Disclosures: The authors report no relevant financial disclosures.
February 03, 2022
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HIV diagnoses among Black adults highest in communities with more social vulnerabilities

Disclosures: The authors report no relevant financial disclosures.
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More than half of Black adults diagnosed with HIV in 2018 lived in communities with the highest social vulnerability index scores, researchers reported in MMWR.

According to Andre F. Dailey, MSPH, an epidemiologist in the CDC’s Division of HIV Prevention, and colleagues, Black people accounted for almost one-half of all HIV diagnoses in 2018, with an incidence four times the rate of all other racial or ethnic groups combined.

Source: Adobe Stock
Rates of new HIV diagnoses among Black adults were increased in communities with higher social vulnerability. Source: Adobe Stock.

“Despite tremendous progress in reducing HIV transmission since the height of the epidemic, HIV continues to disproportionately affect Black people in America,” Demetre Daskalakis, MD, MPH, director of CDC’s HIV Prevention Program, said in a statement accompanying the study, which was published ahead of National Black HIV/AIDS Awareness Day on Feb. 7.

“Health disparities are not inevitable and can be addressed,” Daskalakis said. “The advanced, highly effective HIV prevention and treatment tools and COVID-19 vaccines that have been accessed by some must be accessible to all. While there is no simple solution to equity, our nation must finally tear down the wall of factors — systemic racism, homophobia, transphobia, HIV-related stigma, and other ingrained barriers — that still obstructs these tools against HIV and COVID-19 from equitably reaching the people who could benefit from them.”

Dailey and colleagues hypothesized that community-level social and structural factors, including social vulnerabilities, might explain the higher rate of HIV diagnoses among this population. For their study, they used National HIV Surveillance System and Social Vulnerability Index data through December 2019 to assess the possible association.

Of the 13,807 diagnoses of HIV infections among Black adults in 2018, the number of diagnoses by Social Vulnerability Index (SVI) quartile was 1,045 (7.6%) in quartile one — the lowest SVI quartile — 1,881 (13.6%) in quartile two, 3,423 (24.8%) in quartile three and 7,205 (52.2%) in quartile four.

The study demonstrated that Black adults in quartile four were 1.5 times (RR = 1.5) as likely to receive a diagnosis of HIV infection compared with those in quartile one, the researchers reported.

Looking at specific characteristics, the researchers found that among Black men, the highest disparities in HIV diagnosis rates were for those aged 45 to 54 years (RR = 2.3) and residing in either the Northeast (RR = 2.3) or the West (RR = 2.1). The found that among men with HIV attributed to male-to-male sexual contact and injection drug use, the number of diagnoses in quartile four was 11.6 times that in quartile one.

Comparatively, among Black women with HIV, the highest disparities in HIV diagnosis rates were for women aged 18 to 24 years (RR = 2), 35 to 44 years (RR = 2.4), 45 to 54 years (RR = 2) and those residing in the Northeast (RR = 2.3). Like what was seen among men, Black women with HIV infection attributed to injection drug use saw a 12.3 higher rate between quartile four and quartile one.

“HIV strategies, interventions, and programs that address the needs and challenges of Black adults in communities with the highest social vulnerability are needed,” the authors wrote. “The development and prioritization of interventions that address social determinants of health (ie, the conditions in which persons are born, grow, live, work and age) are critical to addressing the higher risk for HIV infection among Black adults living in communities with high levels of social vulnerability.”