A4.3 Identifying Community Venues for Targeted HIV Transmission Control

Tuesday, March 13, 2012: 10:35 AM
Greenway Ballroom F/G
Jacky Jennings, PhD, MPH1, Jonathan Ellen, MD2, Caroline Fichtenberg, PhD3, Steve Huettner, BS4 and Sarah Polk, MD, ScM4, 1General Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 2School of Medicine Ped Bay Bayview Pediatric Unit, The Johns Hopkins University, Baltimore, MD, 3Office of Epidemiology, Baltimore City Health Department, Baltimore, MD, 4Department of Pediatrics, Johns Hopkins University, Baltimore, MD

Background: Identifying places with current HIV transmission may provide key targets for HIV control strategies. 

Objectives: To determine the prevalence of HIV at community venues; the likelihood of current venue-based HIV transmission by comparing current high HIV-risk heterosexual and parenteral behaviors by HIV (vs. no HIV) venues; and features of venues associated with current high HIV-risk behaviors.

Methods: A venue-based, cross-sectional study of 18-35 year-olds was conducted in one urban area from 2008-2009. Participants reported self and sex partner behaviors.  Venue informants reported on whether the venue was a sex market (i.e exchange sex for money or drugs) or a drug market (i.e. drugs bought or sold).  Venue-level associations between HIV (vs. no HIV) venues and high HIV-risk heterosexual (i.e. past 12 months sex with IDU or HIV + or use of crack) and parenteral behaviors (i.e. past 6 months IDU or needle-sharing) were statistically tested.

Results: Using a systematic venue-identification approach, 87 venues were selected.  Among 1,611 participants, 60 HIV cases were identified. 43% venues had at least one HIV case. Among these venues, 68% had one HIV case and 32% had > 2. At HIV (vs. no HIV) venues high HIV-risk heterosexual sexual (92% vs. 57%, P<0.001) and parenteral behaviors (68% vs. 37%, P<0.01) were significantly greater.  An increased, not statistically significant, percentage of HIV (vs. no HIV) venues were drug markets (65% vs. 44%, P=0.05), sex markets (46% vs. 35%, P=0.30) and drug/sex markets (40% vs. 23%, P=0.09).  In multivariate analyses, HIV (vs. no HIV) venues had significantly greater odds of high HIV-risk heterosexual behaviors (AOR 5.60; 95% CI 1.36, 23.01).

Conclusions: This study highlights the importance of place-based approaches in identifying HIV-risk venues.

Implications for Programs, Policy, and Research: Venues may be key targets for HIV transmission control, i.e. control screening and treatment of HIV positives and secondary transmission prevention.