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Increased Sexual Risk Behavior and High HIV Seroincidence among Drug-Using Low-Income Women with Primary Heterosexual Partners. James M. McMahon , Ph.D. 1 Stephanie Tortu , Ph.D. 2 Enrique R. Pouget 1 Rahul Hamid 1 Leilani Torres 1.
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James M. McMahon, Ph.D.1
Stephanie Tortu, Ph.D.2
Enrique R. Pouget1
1 National Development & Research Institutes, New York, NY
2 Tulane UniversitySchool of Public Health & Tropical Medicine, New Orleans, LA
Funding provided by NIH/NIDA grants R01DA10864, R01DA12805 and R01DA15641
Population size: Total 117, 000
Racial/Ethnic Composition: Hispanic 52%BlackNon-Hispanic 36%
White Non-Hispanic 7%
Completed high school 56%
Receive public assistance 37%
Income below poverty line 40%
HIV seroprevalence 4.8%
Infant mortality rate 9.7 per 1000 births
Hospitalizations due to drug use 724 per 100,000
Data collection Survey on demographics, health, sex & drug risk, risk context & partnerships; all offered HIV, HBV, HCV counseling and testing
Pathogen Study I Study II Study II Women Women Men
HIV 23.3% 22.1% 22.0%
(119/510) (74/335) (75/341)
HBV 52.4% 43.1% 47.8%
(220/420) (128/297) (144/301)
HCV 43.1% 51.5% 52.7%
(182/422) (153/297) (159/301)
Primary Male Partner (PMP):Legal or common-law husband or steady primary boyfriend of at least one year.
Sex Exchange Partner:A sexual partner with whom sex was exchanged directly for money or drugs.
Casual Sex Partner:A sexual partner who is neither a primary nor exchange partner (e.g., one-time sex partner or regular casual sex partner).
Unprotected Sex by Male+/Female- CouplesBy Women’s Awareness of Partner’s HIV Status (CAR, n=39)
(last 30 days)
Solitary: Woman injected alone
Social: Women injected with other IDUs
Risk from PMPs:More common Lower condom useMore freq. exposureSingle Partner
Risk from Non-PMPs:Less common Higher condom useLess freq. exposureMultiple partners
Male-to-Female Transmission Probability per Act:
Vaginal intercourse (.001)
Anal intercourse (.02)
Syringe sharing (.01)
Rate of effectiveness (.90)
Probability of Risk Partner Being Infected:
0 to 1.0 depending on partner type and characteristics
Number of Partners
By partner type
Primary male partner
Subject: uninfected female drug-user
Casual sex partner
Exchange sex partner
Friends, family, running buddyMathematical Modeling:HIV Seroincidence Estimated from Self-Reported Risk Behavior and HIV Transmission Parameters
1. Individual Probability (P) of HIV Seroconversion:
Bernoulli equations applied to each individual in the sample to calculate probability of HIV seroconversion based on self-reported risk behavior.
2. HIV Seroincidence:
Sample mean P used to calculate model-based estimate for seroincidence over the entire sample (number of seroconversions per 100 person years).
Drug-involved women from East Harlem, New York City…
…exhibit one of the highest rates of HIV infection in the United States
…are at greatest risk of acquiring HIV from primary male partners
…continue to engage in sex- and drug-related HIV risk behavior with infected or high-risk male partners
Preliminary data suggest a high rate of HIV seroconversions among women drug-users with PMPs
Interventions promoting “monogamy” may not help these women avoid disease due to the high risk of acquiring HIV from primary male partners
This work was supported by research grants from the U.S. National Institutes of Health/National Institute on Drug Abuse (R01DA10864, R01DA12805 and R01DA15641).
The authors thank the dedicated staff (former and present) of the DUSC, CAR & CHIP projects: Sherelle Bonaparte, Jeanine Botta, Hanifah Burns, Jeanne Campbell, Audrey Grandy-Lampkin, Robert Quiles, William Rodriguez, and Lee Wengraf.
We also thank the men and women who participated in the DUSC and CAR studies.