Black women in the USA continue to be disproportionately affected by HIV, but there’s evidence that the gap may be slowly starting to close

African American and other black women continue to be disproportionately affected by HIV in the USA, reveals the Center for Diseases Control and Prevention (CDC) in their Morbidity and Mortality Weekly Report (MMWR) released 10 May 2019. In 2016, black women accounted for 60% of all new HIV infections in women in the USA, despite only making up 13% of the entire population.

The CDC researchers used a population attributable proportion analysis (PAP), which measures the proportional decrease in new infections if the group with the highest rates of HIV had the same incidence as the group with the lowest. If black women were affected by HIV at the same rate as white women, new infections among black women would drop by 93%. This amounts to between 3,900 and 4,200 HIV infections being prevented between 2010 and 2016.

But the news is not all bad, between 2010 and 2016, new HIV infections among adolescent girls and women fell overall. This was largely attributed to a 21% decline in HIV incidence in black adolescent girls and women, from 32.5 per 100,000 persons in 2010 to 24.4 in 2016. Rates among white women and adolescent girls remained the same.

Using the same PAP analysis, they found that the annual number of new HIV infections in black women would have been 75% lower in 2010 and 70% lower in 2016 if the HIV incidence between the two race groups was the same. They revealed a 7% change in racial disparity between 2010 and 2016.

In their discussion, the investigators note that reducing the racial disparity in HIV will require interventions that address the structural and social factors, including lack of access to health care and HIV-related stigma. These prevent access to vital HIV services including testing and prevention, and contribute to comparatively high prevalence of certain sexually transmitted infections (STIs) including chlamydia and syphilis, both of which increase the risk for HIV infection among black women.

Researchers also note that most HIV transmissions among black women take place in heterosexual relationships, so it’s important that prevention strategies target men as well.

Black people living with HIV also face inequalities in HIV care. Researchers explain that “Targeted measures that address reducing transmission through viral suppression and preventing acquisition through biomedical and behavioral interventions (e.g., preexposure prophylaxis [PrEP] and condom use; and providing adequate treatment once HIV infection is diagnosed) will play important roles in reducing disparities.”

The findings highlight the continued importance of racial/ethnic disparities as a key driver of the HIV epidemic in the USA and give further evidence to strengthen HIV prevention initiatives for black women.