CHARACTERISTICS OF AFRICAN-AMERICAN WOMEN WITH HIV AND AIDS                       417

 

Table 3. History of Selected Sexually Transmitted Diseases (STD's) and Related Variables
in Women with HIV and AIDS Interviewed in Los Angeles County, 1990-1997


Race/Ethnicity of Women

Black White Latina Other
No. % No. % No. % No. %

Characteristic

(n =168)

(n =87) (n =357) (n =12) ORa 95% CI
Selected STD History
   Genital Gonorrhea 54 32 18 21 33 9 1 8 3.7 2.4 5.6
   Syphilis 28 17 7 8 28 8 1 8 2.3 1.4 3.9
   Genital Warts 24 14 17 20 35 10 2 17 1.2 0.7 2.1
   Non-gonococcal Urethritis 40 24 16 18 37 10 3 25 2.2 1.4 3.5
   Genital Herpes 30 18 26 30 49 14 1 8 1.1 0.7 1.7
   Pelvic Inflammatory Disease 22 13 11 13 16 4 3 25 2.1 1.2 3.8
Ever had an STD?
   Yes 111 66 60 69 145 41 7 58 2.2 1.6 3.2
   No 57 34 27 31 212 59 5 42
In past 10 years, number of visits to physician for STD
   >=2 55 33 20 23 59 17 1 8
   1 20 12 11 13 34 10 1 8
   0 93 55 56 64 263 74 10 83
   Unknown 0 - 0 - 1 0 0 -
Odds Ratio1 comparing >=1 to 0 visits:2.0; 95% CI's:1.4, 3.3
In past 10 years, seen at public VD or STD clinic?
   Yes 66 39 25 29 92 26 1 8 1.9 1.3 2.7
   No 102 61 62 71 265 74 11 92

OR, odds ratio; CI, confidence interval; VD, venereal disease; STD, sexually transmitted disease.
aOdds Ratios and 95% CI's were calculated comparing African-American women to women of all other races.

likely that many of these African-American women delay seeking health care because of other pressing concerns, such as providing housing, food, and transportation for their families and for themselves (3).
   The preponderance of multiple male sexual partners and low rates of condom use prior to learning of an HIV infection among the African-American women with HIV and AIDS is also consistent with Namathi's study of high-risk African-American homeless women in Los Angeles in which almost one third participated in vaginal sex with men without the use of condoms (8). The increase in consistent condom use following the notification an HIV infection among all racial groups of women in this study population is encouraging. However, approximately one third to one quarter of the women in all racial groups did not always use a condom following notification of their HIV infection. Low rates of condom use in the African-American community has been attributed to a sense of powerlessness and lack of personal control in sexual relationships with men (2,6). When the association between race and trading sex for drugs or money is controlled for crack use in addition to to number of sexual partners, the association between African-American race and trading sex disappears, suggesting that trading sex in in African-American women is explained in part by crack use. This finding is consistent with data on high-risk homeless women in LAC among
whom sex for drugs or money, an established marker of risky sexual behavior, was more common among African -American women (4,8).
   The more common lifetime history of genital gonorrhea, syphilis, nongonococcal urethritis, and pelvic inflammatory disease for African-American women is consistent with STD surveillance data for LAC and elsewhere reporting a higher incidence of these STD's in African-American women compared with women of other races (16). STD's play a critical role in amplifying HIV transmission (17) and may be an important factor in the local dynamics of HIV, particularly among African-Americans. A study among HIV-infected women in LAC found a high rate of Trichomanas vaginalis infection and a strong association with the African-American race (18).
   Injection drug use was not more common among the African-American women compared with women of other races, a finding supported by research in black homeless women in Loa Angeles in which more than half of the women reported non-injection drug use (8). The finding of more sharing of needles or syringes among black women is consistent with needle-sharing practices studied among IDU's in a methadone treatment program in the Bronx, New York (19).
   An important finding from this research is the disproportionately high frequency of reported crack use among African-American women with HIV and AIDS.

  Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, Vol 19, No. 4, December 1, 1998

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