Printed in U.S.A. DOI: 10.1093/aje/kwh262 Human Immunodeficiency Virus Infection in a Rural Community in the United States

In 1986, a population-based survey of human immunodeficiency virus (HIV) infection in a rural Florida community showed that HIV prevalence was 28/877 (3.2%, 95 % confidence interval (CI): 2.0, 4.4). In 1998–2000, the authors performed a second population-based survey in this community and a case-control study to determine whether HIV prevalence and risk factors had changed. After 609 addresses had been randomly selected for the survey, 516 (85%) residents were enrolled, and 447 (73%) were tested for HIV. HIV prevalence was 7/447 (1.6%, 95 % CI: 0.4, 2.7) in western Palm Beach County and 5/286 (1.7%, 95 % CI: 0.2, 3.3) in Belle Glade (p = 0.2 in comparison with 1986). Independent predictors of HIV infection in both 1986 and 1998–2000 were having a history of sexually transmitted disease, number of sex partners, and exchanging money or drugs for sex. A history of having sex with men was a risk factor among men in 1986 but not in 1998–2000; residence in specific neighborhoods was a risk factor in 1998–2000 but not in 1986. The authors conclude that heterosexually acquired HIV infection did not spread throughout the community between 1986 and 1998 but persisted at a low level in discrete neighborhoods. Interventions targeting HIV-endemic neighborhoods will be needed to further reduce HIV prevalence in this area