Social organization of sexual-economic networks and the persistence of HIV in a rural area in the USA.

In order to determine why high rates of HIV transmission have persisted in a rural area despite community-wide HIV prevention since the mid-1980s, qualitative information was collected about the contexts and social organization of risk behaviour for HIV transmission from residents of a southern Florida community with high HIV prevalence. Original data were collected during 1995-1997 using individual interviews, observations, focus groups, and print media. The research findings were recently reviewed by community members, and the relevance of the data in the present day context was confirmed. We identified risk behaviours including multiple sex partners within heterosexual networks that cross socioeconomic strata and include adults and young people, sex workers, men who have sex with men, prison inmates, truckers, and migrant workers. Crack cocaine was an important feature of some networks. Financial support from multiple male or female sex partners was often part of a personal economic strategy and overlaid traditional social support networks. This type of relationship appears to be historically integrated into the economic fabric of the community and is not likely to receive social censure. Sexual reciprocity may explain, in part, why HIV transmission is rising among women in rural southern communities that have depressed economies.