HIV seroprevalence and risk behaviors among clients attending a clinic for the homeless in Miami/Dade County,Florida, 1990–1996

In the early 1990s, HIV seroprevalence was highest at the Miami homeless clinic among 16 homeless sites participating in a nationwide sentinel survey. To examine dynamic seroprevalence patterns in Miami's homeless clients in relation to demographics and risk behaviors over six years, we analyzed data from an unlinked (blinded) serosurvey of clients attending the principal primary care clinic serving Miami's homeless. Data were from 3,797 medical encounters with homeless persons who, on their initial clinic visit within an annual survey period, received routine serologic testing and a risk behavior survey. Overall HIV seroprevalence was 15.9% and infection rates for men (16.4%) and women (14.5%) did not differ. Seroprevalence for blacks (19.9%) was significantly higher than for Hispanics (9.1%) or whites (8.3%) (p < 0.0001). Seroprevalence was 12.6% (35 times the national rate) for clients reporting heterosexual contact as their only risk. Significant increases in seroprevalence, above this heterosexual-contact-only 'baseline', were found for clients disclosing high-risk behaviors: male-to-male sex, drug injection, receiving or giving money/drugs for sex, and sexual contact with a drug injector or HIV-infected partner (p < 0.0001). Seroprevalence declined over six years from 23.2 to 7.2% (p < 0.0001). Significant downward trends were observed for men and women, blacks and Hispanics, men who have sex with men, and clients reporting heterosexual contact. The proportion of clients reporting high-risk behaviors decreased sharply (p < 0.0001). Elevated HIV seroprevalence in Miami's homeless clients was strongly associated with high-risk behaviors. Expansion of HIV prevention and HIV/drug treatment services for homeless persons is strongly recommended.     

HIV seroprevalence and risk behaviors among clients attending tuberculosis clinics in Miami-Dade County,Florida, 1989–1996

Miami-Dade County is a major HIV epicenter and a port of entry for immigrants from nations with high endemic rates of tuberculosis (TB). We analyzed data from an unlinked (blinded) serosurvey of clients attending four Miami TB clinics to elucidate the dynamic HIV seroprevalence patterns in relation to demographics and risk behaviors. Data were analyzed from 3,107 consecutive TB patients at four TB treatment clinics over eight years. Overall HIV seroprevalence was 23.6% with a significantly higher infection rate for men (26.6%) compared to women (17.3%) (p < 0.0001). In rank order, the HIV infection rates were 30.3% for black non-Hispanics, 24.7% for white non-Hispanics and 14.2% for Hispanics. U.S.-born clients had significantly higher HIV rates compared with foreign-born clients (32.4% vs. 18.5%, p < 0.0001). HIV rates declined over six years from (32.5% to 15.9%, p < 0.0001) with significant trends observed for men and women; and for blacks, whites and Hispanics. Seroprevalence was 15.7% for clients identifying heterosexual contact as their only risk. Highly significant increases in seroprevalence above this heterosexual-contact-only `baseline', were found for clients disclosing the following high-risk behaviors: male-to-male sex, drug injection, smoking crack cocaine, receiving or giving money/drugs for sex, and sexual contact with a drug injector or HIV-infected partner. While highly significant elevations in HIV seroprevalence were associated with each of these definitive risk behaviors, even the baseline HIV infection rate of 15.7% in heterosexual-contact-only clients was markedly higher than that of the general population. These findings underscore the need to obtain routine HIV serology on all TB patients.