For one particular segment of the U.S. population, the news related to HIV infections has been anything but positive.
Blacks, who make up 14 percent of the population, comprise 44 percent of all new HIV infections, according to the U.S. Centers for Disease Control and Prevention. In fact, the CDC estimates that 1 of every 16 black men and 1 of every 32 black women will be diagnosed with HIV, the virus that causes AIDS, at some point in their life.
Blacks also have dramatically higher death rates related to HIV. Black men with HIV and less than a 12th grade education have a death rate of 53 per 100,000 in the general population. For white men with a similar education, that rate is 5 per 100,000 and, for Hispanics, it’s 9 per 100,000, according to research published Oct. 8 in the Archives of Internal Medicine.
Black women face similar odds. Those with less than a 12th grade education have an HIV-related mortality rate of 27 per 100,000 people in the general population, compared with 2 per 100,000 for white and 3 per 100,000 for Hispanics, the study found.
Blacks with HIV who have graduated from college fare significantly better, but their death rates are still far above those of whites infected with the virus.
“If we do nothing, this epidemic will continue and people will continue to get infected,” said Phill Wilson, president and chief executive of the Black AIDS Institute in Los Angeles. “Black communities will be decimated. We have to act fast, and in a responsible way,” he said.
“We need a coordinated intentional effort to educate blacks about HIV,” Wilson explained. “We need people living with HIV to talk about it, and we need to help people understand what treatments are available and how they work.”
To that end, the World AIDS Campaign is sponsoring World AIDS Day Dec. 1.
As to how the racial disparity developed, Dr. Michael Horberg, chairman of the HIV Medicine Association and director of the HIV/AIDS program at Kaiser Permanente in Rockville, Md., said that “there are a lot of theories, but not one clear answer.”
One contributor may be sexual age-mixing, he said, meaning that more younger people are having sex with older people who are already infected with HIV. The CDC notes that because there are already a greater number of blacks living with HIV, it’s more likely that others in the same community will also be infected.
The CDC cites limited access to quality health care and a lack of HIV education as likely contributors to the problem.
Most new HIV infections in black men, 73 percent, occur in men who have sex with other men, whereas 85 percent of black women acquire the disease through heterosexual sex, according to the CDC.
“What we do know is that getting people tested, getting them into care and on treatment lowers the whole community’s load and transmission rates,” Horberg said.
The Ryan White HIV/AIDS Program, which offers treatment to those who can’t afford it, “has permitted clinics to offer comprehensive medical homes to HIV patients, giving them culturally confident care,” Horberg noted.
But, Wilson said, “The real question now is how do we get away from this place? How do we move toward the end of this epidemic?”
Earlier diagnosis and better surveillance are both crucial, he pointed out, and getting people into treatment as soon as possible may help, too.
“HIV is no longer a death sentence,” Wilson said. “Treatments are less toxic, and they’re simpler and more effective than they used to be.” Plus, when the virus is suppressed, he said, the rates of transmission go down.
The two experts agreed that prevention and HIV education are key to stemming the growing disparity.
“People need to know that this is real, and the disparity is not just a gay or straight issue,” Horberg said. “HIV is not just a disease of the gay community. It’s really negatively impacting communities of color in the United States, and we have to think about getting public health efforts to those communities specifically. This can’t be a one-size-fits-all plan.”