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Driving down HIV disparities among African Americans

National Black HIV/AIDS Awareness Day, held every year on February 7, is a time to take stock of the progress we’ve made in addressing the burden of HIV among African Americans. Even though African Americans continue to be disproportionately affected by HIV in the United States, accounting for almost half of all HIV diagnoses in 2014, today we know that our investments in high-impact prevention are starting to pay off. For example, for the first time since the beginning of the epidemic, HIV diagnoses among African American women are falling dramatically. New HIV diagnoses declined 42 percent during the last decade and by 25 percent since 2010 alone—a remarkable shift that causes us to be cautiously optimistic that these improvements could be part of a long-term trend. However, we can’t forget that  African American women continue to be disproportionately affected by HIV infection, with rates 18 times that of white women and nearly five times that of Latina women.

Eugene McCray, M.D., Director, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC

Dr. Eugene McCray

Additionally, African American men are not benefitting equally from the latest advances in HIV prevention, care, and treatment. African American gay and bisexual men, especially younger black gay and bisexual men aged 13 to 24, continue to shoulder a greater burden of HIV compared with men of other races and ethnicities. Over the past decade, we have continued to see very high rates of new HIV diagnoses among African American gay and bisexual men despite some recent signs of stabilization within the last five years. Particularly troubling is the severe regional inequality of HIV, with more than 60 percent of all African American gay and bisexual men diagnosed with HIV in 2014 residing in the South.

New data released this week in CDC’s Morbidity and Mortality Weekly Report provide more concern: African Americans living with HIV were less likely to be consistently retained in HIV care within the first three years after an HIV diagnosis than were Latinos and whites.  And there are disparities within the disparities: African American men were less likely to be consistently retained in care than African American women. And retention in care was highest among African American heterosexuals and lowest for African American gay and bisexual men, for whom homophobia, stigma, and discrimination remain as prevention challenges to HIV care.

Past research has shown that African Americans do not engage in risky behaviors any more or less than members of other racial and ethnic groups. We know that social and economic factors, such as poverty and limited access to high-quality health care, housing, and HIV prevention education can directly and indirectly contribute to a higher prevalence of HIV among African American communities.

Therefore, to stop the HIV epidemic among African Americans, we must tackle the social inequities influencing HIV health outcomes and the disparities that persist at every stage of the continuum of HIV care, including identifying approaches to promote early linkage to and retention in care.

CDC collaborates continually with state and local health departments, community-based organizations, and stakeholders to break down barriers to diagnosis, care, and treatment for African Americans. Some of our efforts to enhance HIV prevention include:

  • Recommending the use of antigen/antibody combination HIV tests for the early identification and diagnosis of HIV infection and to ensure persons who test positive are linked early to treatment and ultimately become virally suppressed.
  • Supporting funding to implement pre-exposure prophylaxis (PrEP) for African Americans at high risk for HIV infection, and Data to Care to identify individuals diagnosed with HIV who are not in care and link them to care.
  • Leading an investment to support health departments to collaborate with CBOs, clinics, behavioral health and social service providers to plan, implement, and sustain comprehensive prevention, care, behavioral health, and social services for African American gay and bisexual men living with or at risk for HIV.
  • Funding demonstration projects, such as the Care and Prevention in the United States project, to support increased testing and to optimize linkage to care, retention in care, and re-engagement with care and prevention services for African Americans diagnosed with HIV.

It is my hope that in the near future, new HIV infections in African American communities will be rare, and that effective and timely treatment will be standard practice. To keep driving down new diagnoses, we must ensure that everyone at risk for HIV infection is provided access to effective prevention tools and that people who are living with HIV have unfettered access to quality health care regardless of who they are or where they live. I firmly believe that if we all continue to push efforts in this direction, we can help end the HIV epidemic for everyone in the United States.