STD Quarterly

HIV diagnoses: Racial differences still exist

New figures from the Centers for Disease Control and Prevention (CDC) show that despite an approximate 5% annual decline in the 2001-2004 rate of diagnoses among African Americans, the epidemic continues to make a severe impact on that ethnic group.1,2

In 2004, the rate of new HIV diagnoses among African Americans was 8.4 times higher then the rate among whites (76 compared to nine per every 100,000).1 From 2001-2004, African Americans accounted for more than half of all diagnoses (51%), while representing 13.5% of the total population.1

Reducing the toll among African Americans will require a diverse and comprehensive approach, says Joseph Prejean, PhD, an epidemiologist at the CDC’s Division of HIV/AIDS Prevention. Unfortunately, there is no simple solution to overcoming such factors as stigma, racism, and poverty; such barriers cannot be changed overnight or by the government alone, he observes.

"Reducing HIV among African Americans will require a collaborative response, as some of our greatest successes have been in partnership with affected communities," states Prejean. "CDC is currently working with community leaders across the country to prioritize prevention needs and determine how to accelerate progress."

As the impact of HIV on this population has grown, so have prevention efforts, reports Prejean. CDC now gives more than $30 million directly to African American community-based organizations, and more funds are directed to African Americans than any other racial/ethnic group, he notes.

NY data now included

The current CDC reports highlight new HIV trend data for 2001-2004. The data come from a subset of 33 states with longstanding, name-based HIV reporting. The new figures are important, as information from New York state, which implemented name-based reporting in 2001, is included for the first time. While the report is not a complete picture of the U.S. epidemic, the addition of New York data provide a more representative look, notes Lisa Lee, PhD, senior epidemiologist at CDC’s Division of HIV/AIDS Prevention.

"New York accounted for 20% of the diagnoses in this analysis and had a significant impact on overall trends," states Lee. "HIV diagnoses declined 9% each year among injection drug users and 4% among heterosexuals, partly due to the influence of trends in New York state."

A number of high-morbidity areas that lack long-standing confidential, name-based HIV reporting, including California and Illinois, are not included in the CDC report. To improve the nation’s ability to monitor the HIV epidemic, CDC recommends that all states and territories adopt confidential, name-based HIV reporting systems.3 The agency is working with states to develop a new system for monitoring new HIV infections more directly through the use of a testing method that distinguishes recent from longstanding infections. Data are expected from that system in 2006, say CDC officials.

What do figures show?

On a national scale, the report indicates that men of all races and ethnicities account for 71% of new HIV diagnoses from 2001-2004; women represent 29%. Among men, African American men continued to face the highest rate of new HIV diagnoses in 2004 (131.6/100,000) — more than seven times that of white males (18.7) and more than twice the rate among Hispanic males (60.2). Among women, African American women had the highest rate of diagnoses in 2004 (67/100,000) — more than 20 times higher than the rate among white females (3.2) and more than four times higher than among Hispanic females (16.3).1

By transmission category, men who have sex with men (MSM) continued to represent the majority of new HIV diagnoses (44% from 2001-2004), with a slight increase in the most recent year.1 During this same time period, HIV diagnoses declined among injection drug users and heterosexuals.

While the November 2005 report from the CDC reported an annual decline in the overall rate of HIV diagnoses for African Americans, the February 2006 article took a more in-depth view of the figures.1,2 It shows about a 4% decrease in the estimated annual rate of HIV diagnoses for each year among African American men, with a nearly 7% decrease in the annual rate of HIV diagnoses among African American women.2

CDC researchers presented new information at a February conference, showing annual declines in African American women in heterosexual transmission and injection drug use categories, as well as significant declines in the annual rate of diagnosis among African American men in similar categories.4 However, there were no significant declines among African American men who have sex with men.4

"These results underscore the impact of the HIV/AIDS epidemic on non-Hispanic blacks and the need to continue monitoring trends particularly among MSM, the largest transmission category," the researchers note.4

References

  1. Centers for Disease Control and Prevention. Trends in HIV/AIDS diagnoses — 33 states, 2001-2004. MMWR 2005; 54;1,149-1,153.
  2. Centers for Disease Control and Prevention. Racial/ethnic disparities in diagnoses of HIV/AIDS — 33 states, 2001-2004. MMWR 2006; 55:121-125.
  3. Centers for Disease Control and Prevention. Fact Sheet. New HIV Diagnoses, 33 States, 2001-2004. Atlanta: December 2005.
  4. Durant T, Satcher A, Prejean J, et al. Trends in HIV Diagnosis among Non-Hispanic Black Americans, 2001-2004. Presented at the 13th Conference on Retroviruses and Opportunistic Infections. Denver; February 2006.