Results of a new study supported by the National Institute on Drug Abuse (NIDA), National Institutes of Health, suggest that young African American adults - but not young white adults - are at high risk for HIV and other sexually transmitted diseases (STDs) even when their relative level of risky behaviors is low. The findings imply that the marked racial disparities in the prevalence of these diseases are not exclusively affected by individual risk behaviors. The paper can be viewed online in the American Journal of Public Health.
"Improving our understanding of the factors that contribute to the health disparities seen in HIV is one of our top priorities," says Dr. Elias Zerhouni, director of the National Institutes of Health. "Studies like this help define the problem, but further research may provide us with a greater understanding of why this population is at higher risk and how best to intervene."
Environmental, institutional, and contextual influences, such as differences in social and dating patterns, are among the many factors identified by the researchers that may play a role in one's risk for HIV. The authors recognize that research that seeks to address racial disparities in STD and HIV infection must proceed with sensitivity and involve dialogue and consensus among all community groups.
"NIDA has conducted many studies that link drug abuse and other risky behaviors to HIV infection," says NIDA Director Dr. Nora D. Volkow. "This study is particularly interesting because it suggests that given similar patterns of risk behaviors across racial groups, young African American adults are more likely to become infected. As a result, we need to look beyond strategies that target individual risk behaviors and focus on outreach and education for this population as a group."
"We found that the most normative category for young African American adults (almost 38 percent of participants) was one of the lowest-risk categories, characterized by having few sexual partners and low alcohol, tobacco, or drug abuse. Yet these same individuals were more than seven times as likely as young white adults in the same category to harbor an STD/HIV infection" says lead scientist Dr. Denise Hallfors of the Pacific Institute for Research and Evaluation in Chapel Hill, North Carolina.
The scientists stratified the participants into 15 behavioral patterns ranging in risk level from relatively low (e.g., having few sexual partners and low alcohol, tobacco, or drug use) to high (e.g., intravenous drug abusers). The researchers observed that the STD/HIV prevalence among young African American adults was high for all 15 defined behavior patterns regardless of risk level, whereas among young white adults, the STD/HIV infection prevalence was only high for the four most risky behavior patterns - exchanging sex for money, intravenous drug abuse, men having sex with men, and abusing marijuana and other drugs.
The study authors recommend continuing a proactive strategy to reach all African American young adults, including universal screening and expanding information, testing and treatment services to non-traditional venues, such as churches, beauty salons and barber shops, colleges, prisons and jails.
The researchers analyzed 2001-2002 population-based data from 6,257 young white adults and 2,449 young African American adults nationwide 18 to 26 years old. They were participants in The National Longitudinal Study of Adolescent Health and had completed initial surveys when they were in 7th to 12th grades in 1994-1995. In this assessment, participants used computer assisted self-interviewing technology to respond to sensitive questions about sexual and substance abuse history. Following the interview, participants were tested for STDs and HIV.
"These surprising new findings suggest that a more comprehensive research approach is needed to understand the factors that make young African American adults vulnerable to STD and HIV infection beyond the commonly known individual risk behaviors," says Dr. Volkow. "Most STDs can be cured, the health and lifespan of people infected with HIV can be significantly increased by available therapies, and prompt diagnosis and treatment may reduce the spread of these diseases."