HIV among Foreign-Born Residents in the District of Columbia, 2008

Background The District of Columbia (DC) has one of the highest rates of HIV among US cities. DC has a sizeable immigrant population; estimated at 12% in 2007. The burden of HIV among foreign-born DC residents, who account for 4% of HIV-infected persons living in DC, has not been well described. This study aims to characterize HIV-infected (not imported), foreign-born residents in DC to support improved HIV prevention. Methods HIV case surveillance and DC CAREWARE (which links clinical encounter, lab results and insurance information for HIV-infected persons receiving care in DC) data of those living with HIV in 2008 (as reported through June 2009) were reviewed. Variables included: age at diagnosis, transmission category, birth region, insurance coverage and CD4 T-cell counts. Results Data were available for 687 of HIV-infected foreign-born persons ages ≥ 13 years and living in DC in 2008. Sixty-five percent were male, 67% were diagnosed between ages of 20-39, and Africa (45%) and Central America (23%) were the reported continent of origin. Heterosexual contact was the transmission category for 51%, while 30% reported male-to-male contact. Fifty-five percent were uninsured. Fifty-six percent had documented clinical labs (CD4 count or viral loads) within 12 months of their HIV diagnoses. Conclusion Forty-five percent of HIV-infected foreign-born DC residents had no documented clinical visit within a year of HIV diagnosis, suggesting increasing access to HIV care as critical strategy to stop ongoing HIV transmission. As sexual contact was the primary transmission category, condom distribution may be an optimal means of prevention.