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HIV Infection among Heterosexuals at Increased Risk

U.S. Centers for Disease Control and Prevention, “HIV Infection among Heterosexuals at Increased Risk – United States, 2010,” Morbidity and Mortality Weekly Report (March 2013)   


The 2006-2007 National HIV Behavioral Surveillance System (NHBS) study of heterosexuals in urban areas with a high prevalence of Acquired Immunodeficiency Syndrome (AIDS) found correlations between HIV prevalence and annual household income, as well as education.  Because of these findings, the 2010 follow up focused on HIV testing results among heterosexuals with low socioeconomic status in areas with a high prevalence of AIDS. [1] The study covered 21 metropolitan statistical areas (MSAs) monitored by NHBS.  While MSAs often include urban areas, the term refers to a densely populated geographic region and can include more than one city or nonurban areas.

Survey participants were interviewed about sexual behaviors, drug use, previous HIV testing experience, and use of HIV prevention services.  Of those who were eligible to participate, 61% were between 18 and 39 years of age, 36.2% had less than a high school education, and 62.5% reported an annual household income of less than $10,000.

Key Findings:

  • 25.8% of all participants had never been tested for HIV.
  • Among the 75% of participants who did not report a previous positive HIV test result 1.1% tested positive for HIV.
  • HIV prevalence increased as reported participant household income and/or education level decreased. 
  • The areas with the highest prevalence of HIV were MSAs in the Northeast (4.1%) and South (3.9%). 


Heterosexuals in the U.S. continue to be at risk for HIV infection, especially those in minority or marginalized communities.  In the U.S., approximately 27% of HIV infections are attributed to heterosexual contact.  Rates of HIV infection in this study were higher among participants who reported being unemployed or disabled, black, and persons who use crack cocaine or engage in exchange sex.  The survey found the higher HIV prevalence among study participants is actually about five times the estimate for all of the U.S. (age 13 years and older).

The results suggest next steps in addressing the HIV epidemic in this country.  CDC has recognized the need for behavioral and structural interventions and the need to reduce health inequalities, especially among African Americans and Hispanics/Latinos.  In addition, CDC has identified two other areas of focus: 1) reducing the stigma of HIV, making testing accessible, affordable and culturally acceptable; and 2) improving connections to care and treatment for individuals who test positive for HIV, especially in populations with higher rates of poverty and homelessness.

Sexuality educators can play a role in supporting these future steps by being as inclusive as possible when developing or delivering HIV prevention activities.  This might include reaching out to the most at-risk members of their community to engage them as learners, including stories and voices from member of the community in educational materials, and advocating on behalf of those at highest risk to those advocates and educators with more resources to address the epidemic.

[1] Miles IJ, Le BC, Wejnert C, Oster A, DiNenno E, Paz-Bailey G (2013).HIV infection among heterosexuals at increased risk – United States, 2010. MMWR 62(10): 183-188. March 15, 2013, <>.