Women at a sexually transmitted disease clinic who reported same-sex contact: their HIV seroprevalence and risk behaviors.

OBJECTIVES: This study compares characteristics, behaviors, and human immunodeficiency virus (HIV) infection in women who reported same-sex contact and women who had sex only with men. METHODS: Participants were patients attending a New York City sexually transmitted disease clinic. Structured questionnaires were administered by interviewers. RESULTS: Overall, 9% (135/1518) of women reported same-sex contact; among these, 93% also reported contact with men. Women reporting same-sex contact were more likely than exclusively heterosexual women to be HIV seropositive (17% vs 11%; odds ratio [OR] = 1.7, 95% confidence interval [CI] = 1.0, 2.6), to exchange sex for money/drugs (48% vs 12%, OR = 6.7, 95% CI = 4.6, 9.8), to inject drugs (31% vs 7%, OR = 6.3, 95% CI = 4.1, 9.5), and to use crack cocaine (37% vs 15%, OR = 3.3, 95% CI = 2.2, 4.8). HIV in women reporting same-sex contact was associated with history of syphilis (OR = 8.8), sex for crack (OR = 5.7), and injection drug use (OR = 4.5). CONCLUSIONS: In this study, women who reported same-sex contact were predominantly bisexual. They had more HIV risk behaviors and were more often HIV seropositive than women who had sex only with men. Among these bisexual women, heterosexual contact and injection drug use were the most likely sources of HIV. There was no evidence of female-to-female transmission.

HIV-1 seroconversion in patients with and without genital ulcer disease. A prospective study.

OBJECTIVE: To determine the relative risk for human immunodeficiency virus (HIV-1) seroconversion in patients with and without genital ulcers caused by chancroid, syphilis, and herpes. DESIGN: A prospective cohort study. SETTING: An inner-city, sexually transmitted disease clinic. PATIENTS: Patients seronegative for HIV-1 with and without genital ulcers who were followed for a minimum of 3 months. INTERVENTIONS: Questionnaire to obtain data on demographics, sexual behavior, and illicit drug use; testing for HIV-1 at entry and at a minimum of 3 months after entry; medical examination for the presence or absence of genital ulcer disease. RESULTS: Overall, 758 heterosexual men with no history of injection drug use completed the study; HIV-1 seroconversion occurred in 10 of 344 (2.9%; 95% CI, 1.4% to 5.3%) men with a genital ulcer and in 4 of 414 (1%; CI, 0.2% to 2.5%) without a genital ulcer (relative risk, 3.0; P = 0.05). In a multiple logistic regression analysis, those men with chancroid and a new sexually transmitted disease during follow-up each had about three times the risk for HIV-1 seroconversion (P < or = 0.04). CONCLUSIONS: In this group of heterosexual men, chancroid and repeated acquisition of sexually transmitted diseases appeared to facilitate the sexual transmission of HIV-1.