HIV prevention programs tailored to blacks crucial for reducing related disparities
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Blacks accounted for nearly 50% of all individuals diagnosed with HIV in 2017 and more than 43% of all individuals who were tested for the virus through a CDC-funded program that same year, according to new data from the Ending the HIV Epidemic: A Plan for America program.
“Targeted efforts to address HIV-related racial and ethnic disparities are making a difference,” Aba D. Essuon, PhD, health scientist in the CDC’s Division of HIV/AIDS Prevention, told Healio. “Yet, far too many blacks are still not benefiting from quality HIV care and prevention. CDC is working to close these gaps in HIV prevention and care through public awareness campaigns, scientific research and federal initiatives such as the Ending the HIV Epidemic (EHE): A Plan for America.”
Essuon added that prevention programs focused on local, evidence-based testing, linkage and treatment strategies for blacks could help to achieve the goal of ending the HIV epidemic. This prompted researchers to examine HIV testing outcomes among blacks in high-prevalence EHE jurisdictions.
The CDC examined 2017 HIV testing, linkage to care and partner services data submitted to the National HIV Prevention Program Monitoring and Evaluation system by 61 CDC-funded health departments and 150 CDC directly funded community-based organizations.
In 2017, a total of 3,110,049 CDC-funded tests were completed in the United States, including 1,954,741 (62.9%) in phase 1 jurisdictions. The phase 1 jurisdiction includes 48 counties, as well as Washington, D.C., and San Juan, where more than 50% of new HIV diagnoses were made in 2016 and 2017, in addition to seven states – Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma and South Carolina – where there are a substantial number of HIV diagnoses in rural areas.
Essuon and colleagues found that blacks accounted for almost half (43.2%) of those tested and newly diagnosed with HIV (49.1%). Additionally, blacks also accounted for more than half (58.5%) of previously diagnosed persons not known to be in care. While 79.2% of blacks newly diagnosed with HIV in these areas were linked to HIV medical care within 90 days, that is still below the goal of 85% of persons being linked to care within 90 days of diagnosis.
Black men who have sex with men accounted for 15% of those individuals tested and 64.9% of new HIV diagnoses in non–health care settings. Most black MSM newly diagnosed with HIV were linked with medical care (80.6%), interviewed for partner services (71.3%) or referred to HIV prevention services (84.2%).
“This analysis found that HIV testing services supported by CDC funding are an important resource for identifying persons with new and previously diagnosed HIV infection who are not in care, especially in phase 1 jurisdictions, but challenges in linkage to care remain,” Essuon said. “Therefore, locally tailored, evidence-based HIV prevention programs are critical for reducing HIV-related disparities and achieving the goals of the EHE plan.” – by Caitlyn Stulpin
Disclosure: Essuon reports no relevant financial disclosures.
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Greg Millett, MPH
Like national data, blacks comprise the majority of new HIV infections (by race) in EHE jurisdictions. Surprisingly, when researchers categorized participants by age, black youth (ages 13-19) had the highest proportion of individuals linked to care within 90 days of diagnosis (84.2%). This is an achievement, given how difficult it is to engage youth in care. However, blacks who inject drugs were least likely to be linked to care within 90 days (42.1%). Further investigations must assess whether such lack of engagement was due to active drug use, lack of cultural sensitivity among providers or other issues. As always, new HIV diagnoses were highest among black MSM and transgender individuals, but non-health care settings in EHE districts did not target HIV tests according to risk for HIV infection. Only 15% of HIV tests in non-health care settings targeted black MSM, yet black MSM in those environments comprised nearly 65% of all new HIV diagnoses. This is unacceptable and must be addressed.
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