HIV seroprevalence and risk behaviors among clients attending tuberculosisclinics in Miami-Dade County, Florida, 1989-1996

Miami-Dade County is a major HIV epicenter and a port of entry for immigran ts from nations with high endemic rates of tuberculosis (TB). We analyzed d ata from an unlinked (blinded) serosurvey of clients attending four Miami T B clinics to elucidate the dynamic HIV seroprevalence patterns in relation to demographics and risk behaviors. Data were analyzed from 3,107 consecuti ve TB patients at four TB treatment clinics over eight years. Overall HIV s eroprevalence was 23.6% with a significantly higher infection rate for men (26.6%) compared to women (17.3%) (p < 0.0001). In rank order, the HIV infe ction rates were 30.3% for black non-Hispanics, 24.7% for white non-Hispani cs and 14.2% for Hispanics. U.S.-bom clients had significantly higher HIV r ates compared with foreign-born clients (32.4% vs. 18.5%, p < 0.0001). HIV rates declined over six years from (32.5% to 15.9%, p < 0.0001) with signif icant trends observed for men and women; and for blacks, whites and Hispani cs. Seroprevalence was 15.7% for clients identifying heterosexual contact a s their only risk. Highly significant increases in seroprevalence above thi s heterosexual-contact-only 'baseline', were found for clients disclosing t he following high-risk behaviors: male-to-male sex, drug injection, smoking crack cocaine, receiving or giving money/druas for sex, and sexual contact with a drug injector or HIV-infected partner. While highly significant ele vations in HIV seroprevalence were associated with each of these definitive risk behaviors, even the baseline HIV infection rate of 15.7% in heterosex ual-contact-only clients was markedly higher than that of the general popul ation. These findings underscore the need to obtain routine BTV serology on all TB patients.