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Addressing racial disparities in HIV care crucial to meeting US goals
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Recently published data in MMWR suggest blacks in the United States have lower levels of viral suppression and less access to medical care than other racial and ethnic groups, and improving these numbers is essential to achieving objectives in the National HIV/AIDS Strategy by 2020.
However, the researchers said that the findings have greater implications than simply meeting nationwide goals.
“Improving health outcomes for blacks living with HIV infection is necessary to reduce HIV infection in the United States,” Andre F. Dailey, MSPH, from the CDC’s Division of HIV/AIDS Prevention, and colleagues wrote.
The National HIV/AIDS Strategy (NHAS) 2020 goals include: 80% of all persons diagnosed with HIV to have an undetectable viral load, 85% to be linked to medical care within 1 month of their diagnosis and 90% to be retained in medical care.
Using National HIV Surveillance System data from persons aged 13 years and older in 33 U.S. jurisdictions, the researchers identified 257,316 blacks living with HIV as of Dec. 31, 2013, comprising 65.3% of blacks living with HIV in the U.S. In this group, 53.5% were retained in medical care and 48.5% had an undetectable viral load at their most recent test. The researchers also wrote that persons aged younger than 35 years had lower percentages of linkage to care, retention in care, and viral suppression than those aged 35 years or older, and the lowest levels of care and viral suppression were found among those whose infection was linked to injection drug use and among men with infection acquired through heterosexual contact. In 2014, 21.9% of infections diagnosed among blacks had progressed to AIDS at the time of diagnosis, the researchers said.
Of the 12,269 blacks who received a diagnosis of HIV that year, 71.6% were linked to medical care within 1 month of their HIV diagnosis.
Dailey and colleagues noted that their study did not cover all jurisdictions and thus, may not be indicative of the entire black population. Although they stated that the CDC is working with its stakeholders to make the most use of care and prevention methods already in place, work must still be done to improve the health of blacks with HIV/AIDS, which could help reach the NHAS 2020 goals.
“The results of the analyses described in this report underscore the need for routine testing and greater linkage to care, retention in care, and viral suppression among blacks, particularly those who inject drugs and young males with infection attributed to heterosexual contact. Focusing prevention and care efforts on populations that bear a disproportionate burden of HIV disease could lead to reductions in HIV incidence and health inequities,” Dailey and colleagues wrote. “Focusing on HIV prevention and care among blacks might be beneficial in meeting NHAS 2020 goals of improving care outcomes and reducing HIV–related racial/ethnic disparities in the United States.”
In an additional report released by the CDC, researchers found that between 2010 and 2014, the disparity in HIV diagnosis rates and the overall HIV diagnosis rates among black, Latina and white women decreased. – by Janel Miller
- References:
- Dailey, AF, et al. MMWR Morb Mortal Wkly Rep. 2017;doi:10.15585/mmwr.mm6604a2.
- McCree DH, et al. MMWR Morb Mortal Wkly Rep. 2017;doi:10.15585/mmwr.mm6604a3.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Eugene McCray, MD
This year’s National Black HIV/AIDS Awareness Day (Feb. 7) offers us a moment to reflect on the tremendous toll HIV has taken on a generation of African-Americans in this country. It is also an opportunity to recognize the collective progress we’ve achieved in the African-American community: new diagnoses among African-Americans dropped by 14 percent from 2010 to 2014.
We must continue to build upon these successes to further reduce the impact of HIV on African-American communities.
For people living with HIV, getting diagnosed and starting treatment early is an essential first step toward long-term health. Newly released CDC data show that in 2014, one in five African Americans had progressed to AIDS by the time their infection was diagnosed. The same analysis also shows that once diagnosed, less than half of African Americans with HIV have achieved viral suppression through care and treatment – that is, the virus is under control and at a level that dramatically reduces the risk of transmission.
While it is clear improvements are needed, evidence suggests that efforts are paying off in many ways. A second CDC analysis shows that the large disparity in HIV diagnoses between African American women and women of other race/ethnicities is shrinking. The findings show that the difference in HIV diagnosis rates between African American women and white women (the group with the lowest rates) decreased by almost 25 percent from 2010 to 2014. There have also been substantial declines in recent years in diagnoses among African-Americans overall. And after years of increases, we are now seeing diagnoses among African-American gay and bisexual men level off.
We have more tools today to build on this momentum and to continue advancing in the fight against HIV. For those living with HIV, an HIV test is the gateway to effective treatment that improves health and reduces the risk of transmission. Advances in HIV testing and treatment offer greater opportunities to identify people living with HIV sooner and to link them to care earlier. Increases in HIV testing in both health care and non-health care settings can improve the proportion of African Americans with HIV who know their status and who are receiving care. And new biomedical interventions, like PrEP, are also playing a key role in HIV prevention when combined with other proven strategies.
CDC will continue working with the African American community, prevention partners, and providers to find solutions to close the gaps in HIV prevention and care.
On National Black HIV/AIDS Awareness Day, join me as we forge a path to a future free of HIV– know your status, your risk, and how you can prevent HIV.
Disclosure: McCray has no relevant financial disclosures.
Editor’s Note: McCray’s comments were released by the CDC in conjunction with the new studies.
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