Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology
19:413-20 1998 Lippincott Williams & Wilhns, Philadelphia

Sociodemographic and Behavioral Characteristics of
African-American Women With HIV and AIDS in
Los Angeles County, 1990-1997

Amy Rock Wohl, Sharon Lu, Sylvia Odem, Frank Sorvillo, Clare F. Pegues, and
Peter R. Kerndt

HIV Epidemiology Program, Los Angeles County Department of Health Services, Los Angeles, California, U.S.A.

Summary: African-American women have the highest AIDS rate of any racial/ethnic group of women in both Los Angeles County (LAC), California and in the United States. Limited population-based epidemiologic studies of African-American women with HIV and AIDS describe this group and examine the factors associated with the excessive rates. Interview data collected from 1990 to 1997 on a population-based sample of AIDS cases and a group of HIV-infected women in LAC were analyzed to highlight the sociodemographic and behavioral characteristics of African-American women. This group of African-American women with HIV or AIDS in LAC were unemployed (88%), single mothers (64%), living on public assistance (86%) with annual household incomes <$10,000 U.S. (76%). A history of crack use predominated (50%). Compared with women of other races with HIV and AIDS, African-American women reported more sexual partners; reported more infections with sexually transmitted diseases; sought treatment for their HIV infection later; were more likely to trade sex; and were almost five times more likely to have ever used crack cocaine. HIV prevention for African-American women in LAC should focus on improving self-esteem and negotiation skills within the context of the crack cocaine culture and the disadvantaged social and economic situation described. Key Words: Black women— Risk factors—Race—Crack cocaine.

   The AIDS rate among African-American women in Los Angeles County (LAC) in 1996 was the highest of any racial or ethnic group of women in LAC. When adjusted for reporting delay and the 1993 change in the AIDS case definition, a rate of 25/100,000 in African American women was reported compared with 8/ l00,000 for Latino women and 4/100,000 for white women (1). A similar pattern is seen nationally where adjusted rates of AIDS in African-American women (51/ 100,000) in 1996 were 17 times that of white women (3/100,000) and 3 times that of Latinas (19/100,000; U.S. Centers for Disease Control and Prevention, Division of

   Address correspondence and reprint requests to Amy Rock Wohl, HIV Epidemiology Program, Los Angeles County Department of Health Services, 600 South Commonwealth Avenue, Suite 805, Los Angeles, CA 90005, U.S.A.

   Manuscript received December 3, 1997; accepted July 1, 1998.

HIV/AIDS Prevention, Surveillance Branch, personal communication, August 1997).
   It is not entirely clear why African-American women have such high AIDS rates, because only limited data examine in detail high-risk sexual and drug-using behaviors for African-American women with HIV or AIDS (2-5). The groups of African-American women in whom HIV research has been conducted were at high risk for HIV and AIDS; however, the selection criteria for these studies did not include women diagnosed with HIV infection or AIDS (4,6-8). In addition, none of the study samples was population based, limiting the generalizability of these data. To obtain representative data to steer HIV prevention interventions in African-American women in LAC, a descriptive and comparative analysis of the sociodemographics and high-risk sexual and drug-using behaviors of African-American women with HIV and AIDS was conducted. This examination is based on interview data collected on a population-based sample of women reported with AIDS and an additional group of HIVinfected women.