February 5, 2001
This study attempted to identify the proportion of heterosexual transmission in the U.S. that is secondary (i.e., cases where the patient cannot identify a primary risk factor for HIV in their partner(s)), such as homosexual sex and injection drug use. While distinguishing "primary" from "secondary" transmission may be useful in targeting specific educational interventions, from a clinical standpoint it is irrelevant to appropriate management.
A random sample of 598 adults in six states who were diagnosed with AIDS from 1992-95 acquired either heterosexually or reported without risk were interviewed about their knowledge of sexual partners' risk behaviors. 581 had at least one sexual partner since 1977. Persons with multiple partners (mean of 16 for women and 22 for men), less than high school education, female gender, black race, and a history of IDU were more likely to lack information about their partners' potential risks for HIV. Generalizing from these data, <4.8% of all adult AIDS cases and <20.8% of all heterosexual cases reported in 1999 would have been acquired secondarily.
This study was marred by overrepresentation of African Americans in the interview sample, a focus of patients with AIDS rather than just HIV infection, and reliance on recall despite the high number of partners. Unfortunately, these methodologic concerns hamper the study's overall value.
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