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Geographic variation of HIV infection in childbearing women with
syphilis in the United States.
AIDS 2000;14(3):279-287.
Koumans EH, Sternberg MR, Gwinn M, Swint E, Zaidi A, St. Louis ME.
Abstract
OBJECTIVES: Substantial biologic and epidemiologic data indicate the importance
of syphilis as a potential cofactor for sexual transmission of HIV infection,
but few detailed data exist on the geographic covariation of these two important
sexually transmitted infections. DESIGN: HIV prevalence in childbearing women
and primary and secondary (P&S) syphilis data from 29 states were examined
to explore the importance of the epidemiology of syphilis as a factor in
facilitating HIV transmission. METHOD: The spatial relationship between P&S
syphilis and HIV infection in the health districts of 29 states was analyzed
and adjusted for demographic and socioeconomic factors such as racial composition,
income, housing, education levels, and access to medical services using the
1990 US census, and geographic location. RESULTS: In 29 states and the District
of Colombia, 448 health districts, representing more than 75% of the US population,
reported HIV prevalence rates for mothers' district of residence. The HIV
seroprevalence ranged from 0 to 1258/10 000 in these health districts. The
incidence of P&S syphilis from 1984-1994 in these districts ranged from
0 to 87/100 000. The P&S syphilis incidence was positively associated
with the prevalence of HIV infection among childbearing women (P < 0.0001).
CONCLUSIONS: Syphilis that persists in communities in the United States appears
to represent a 'sentinel public health event' reflecting risk for sexual
HIV transmission. These findings, along with other biologic and epidemiologic
information, reinforce the importance of syphilis as an indicator for targeting
HIV prevention efforts generally, as well as syphilis control as a specific
HIV-prevention strategy.