HIV seroprevalence and risk behaviors among clients attending a clinic forthe homeless in Miami/Dade County, Florida, 1990-1996

In the early 1990s, HIV seroprevalence was highest at the Miami homeless cl inic among 16 homeless sites participating in a nationwide sentinel survey. To examine dynamic seroprevalence patterns in Miami's homeless clients in relation to demographics and risk behaviors over six years, we analyzed dat a from an unlinked (blinded) serosurvey of clients attending the principal primary care clinic serving Miami's homeless. Data were from 3,797 medical encounters with homeless persons who, on their initial clinic visit within an annual survey period, received routine serologic testing and a risk beha vior survey. Overall HIV seroprevalence was 15.9% and infection rates for m en (16.4%) and women (14.5%) did not differ. Seroprevalence for blacks (19. 9%) was significantly higher than for Hispanics (9.1%) or whites (8.3%) (p < 0.0001). Seroprevalence was 12.6% (35 times the national rate) for client s reporting heterosexual contact as their only risk. Significant increases in seroprevalence, above this heterosexual-contact-only 'baseline', were fo und for clients disclosing high-risk behaviors: male-to-male sex, drug inje ction, receiving or giving money/drugs for sex, and sexual contact with a d rug injector or HIV-infected partner (p < 0.0001). Seroprevalence declined over six years from 23.2 to 7.2% (p < 0.0001). Significant downward trends were observed for men and women, blacks and Hispanics, men who have sex wit h men, and clients reporting heterosexual contact. The proportion of client s reporting high-risk behaviors decreased sharply (p < 0.0001). Elevated HI V seroprevalence in Miami's homeless clients was strongly associated with h igh-risk behaviors. Expansion of HIV prevention and HIV/drug treatment serv ices for homeless persons is strongly recommended.