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February 16, 1994

HIV Infection and Risk Behaviors Among Heterosexuals in Alcohol Treatment Programs

Author Affiliations

From the Division of General Internal Medicine, San Francisco (Calif) General Hospital (Dr Avins); Division of Clinical Epidemiology, Department of Epidemiology and Biostatistics, University of California, San Francisco (Drs Avins, Woods, Lindan, Hudes, Clark, and Hulley); and Community Substance Abuse Services, San Francisco Department of Public Health (Dr Clark).

JAMA. 1994;271(7):515-518. doi:10.1001/jama.1994.03510310045036

Objective.  —To measure the prevalence of human immunodeficiency virus (HIV) infection and high-risk behaviors among heterosexuals in alcohol treatment.

Design.  —Cross-sectional survey.

Setting.  —Five public alcohol treatment centers.

Subjects.  —Consecutive sample of 888 heterosexual clients entering treatment between October 1990 and December 1991. Respondents were 51% black, 10% Hispanic, 33% white, and 76% male. The overall response rate was 68%.

Measurements.  —Structured interview and serotesting for HIV antibodies.

Results.  —The overall seroprevalence of HIV infection was 5% (95% confidence interval, 3% to 6%). There were no significant differences in rates of infection by age, gender, or race. The prevalence of infection in heterosexual respondents without a history of injection drug use was 3% in men and 4% in women, several times higher than published estimates from a similar community-based heterosexual sample. Unsafe sexual practices were common: 54% of respondents reported multiple sexual partners in the previous year, 97% of nonmonogamous respondents did not use condoms during all sexual encounters, and few respondents consistently asked new sexual partners about previous high-risk behaviors.

Conclusions.  —There is a substantial prevalence of HIV infection among heterosexual clients in San Francisco (Calif) alcohol treatment programs, much of which is not associated with injection drug use. Because of this and the high prevalence of unsafe sexual behaviors, there is a relatively high likelihood of heterosexual spread of HIV among the large population of clients seeking treatment for alcohol dependency. Interventions to prevent HIV spread should become a standard part of alcohol treatment programs.(JAMA. 1994;271:515-518)