摘要：Objectives . We examined differences in HIV seroprevalence and the likely timing of HIV infection by birth region. Methods . We analyzed unlinked HIV antibody data on 61 120 specimens from 7 public health centers in Los Angeles County from 1993 to 1999. Results . Most (87%) immigrant clients were Central American/Mexican–born. HIV prevalence was similar for US- and foreign-born clients (1.8% [95% confidence interval (CI) = 1.7%, 1.9%] and 1.6% [95% CI = 1.5%, 1.8%], respectively). Seroprevalence was high among sub-Saharan African females and low among Asian/Pacific Islander males and females. For HIV-positive immigrants, the average age at and time since immigration were 20.6 years and 12.3 years, respectively. Conclusions . The relatively young age at arrival and long time since arrival for HIVpositive foreign-born clients suggest that most were infected after immigration. A complex set of factors may reduce or enhance immigrant populations’ HIV risk compared with that of native-born populations. Foreign-born individuals make up more than 10% of the US population, 1 and the parents of an additional 11% were born in other countries. 2 These immigrants often concentrate in urban HIV epicenters. 1 Despite these realities, efforts to describe the distribution of the US HIV epidemic have largely ignored differences by birth country. Research among many immigrant groups has shown deficiencies in HIV/AIDS knowledge, 3, 4 lack of access to health care, 5, 6 and delays in accessing HIV-related testing 7 and care. 8 Furthermore, foreign-born individuals are disproportionately represented among the age groups most at risk for HIV 1 and may emigrate from countries with even more severe HIV epidemics than the United States. Although these factors may increase immigrants’ likelihood of acquiring HIV or developing AIDS, little research has been undertaken to identify high-risk immigrant populations. Conversely, the better overall health of foreign-born populations relative to those born in the United States 9– 11 indicates the presence of health-promoting factors that may reduce immigrants’ HIV risk. As improvements in HIV medical treatments increase the number of persons living with HIV, limited resources must be used to provide prevention and care services to a growing at-risk and HIV-infected population. Identification of highly affected communities is therefore critical to ensuring that funding and services are efficiently targeted. To assist US policymakers in this process and to enhance understanding of HIV prevalence patterns among at-risk foreign-born individuals, we examined the distribution of HIV infection by birth country among attendees of Los Angeles County sexually transmitted disease (STD) clinics.
