VIENNA—The prevalence of HIV infection among heterosexuals in U.S. inner cities constitutes a generalized epidemic, a new U.S. study says.
The report, based on interviews of more than 9,000 people not considered at high risk of HIV/AIDS who live in high-poverty areas of 23 U.S. cities, found that 2.1% of that population was infected with HIV, the virus that causes AIDS.
That figure is more than double the 1% considered the threshold for a generalized epidemic as defined by the Joint United Nations Programme on AIDS. And it’s about 20 times as high as the prevalence of the virus among heterosexuals in the general U.S. population.
The U.S. Centers for Disease Control and Prevention, which ran the study, says the findings reveal the strongest evidence yet of a link between poverty and HIV infection. People in low-income communities lack access to medical care and spread the disease more readily because they are unaware that they are infected and therefore not being treated, the researchers said.
“This is one of the first large-scale studies to show a very strong link between living below the poverty line and being infected with HIV,” said Kevin Fenton, director of the CDC’s National Center for HIV/AIDS and certain other infectious diseases. “Socio-economic deprivation and especially poverty are major drivers of the epidemic” in the inner city.
The CDC’s findings are based on surveys conducted in 2006 and 2007 among 9,078 participants aged 18 to 50, 188 of whom tested positive for HIV. Of those, 55% were women and 75% had incomes at or below the threshold for poverty.
The U.S. Census Bureau’s poverty threshold for a single-person household in 2006 was $10,294 in annual income. All neighborhoods surveyed had 20% or more of its residents living below the poverty line.
CDC researchers say they deliberately left out of the study members of high-risk populations, such as gay and bisexual men and users of injectable drugs, to gain a better understanding of inner-city forces that are affecting the epidemic.
The results showed that “when you take out the high-risk groups, there is enough HIV in the heterosexual population to sustain an epidemic” on its own, Dr. Fenton said.
The findings don’t change the fact that high-risk groups remain the fundamental drivers of the disease in the U.S.
Among the about 56,000 new cases of HIV/AIDS infection reported each year, 53% occur among gay and bisexual men and 16% among people who inject drugs, according to the Obama administration’s National HIV/AIDS Strategy for the U.S., which was released last week. More than 1.1 million Americans are living with HIV.
Smaller studies have described an association between poverty and AIDS, and the results of the new report weren’t surprising, especially to people on the front lines of the fight against HIV. But the findings nevertheless challenge some conventional perceptions about the nature of the disease in the U.S.
“My experience in Harlem is that HIV is at least as much a function of where you live as who you are,” said Patrick McGovern, chief executive of Harlem United Community AIDS Center Inc. in New York, which provides about 8,000 HIV tests a year in Upper Manhattan and the Bronx.
He cited a lack of access to HIV testing and treatment as major factors behind the spread of the epidemic in poor communities. “We don’t see greater promiscuity in poorer communities,” he said. “We do see less access to diagnosis and treatment.”
The study is being released Monday at the XVIII International AIDS Conference, which opened Sunday night in Vienna.
At the opening ceremony, speakers cited major progress against the epidemic in developing countries, where with the help of global funding, more than five million people with HIV/AIDS are being treated with effective medicines.
By RON WINSLOW And BETSY MCKAY