularly Blacks with gonorrhoea or syphilis are indicators of increased risk of subsequent HIV infection. These women can be easily identified in clinical settings and targeted for risk-reduction interventions.