Subgroups of homeless in San Francisco have different HIV risk factors.Members of San Francisco's indigent indigent 1) n. a person so poor and needy that he/she cannot provide the necessities of life (food, clothing, decent shelter) for himself/herself. 2) n. one without sufficient income to afford a lawyer for defense in a criminal case. population have many sexual and other risk factors that put them at particularly high risk of HIV HIV (Human Immunodeficiency Virus), either of two closely related retroviruses that invade T-helper lymphocytes and are responsible for AIDS. There are two types of HIV: HIV-1 and HIV-2. HIV-1 is responsible for the vast majority of AIDS in the United States. infection. (1) Among a sample of the city's homeless and marginally housed population, the overall HIV prevalence was 11%; for the subgroup of men who have sex with men Men who have sex with men (MSM) is a term used mostly in the United States to classify men who engage in sex with other men, regardless of whether they self-identify as gay, bisexual, or heterosexual. , the prevalence was 30%. Sexual risk factors including being a man who has sex with men, having ever had syphilis, having ever traded sex for drugs or money, and having had receptive anal sex Noun 1. anal sex - intercourse via the anus, committed by a man with a man or woman
anal intercourse, buggery, sodomy
sexual perversion, perversion - an aberrant sexual practice; within the previous year were significantly associated with HIV infection among the overall sample (odds ratios, 1.6-4.6). Certain sexual risk factors were also significant among men who have sex with men and injection drug users.
To examine the prevalence of and risk factors associated with HIV infection among homeless and marginally housed adults in the San Francisco San Francisco (săn frănsĭs`kō), city (1990 pop. 723,959), coextensive with San Francisco co., W Calif., on the tip of a peninsula between the Pacific Ocean and San Francisco Bay, which are connected by the strait known as the Golden area, researchers interviewed a sample of clients at overnight shelters, midday free-meal programs and low-cost residential hotels throughout the city and county. Between April 1996 and December 1997, participants answered questions about their social and demographic backgrounds; their sexual behavior sexual behavior A person's sexual practices–ie, whether he/she engages in heterosexual or homosexual activity. See Sex life, Sexual life. and substance use histories; and their current, chronic and lifetime homelessness status. In addition, participants provided a blood sample for HIV testing. The final sample consisted of 2,508 individuals. The researchers used bivariable and logistic regression In statistics, logistic regression is a regression model for binomially distributed response/dependent variables. It is useful for modeling the probability of an event occurring as a function of other factors. analyses to examine the independent associations between respondents' characteristics and HIV status for the overall sample and for three subgroups: men who have sex with men, injection drug users (excluding men who have sex with men) and those not included in either of the other subgroups (referred to as the residual subgroup).
Three-quarters of the sample were male, and six in 10 were nonwhite non·white
A person who is not white.
nonwhite adj. . The vast majority were aged 30 or older and had been living in the San Francisco area for a year or more; most were heterosexual and had at least a high school education. Twenty-four percent had ever been in prison, and 14% had had a blood transfusion blood transfusion, transfer of blood from one person to another, or from one animal to another of the same species. Transfusions are performed to replace a substantial loss of blood and as supportive treatment in certain diseases and blood disorders. between 1978 and 1985. Seventy-eight percent of the sample had been homeless as adults, 43% had been homeless the night before the survey and 48% had spent the previous night in a single-room occupancy hotel. The median monthly income was $585.
A history of drug use was common among the sample; for example, 45% of respondents reported having ever injected drugs, and 63% had used crack. Current drug use was also common: Forty-four percent reported having used crack, other cocaine, heroin or stimulants Stimulants
A class of drugs, including Ritalin, used to treat people with autism. They may make children calmer and better able to concentrate, but they also may limit growth or have other side effects.
Mentioned in: Autism within the last 30 days, and 35% reported having injected drugs during that time. Twenty-seven percent had ever shared a needle or syringe, 26% had ever taken part in a needle exchange program needle exchange program Syringe exchange program Public health Any program intended to slow the spread of AIDS among IV drug users, in which a governmental or charitable agency exchanges sterile needles for dirty, potentially HIV-contaminated needles used by IVDAs and 13% had ever used a shooting gallery shooting gallery Substance abuse A place–eg, an abandoned building in an economically-depressed urban area–ie, a ghetto, where IV drug users congregate, purchase, inject–'shoot' heroin, cocaine, oxycodone or other drug. .
Although less prevalent than drug-related risk factors, sexual risk factors were somewhat common among the homeless and marginally housed. Nineteen percent were men who have sex with men, 18% had had five or more sexual partners in the past year, 11% had had receptive anal sex in the past year and 9% had ever had syphilis. Nearly one-third had ever traded sex for money or drugs.
Overall, the prevalence of HIV infection among the sample was 11%. In bivariable analysis, HIV infection was significantly associated with being male, white, 18-29, bisexual, a gay male and having lived in San Francisco for at least one year. In addition, HIV infection was associated with all sexual and drug use risk factors, except injection of cocaine. Of the three subgroups, men who have sex with men had the highest prevalence of HIV (30%); the prevalence of infection was 8% among injection drug users and 5% in the residual subgroup. The bivariable results suggest that each subgroup has different risk factors for HIV infection.
As in the bivariable analyses, the factors found to be significant in the multivariable analyses differed by group; however, for all groups, sexual risk factors seemed to be more important than other factors. In the overall sample, men who have sex with men were more likely than others to be infected with HIV (odds ratio, 4.6). Other factors associated with HIV infection included ever having had syphilis, being a white injection drug user, having had a blood transfusion, being nonwhite, having ever traded sex for money or drugs, and having had receptive anal sex in the last year (1.6-2.2). Among men who have sex with men, those who were white and traded sex were more likely than others to be infected with HIV (5.9); other significant risk factors for this subgroup were being nonwhite, having had receptive anal sex in the last year and ever having had syphilis (2.0-3.4). Having ever had syphilis was also significantly associated with increased risk of HIV infection among the injection drug use group (3.3), along with having less than a 12th-grade education (2.6), ever having been in prison and having had a blood transfusion (2.1 for each). Finally, among the residual subgroup, HIV infection was associated with having had five or more sexual partners in the last year and being a female crack cocaine user who traded sex (2.9 and 6.1, respectively).
The researchers comment that the high HIV prevalence among the indigent of San Francisco, which is five times that of the general public, is "striking." They conclude that although the homeless and marginally housed have "numerous complex problems such as extreme poverty, social marginalization mar·gin·al·ize
tr.v. mar·gin·al·ized, mar·gin·al·iz·ing, mar·gin·al·iz·es
To relegate or confine to a lower or outer limit or edge, as of social standing. and drug abuse," sex is the most important factor in regard to HIV infection among this population. The researchers suggest that HIV intervention programs for men who have sex with men--the subgroup with the highest prevalence of infection--should "reinforce the focus on sexual risk."
(1.) Robertson MJ et al., HIV seroprevalence seroprevalence Immunology The proportion of a population that is seropositive–ie, has been exposed to a particular pathogen or immunogen; the seropositivity of a population is calculated as the number of individuals who produce a particular antibody divided among homeless and marginally housed adults in San Francisco, American Journal of Public Health The American Journal of Public Health (AJPH) is a peer reviewed monthly journal of the American Public Health Association (APHA). The Journal also regularly publishes authoritative editorials and commentaries and serves as a forum for the analysis of health policy. , 2004, 94(7):1207-1217.