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Background: Human immunodeficiency virus (HIV) infection among women in the southern United States is on the rise. This study examined sociodemographic profile and behavioral risk factors for HIV and sexually transmitted infections and assessed factors associated with HIV-1 viral control in a cohort of 280 HIV-infected Alabama women aged 17 to 66 years., Methods: Women receiving care for HIV infection at a university outpatient HIV clinic were enrolled in the study. Women completed a self-administered questionnaire on demographics and behavioral risk factors at enrollment. They were followed up with appointments at least every 6 months with Papanicolaou smears, cervicovaginal lavages, cervical and vaginal swabs, and blood specimens collected at each visit., Results: Of the women in the study, 69% were black, had mean age of 36 years, and approximately three fourths were mothers with annual household income <$20,000. White women were likely to have been HIV infected for a longer period (50.2 versus 36.3 months; P = 0.02) and had significantly lower viral loads at enrollment (P = 0.04) than black women. Factors associated with lack of HIV-1 control (> or =10,000 RNA copies/mL) at enrollment included black race/ethnicity (odds ratio [OR]: 2.8; 95% confidence interval [CI]: 1.2-6.8), CD4+ T-cell count <200 cells/microL (OR: 20.1; CI: 8.6-47.0), being diagnosed with HIV <6 months (OR: 3.5; CI: 1.4-8.9) and not being on any antiretroviral therapy (OR: 2.5; CI: 1.1-5.7)., Conclusion: Poorer HIV-1 viral control in black women at enrollment may indicate suboptimal access to HIV testing, delays in receipt of medical care after HIV-1 diagnosis, and/or some underlying biologic or social race-related influence.

Background: Despite the proven benefits conferred by early human immunodeficiency virus (HIV) diagnosis and presentation to care, delays in HIV medical care are common; these delays are not fully understood, especially in the southern United States., Methods: We evaluated the extent of, and characteristics associated with, delayed presentation to HIV care among 1,209 patients at an HIV/AIDS Outpatient Clinic in Birmingham, Alabama between 1996 and 2005., Results: Two out of five (41.2%) patients first engaged care only after they had progressed to CDC-defined AIDS. Among these, 53.6% were diagnosed with HIV in the year preceding entry to care. Recent presentation (2002 - 2005), male sex, age > or = 25, Medicare or Medicaid insurance coverage, and presentation within six months of HIV diagnosis were independently associated with initiating care after progression to AIDS., Conclusions: A high proportion of patients entered clinical care after experiencing substantial disease progression. Interventions that effectively improve the timing of HIV diagnosis and presentation to care are needed.

Health care needs of those infected with the human immunodeficiency virus (HIV) and subsequent transmission dynamics are altered by migration after infection. We interviewed 760 HIV-infected persons attending HIV-specialty clinics living in non-urban Alabama and Mississippi to ascertain the likely geographic origins of their infections, determine their post-HIV diagnosis mobility, and identify predictors of this mobility. Most subjects (81%) were living in these two states when diagnosed and have not moved since learning of their HIV status (70%). Of those who moved their primary residence post-HIV diagnosis (25% of the entire study population), the majority in-migrated to Alabama or Mississippi from elsewhere. Persons who had moved post-HIV diagnosis were more likely to be male, an injection drug user, an urban resident at HIV diagnosis, have an AIDS-defining condition, and have moved prior to HIV diagnosis. We conclude that most HIV transmission in non-urban Alabama and Mississippi is acquired locally. These results underline the need to expand HIV prevention programs in the Deep South.

The objectives of this study were to assess the prevalence and incidence of curable sexually transmitted infections (STI), i.e., gonorrhea, chlamydial infection, or trichomoniasis, in a cohort of HIV-infected women. The study population was derived from women seeking primary care at an outpatient university HIV clinic who were participants in a women's natural history study. Enrollees (n = 225) were predominantly African-American, heterosexually infected, with mean age 35 years. Mean entry CD4+ T cell count was 405 cells/mm3. Over 6% were STI positive at initial screening. Subsequently, the combined curable STI incidence was 4.82/1000 woman-months over a median of 33 months of observation. Of 36 incident STIs, trichomoniasis was most common (n = 32). Predictors for acquisition of a curable STI included absenteeism at scheduled clinic appointments, RR = 1.99 (1.28, 3.08), and a higher CD4+ T cell count, RR = 1.15 (1.0028, 1.3115) for 100 cells. Interventions to prevent curable STI in HIV-infected women are warranted in primary care settings.

Background: The study reported here assessed the implementation of recommendations for routine universal prenatal counseling and voluntary HIV testing among Alabama physicians who provide prenatal care and determined factors associated with noncompliance., Methods: Voluntary, confidential mailed survey of obstetrics and family medicine practitioners., Results: Of the 138 physicians who responded to a mailed survey in Alabama, 17 (12.3%) indicated that they did not offer universal HIV counseling and testing to pregnant women. Factors associated with failure to offer universal HIV counseling and testing included having more than 50% of patients refuse HIV counseling and testing when offered and never knowingly having given prenatal/perinatal care to women with HIV. Low/medium familiarity with the US Public Health Service recommendations for perinatal zidovudine use to reduce HIV transmission and physician specialty are also suggested as predictors of not offering universal testing., Conclusions: Despite the well-established benefits of antiretroviral prophylaxis to prevent vertical transmission of HIV, some physicians in Alabama have been slow to adopt universal testing of their pregnant patients for HIV in the prenatal period. Practitioner education is as important as patient education in eliminating pediatric HIV in the Deep South.

Background: The objective of the study was to determine whether treatment with protease inhibitors is associated with unprotected sexual behavior., Methods: A total of 592 HIV-infected persons recruited from statewide public clinics in nonurban Alabama communities completed an assessment that, among other variables, elicited information on demographics, current sexual practices, health status, and medication use. Associations of treatment with protease inhibitors and high-risk sexual behavior were estimated, adjusting for potential confounders., Results: Treatment with protease inhibitors was not associated with whether a person was sexually active or with high-risk practices among sexually active heterosexual men and women. Among men who had sex with men, however, treatment with protease inhibitors was associated with never using condoms and with inconsistent use of condoms., Conclusions: Clinicians treating patients with protease inhibitors should consider providing risk-reduction counseling.

Deals with a study which identified opportunities to improve prevention and services for HIV-infected women in nonurban Alabama and Mississippi. Methods; Results; Discussion.