Trends in HIV Diagnoses Rates and Outcomes Among U.S. Blacks

CDC published two reports in the Morbidity and Mortality Weekly Report (MMWR) focusing on HIV among U.S. Blacks. One report analyzed changes in HIV diagnosis rate disparities among U.S. Black women during the period from 2010 through 2014, while the other study focused on HIV care outcomes for U.S. Black men and women in 2014.

In the U.S., Black women have historically had higher HIV diagnosis rates than women of other race/ethnicities. Noting that the overall HIV diagnosis rates among U.S. women declined significantly during the period from 2010 through 2014, CDC decided to conduct a detailed analysis by race/ethnicity to determine whether there was any change in the disparity of HIV diagnosis among Black women, compared to Hispanic and White women.

The researchers used three different measures of disparity: 1) the absolute rate difference, 2) the diagnosis disparity ratio, and 3) the Index of Disparity-each of which is described in detail in the MMWR paper.

The absolute rate difference between Black women and White women decreased each year, falling from 36.9 in 2010 to 28.3 by 2014. The diagnosis disparity ratio for Black women decreased from 1.7 in 2010 to 1.2 in 2014. The Index of Disparity increased during 2010-2011, and then decreased each year during 2012-2014.

"This decrease in all three measures of disparity suggests that prevention measures targeting women might be reducing HIV infections in Black women," the researchers concluded. Despite this recent progress, Black women still accounted for 61 percent of new HIV diagnoses among women during 2015. "Because black women remain disproportionately affected by HIV infection, additional interventions that are culturally tailored to them might aid in further reducing the prevalence of HIV among this group."

HIV Care Outcomes Among U.S. Blacks in 2014

U.S. Blacks living with diagnosed HIV infection have historically had lower levels of care and viral suppression than persons in other racial/ethnic groups. Among persons with HIV infection diagnosed through 2012 who were alive at the end of 2013, only about 68 percent of Blacks received any HIV medical care compared with 74 percent of Whites.

In this second study, CDC researchers used data from the National HIV Surveillance System (NHSS) to examine HIV care outcomes among Blacks recently diagnosed with HIV.

Among Blacks who were diagnosed with HIV infection during 2014, about 72 percent were linked to care within one month after diagnosis, compared with 79 percent for Whites. The researchers also found that retention in care and viral suppression rates were also lower among Blacks with HIV infection compared to Whites.

Among persons diagnosed through 2012 who were alive at the end of 2013, 53.5 percent of Blacks were receiving continuous HIV medical care, compared with 58.2 percent of Whites. Less than half (48.5 percent) of Blacks reached viral suppression, compared with 62.0 percent of Whites.

The analysis showed that the lowest levels of care and viral suppression were among persons with infection attributed to injection drug use and among males with infection attributed to heterosexual contact. There were also disparities in different age groups: linkage to care and viral load suppression were lower among persons under 35 years old compared to persons aged 35 or older.

The CDC researchers noted that the current HIV care outcomes for Blacks are far below the National HIV/AIDS Strategy (NHAS) goals of 85 percent linkage to care, 90 percent retention in care, and 80 percent viral load suppression by 2020.

"Increasing the proportion of Black persons living with HIV who are receiving care is critical for achieving the NHAS 2020 goals to reduce new infections, improve health outcomes, and decrease health disparities," they concluded. "Tailored strategies for Black subpopulations, including persons who inject drugs and young males with infection attributed to heterosexual contact, might be needed to achieve improvements in linkage and retention in care."

Eric Brus writes about HIV policy. His HIV/AIDS Disparities Report is produced by the New England AIDS Education and Training Center Minority AIDS Initiative Project. The full version is available online.