Efforts to Find Heterosexual HIV in San Francisco, 2007-2013

Nationally heterosexuals are an HIV prevention priority. In addition to case based HIV surveillance, behavioral surveillance surveys are conducted among heterosexuals living in high AIDS morbidity neighborhoods. We report on risk behaviors and HIV prevalence among "high-risk" heterosexuals in San Francisco. National HIV Behavioral Surveillance System is coordinated by the CDC and implemented in 21 health jurisdictions. The studies were conducted in 2006, 2010 and 2013 in San Francisco. Respondent driven sampling was used to sample participants. Eligible persons were 18-50 years old and had sex with at least one opposite gender partner in the past year. We obtained samples of 371, 421, 165 heterosexuals in 2007, 2010 and 2013, respectively. Some demographics varied across the 3 years. Residential neighborhoods changed, homelessness and healthcare coverage increased. Binge drinking, cocaine and heroin use increased while methamphetamine use declined. There were no changes in numbers of partners, unprotected vaginal intercourse or unprotected anal intercourse. Commercial sex work increased. Even with "fine tuning" of eligibility criteria to attempt to find heterosexual HIV cases, we estimate that HIV prevalence was 0.3, 0.2 and 2.4 % in 2007, 2010 and 2013 respectively. The increase was not statistically significant. For the present, effective prevention among persons in the populations most severely affected by HIV remains the priority, for their own benefit and to prevent transmission to other vulnerable populations to which they may be connected.