BB/SS Background

At the current time approximately 45% of HIV/AIDS cases in Montgomery County Ohio, involve African Americans, an increase from previous years. Twenty-five percent of all cases involve women. Although these statistics illustrate the heightened risks of the minority population, they do so inadequately. Only one-half or less of individuals with HIV/AIDS are reported in local systems, due to people hiding their condition or not wanting to know their test outcomes. According to health officials, additional barriers exist in Montgomery County regarding HIV blood testing, which is frequently avoided by individuals of the at-risk population. Testing protocols and notification spans not only a decreased number of persons being tested, but also a decreased test site capacity to notify individuals. Furthermore, not all testing sites contribute information to the CDC-maintained database.

From July 1999 to June 2001, there were 1,136 new individuals diagnosed with HIV and 916 diagnosed with AIDS. The CDC estimates that in Dayton, and other cities across the nation, 1 in 50 African American men are believed to be infected with HIV and 1 in 160 African American women are believed to be infected. In comparison, 1 in 250 Caucasian men and 1 in 3000 Caucasian women are believed to be infected. Although African-Americans make up 13% of the U.S. population, they represent 48% of all reported AIDS cases. It is the leading cause of death for African Americans, ages 25-44. AIDS mortality rates remain nearly 10 times higher among African Americans than among Caucasians.

Recent estimates suggest that the HIV/AIDS epidemic in the Dayton area is being driven by sub-epidemics in three groups:

• Injection drug users and their sexual partners;
• Heterosexual women who use crack; and
• Men of color who have sex with men (Holmberg, 1996)

Of these three sub-groups, two are directly associated with drug use and underscore the importance of drug use and sexual behaviors to the spread of HIV. In addition, there is evidence that the third sub-epidemic also is associated with drug use. Among MSMS, non-injection drug use (e.g., current or past heavy alcohol use; current use of stimulants, hallucinogens, and inhalants [Woody et al., 1996]), has been shown to be associated with higher-risk sexual behavior.