Black Americans continue to be disproportionately affected by HIV, due in part to discrimination, stigma, poverty and a lack of access to health care, according to a statement from amfAR, The Foundation for AIDS Research. This is largely seen in the southern U.S., where approximately half of new HIV infections occur, with black patients accounting for nearly 80% of cases.
In recognition of National Black HIV/AIDS Awareness Day, which is observed annually on Feb. 7, Greg Millett, MPH, vice president and director of public policy at amfAR, discussed six facts highlighting the impact of HIV in black Americans. According to Millett:
1. Black Americans account for almost half of new infections in the U.S. each year despite representing only 13% of the population.
Although prevention efforts have contributed to a decrease in the number of new HIV diagnoses among black Americans, progress has been inconsistent. Black Americans remain more likely to be exposed to HIV, not because they participate in more risky behavior, but because the prevalence of HIV is much greater in this community compared with other racial/ethnic groups, Millett said.
2. An estimated 14% of black Americans living with HIV are not aware of their status.
Black Americans are often diagnosed with HIV late in infection. As a result, treatment is frequently delayed, and patients can potentially transmit the infection to others. Over the last decade, however, the CDC has expanded access to HIV testing in the black community so that more individuals are aware of their status and can take the necessary precautions to prevent spreading the virus, Millett told Infectious Disease News.
“This is important because people with HIV who are undiagnosed are more likely to transmit the virus to others unknowingly,” he said. “Once patients know their status, it dramatically helps in reducing the impact of HIV.”
3. One in two black men in the U.S. who are gay will be diagnosed with HIV in their lifetime.
Although there has been a decrease in HIV among other populations in the United States, including injection drug users, the incidence of HIV continues to increase in men who have sex with men (MSM), particularly those who are black. Black gay men have the highest risk for HIV compared with all other groups, accounting for 30% of infections. There are very few interventions to reduce infections in this population, Millett said. Key strategies include expanding access to testing and HIV care, and promoting the use of pre-exposure prophylaxis.
“Those two interventions are the biggest tools in our arsenal against HIV for men who have sex with men, particularly black gay men” Millett said. “We need to double-down and make sure that we actually get to the point where we can see decreases in these populations as we are in other populations.”
4. The incidence of HIV has decreased among black women in the U.S.
The CDC estimated that the number of new HIV diagnoses among black women decreased 42% from 2005 to 2014. However, new infections remain more common in black women than in women of other racial/ethnic groups, according to Millett. In 2014, they accounted for six in 10 new infections among women. Further, the CDC projects that one in 48 black women will be diagnosed with HIV in their lifetime.
5. Black transgender women are more likely to be infected with HIV compared with transgender women of other racial/ethnic groups.
Results from a 2009 NIH study showed that more than 56% of black transgender women in the United States were HIV positive.
6. HIV-related deaths are more likely to occur in black Americans compared with other groups.
According to the CDC, black Americans accounted for nearly half of AIDS-related deaths in the U.S. since the start of the epidemic. Although the mortality rate among blacks decreased 28% from 2008 to 2010, it was 13% higher than the mortality rate of whites and 47% higher than that of Hispanics.
“This is not an HIV-specific issue,” Millett said. “You see in other chronic conditions that African-Americans may be just as likely or less likely to be diagnosed with the condition, but they have far worse outcomes. The reason that we see this is because of ongoing issues of marginalization.”
Many black Americans lack access to health care because of issues regarding unemployment, homelessness and incarceration.
“There are people who get reasonable access to health care once their incarcerated — the problem is transitioning out of prison or jail,” he said. “People don’t necessarily transition into another health care system, and if they fall out of the system, then they continue to have poor outcomes. So, there’s many different things that are taking place in the black community as to why we see higher mortality rates still compared with whites and other groups.”
More progress needed
Even though more efforts are needed to reduce the burden of HIV/AIDS among blacks, Millett said that the introduction of the Affordable Care Act (ACA) has helped to increase access to health insurance, HIV care and treatment in the black community. Although the ACA is expected to be repealed under the new administration, Millett said it is still unclear whether this will impact progress in HIV/AIDS.
“What I do know from meeting with administration officials and Republicans is that people do not want to see Americans going without health care, and they particularly don’t want to see Americans who are HIV positive going without health care, especially after the huge outbreak that we had in Indiana with HIV among injection drug users,” he said. “They want to ensure that people remain covered, and that’s something that we look forward to working with them around.”
In addition to the ACA, improvements in HIV/AIDS within the black community have been linked to an increase in HIV/AIDS awareness prompted by discussions and information campaigns.
“More awareness certainly helps to reduce stigma around HIV/AIDS,” Millett said. “We recently had a president who was also African-American and got tested for HIV during the presidential campaign. He also released the first National HIV/AIDS Strategy where he prioritized communities at high risk for HIV in the U.S., including African-Americans. All of that really went a long way in helping to reduce stigma and to normalize discussion around HIV/AIDS.
“We have made some fantastic gains in reducing HIV infections among African-Americans, but there are specific things that we need to do in terms of clinical care and clinical care experiences for African-Americans to make sure that their outcomes are similar to those of other groups. I’m guardedly optimistic that we can get there, but there’s still a lot of work to do.” – by Stephanie Viguers
Disclosure: Millett reports no relevant financial disclosures.
*Photo courtesy of The Black AIDS Institute.