Risks for HIV Infection Among Persons Residing in Rural Areas and Small Cities -- Selected Sites, Southern United States, 1995--1996

MMWR Morbidity and Mortality Weekly Report, November 20, 1998/Vol. 47/No. 45
Centers for Disease Control and Prevention

SUMMARY: The southern region of the United States* accounts for the largest proportion (34%) of the 641,086 acquired immunodeficiency syndrome (AIDS) cases reported through 1997 and for 54% of the 58,689 AIDS cases among persons residing in rural areas (CDC, unpublished data, 1998). This report describes characteristics of persons in-fected with human immunodeficiency virus (HIV) who reside in rural areas and small cities of the southern United States and indicates that, before infection, there was a low prevalence of perceived risk.

The Supplement to HIV/AIDS Surveillance Project (SHAS) interviews persons who are reported with HIV infection or AIDS to state health departments. Participants must be aged ³18 years and medically able to complete the interview ( 1 ). Interviews were conducted during 1995--1996 in selected rural areas and small cities -- of four southern states that participate in SHAS (Delaware, Florida, Georgia, and South Carolina). In all four states, persons with AIDS who met the eligibility criteria were identified from AIDS case reports and were invited, through their health-care provider, to participate; persons with HIV infection but not AIDS were recruited at clinics where they received HIV care. Of all persons reported with AIDS during 1995--1996 from the four states, the percentages who resided in rural areas and small cities at the time of AIDS diagnosis were as follows: Delaware, 19%; Florida, 9%; Georgia, 18%; and South Carolina, 44%. The survey instrument included questions about sociodemographics, and, for the time before HIV infection was diagnosed, perceived risk for infection, sexual behavior, and substance use. Category of exposure to HIV was determined from the case report form or based on the interview data and assigned according to the CDC surveillance risk hierarchy ( 2 )

Sociodemographic Characteristics of Respondents

Of 956 persons who met all eligibility criteria, 608 (64%) completed the interview (AIDS, 58%; HIV, 42%); 348 (36%) refused or could not be located. Persons who com-pleted the interview were more likely than nonrespondents to have progressed to AIDS (71% versus 52%, p=0.001). Adjusting for disease status, respondents did not differ from nonrespondents by sex, race/ethnicity, and category of exposure to HIV. Of the 608 persons interviewed, 403 (66%) resided in Georgia; 89 (15%), Florida; 67 (11%), South Carolina; and 49 (8%), Delaware.

Most (66%) respondents were men (Table 1). The median age for men was 36 years (range: 19-75 years) and for women was 33 years (range: 18-67 years). Most respon-dents were non-Hispanic black and of low socioeconomic status (Table 1). Sexual be-havior was the most common risk for exposure to HIV (67% for men and 66% for women). Among men, the most common category of exposure was having sex with men (40%); for women, it was heterosexual contact with an at-risk or infected partner (66%) (Table 1).

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