African American women hit hard by HIV/AIDS

Rates are 19 times higher than white women

African American women are far more likely to be infected with HIV than are white women and Hispanic women, a problem that has been growing, according to recent reports by the Centers for Disease Control and Prevention (CDC).

Non-Hispanic black females have 19 times the rate of HIV infection as non-Hispanic white females and five times the rate as Hispanic women, according to surveillance data from 32 states between 2000 and 2003.1

In all, 28% of the HIV/AIDS cases diagnosed in the 32 states from 2000 to 2003 were of women; and of these cases, about 69% were African American women. CDC surveillance data counted 25,254 HIV/AIDS diagnoses among African American women, compared with 6,545 cases among white women and 3,792 cases among Hispanic women.1

"When you look at the HIV/AIDS rates, the rates were higher among minorities since the beginning, but the numbers didn’t [ratchet up] until the mid-’90s, and since then it’s been predominantly a racial minority epidemic," says Robert Janssen, MD, director of the CDC’s Division of HIV/AIDS Prevention-Surveillance and Epidemiology.

The HIV epidemic among African Americans is fueled by socioeconomic factors, including poverty and lack of access to health care and preventive services as well as stigma and discrimination, reports Allan Rosenfield, MD, dean of the Mailman School of Public Health at Columbia University in New York City.

Drug use by women or their partners also contributes to the epidemic, he says.

There need to be better educational efforts aimed at this population, as well as continued use of needle exchange programs and easier access to the health care system, Rosenfield adds.

Too many unanswered questions

Historical data show that most of the earlier HIV/AIDS cases were among African American women involved in injection drug use (IDU), but now most are infected as a result of heterosexual sex, Janssen says.

In targeting prevention programs for African American women, there are obstacles due to unanswered questions, he notes.

"We don’t know the women’s partners," Janssen says. "For example, are their partners men who are injection drug users and were infected that way and then infect their women partners sexually, or are their partners men who also have sex with men?"

CDC data show that 80.4% of the African American women diagnosed with HIV/AIDS in 2000-2003 were infected through high-risk heterosexual contact, while 16.7% were infected through IDU. For white women, 67.1% were infected through high-risk heterosexual contact, and 30.4% were infected through IDU. Among Hispanic women, the IDU group was 17.9%, and the high-risk heterosexual contact group was 78.7%.1

While researchers have studied the possibility that some women are infected with HIV after having high-risk sex with men who have been incarcerated, this does not appear to be a major cause of transmission, Janssen says. "There’s a lot more sex going on in the communities than in jail. What’s been known for a while is people who are HIV positive are among the groups being at high risk for imprisonment as well."2,3

The CDC spent $49 million in early 2004 to provide prevention services predominantly for racial and ethnic minorities, Janssen says.

"We wanted to be sure we were getting services to high-risk people and not only men who have sex with men (MSM), which is a very important population, but also African American women, who are important, as well," he explains. "The grants are written in a way that there’s preferential funding for targeting one of those populations."

Testing and counseling is a good entry point for prevention services because it identifies people whose behavior places them at risk for HIV and diagnoses people who don’t know they’re infected, Janssen notes. "Testing and counseling presents an opportunity to get people into the appropriate prevention services," he adds.

According to a CDC data and the National Health Interview Survey in the United States in 2002, most HIV tests (43.5%) conducted among persons ages 18-64 occurred in private doctor offices. Hospitals, including outpatient clinics and emergency departments, accounted for 22.4% of HIV tests. However, AIDS clinics had conducted only 5.2% of the tests, while community health clinics accounted for 3%, STD clinics only 0.1%, and family planning clinics conducted 1.6% of the HIV tests.4

The CDC reported that greater percentages of pregnant women (about half) and of persons at increased risk for HIV (about one-quarter) had been tested during the preceding 12 months than were other persons.4 The latest CDC guidelines promote routine HIV testing of all pregnant women and advise health care providers to include HIV testing, when indicated, as part of routine medical care on a voluntary basis, similar to how other diagnostic and screening tests are offered.5

References

1. Diagnoses of HIV/AIDS — 32 states, 2000-2003. MMWR 2004; 53:1,106-1,110.

2. Lane SD, Rubinstein RA, Keefe RH, et al. Structural violence and racial disparity in HIV transmission. J Health Care Poor Underserved 2004; 15:319-335.

3. Clark JG, Stein MD, Hanna L, et al. Active and former injection drug users report of HIV risk behaviors during periods of incarceration. Subst Abus 2001; 22:209-216.

4. Number of persons tested for HIV — United States, 2002. MMWR 2004; 53:1,110-1,113.

5. Advancing HIV prevention: New strategies for a changing epidemic — United States, 2003. MMWR 2003; 52:329-332.