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Trends in HIV prevalence among public sexually transmitted
disease clinic attendees in the Western Region of the United States (1989-1999).
Journal of Acquired Immune Deficiency Syndromes 2004;37(1):1206-1215.
Harawa NT, Douglas J, McFarland W, Thiede H, Kellogg TA, Vorhees K, Donovan
KM, Bingham TA.
Abstract
OBJECTIVES: Using data from anonymous unlinked testing of routinely collected
sera, trends in HIV are compared among sexually transmitted disease patients
in 4 Western urban centers. METHODS: Between 1989 and 1999, remnant sera
obtained for routine syphilis testing from 256,819 patient visits to Denver,
Los Angeles, San Francisco, and Seattle clinics were tested for HIV antibodies
in an unlinked survey. HIV antibody test results were linked to anonymous
demographic and risk information abstracted from the medical record. RESULTS:
Overall cumulative HIV seroprevalences among women and among men who had
sex exclusively with women were \H2%, declined over time, and did not exceed
8% among those who injected drugs. In contrast, cumulative HIV seroprevalences
among men who have sex with men ranged from 13% in Seattle to 30% in San
Francisco and declined a mean of 2.1% (95% CI, 1.6, 2.6) to 2.8% (CI 2.6,
3.1) per year, after adjustment. CONCLUSIONS: HIV infection declined over
time across counties. Relative levels of HIV differed little by demographic
and behavioral risk group despite differences in the severity of each county's
epidemic. Because of the unique contribution of unlinked serosurveillance
studies in monitoring these trends, their reinstitution in high-risk settings
should be considered.