HIV transmission in the United States: Considerations of viral load, risk behavior, and health disparities

H. Irene Hall, David R. Holtgrave, Tian Tang, Philip Rhodes

Research output: Contribution to journalArticlepeer-review

68 Scopus citations


Ongoing HIV transmission is related to prevalence, risk behavior and viral load among persons with HIV. We assessed the contribution of these factors to HIV transmission with transmission rate models and data reported to National HIV Surveillance and published rates of risk behavior. We also estimated numbers of persons with risk behaviors and unsuppressed viral load among sexual risk groups. The transmission rate is higher considering risk behavior (18.5 infections per 100 people with HIV) than that attributed to unsuppressed viral load (4.6). Since persons without risk behavior or suppressed viral load presumably transmit HIV at very low rates, transmission can be attributed to a combination of these factors (28.9). Service needs are greatest for MSM; their number with unsuppressed viral load engaging in unprotected discordant sex was 8 times the number of male heterosexuals and more than twice the number of female heterosexuals with high-risk transmission potential. While all persons with HIV need optimal care, treatment as prevention is most relevant when risk behavior is present among persons with unsuppressed HIV viral load.

Original languageEnglish (US)
Pages (from-to)1632-1636
Number of pages5
JournalAIDS and behavior
Issue number5
StatePublished - Jun 2013


  • Disparities
  • HIV
  • HIV transmission
  • Men who have sex with men
  • Race/ethnicity

ASJC Scopus subject areas

  • Social Psychology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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