HIV hits black women hardest, CDC report says

While new HIV infections among black women declined 21 percent from 2010–16, they still accounted for 6 in 10 new HIV infections among women in 2016.
Image: AIDS activists protest in New York's Grand Central Station on Sept. 2, 2004, on the final day of the Republican National Convention.
AIDS activists protest in New York's Grand Central Terminal on Sept. 2, 2004. Stuart Ramson / AP

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By Shamard Charles, M.D.

Black women continue to be diagnosed with HIV at disproportionately high rates relative to white and Hispanic/Latina women, according to a report released Thursday by the Centers for Disease Control and Prevention.

Despite recent progress that has seen new HIV diagnoses decrease by 21 percent from 2010 to 2016, black women still accounted for 6 in 10 new HIV infections among women in 2016.

“We know that African American women are disproportionally affected by the HIV epidemic in the United States, and the interventions that have been laid out have not impacted this group in the same way it has males and nonblack women,” said Dr. Michael Angarone, assistant professor in the division of infectious diseases at the Northwestern University Feinberg School of Medicine.

The researchers looked at HIV data collected over a seven-year period and used a model to measure the disparity among different groups called the population attributable proportion, or PAP. They modeled the reductions in new HIV infections that would have occurred if the rate of infections among black women were the same as white women. They found that the PAP decreased from 0.75 in 2010 to 0.70 in 2016.

In other words, HIV infections among black and white women would have been 75 percent lower in 2010 and 70 percent lower in 2016 if rates of new HIV infections were the same between white and black women. Additionally, in 2016, 93 percent of infections among black women would not have occurred.

This supports the argument for strengthening HIV prevention and care efforts in heterosexual black men and women to close the racial disparity gap in HIV infection among women.

The report did not cite specific initiatives that were in place to reduce HIV in black communities but they did note that “reducing racial disparities among women is needed to achieve broader HIV control goals” and that “applying tailored strategies to reduce HIV incidence in black women and their partners are important elements to achieving health equity.”

Earlier this year, the Trump administration laid out a plan to end the U.S. HIV epidemic by 2030.

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Why black women are hit hardest

Though HIV diagnoses among women have declined in recent years, largely as a result of robust public health efforts, more than 7,000 women — 19 percent of all new cases — received an HIV diagnosis in the United States in 2017.

African American women are hit hardest by HIV as the rate of diagnosis is 15 times as high as that of white women, and almost five time that of Latino women. In fact, HIV/AIDS-related illness is among the leading causes of death for black women ages 25-34, the CDC says.

A number of challenges contribute to the epidemic among black people, including higher rates of poverty; lack of access to health care; higher rates of some sexually transmitted infections and smaller sexual networks; lack of awareness of HIV status; and stigma underscoring the need for strengthened, more focused and innovative efforts to address this disparity.

As in many communities of color, discrimination and stigma are significant factors that deter women and girls from knowing they should get tested, seeking more information on prevention and treatment options, and disclosing their status.

Compared with their white counterparts, black women and men experience longer delays in diagnosis and are less likely to be virally suppressed, the report cited.

Angarone notes that lack of access to care and under-education coupled with stigma make for a perfect storm of health disparity.

“Advances are being made, but it seems like the African American community is missing out on some of those advances,” Angarone told NBC News.

“Often there’s a stigma associated with HIV that can lead to a delay in seeking treatment. HIV may be kept secret or some may not disclose their status because of fear of how they would be viewed in the community. During visits with providers are African American women being told about HIV testing or Prep? Are AA women even aware that you can be tested for HIV even without being sick?”

According to the Black Women’s Health Imperative, every 35 minutes a woman tests positive for HIV in the U.S. Of the total estimated number of women living with HIV at the end of 2013, 61 percent were African American, and only 30 percent of them were virally suppressed.

Eliminating HIV-related disparities is a national goal

Fewer new HIV infections, fewer people with undiagnosed HIV infection, and fewer people with a detectable viral load all mean that the risk of transmission is lower in the community as a whole and that costs associated with HIV care and treatment will be less than they would have been if these adverse outcomes had not been averted.

Prep is one way for black women to protect themselves from the virus.

“When we look at the use of Prep, we find that there are disproportionate uses of the drugs. We find that communities of color use Prep less than other communities. Some are not even aware that Prep is out there,” Angarone said.

Cost also plays a crucial role in black women seeking treatment. Public health experts believe that making Prep and HIV-treatment medications, such as Truvada, affordable to all populations is vital.

“Cost plays a significant role in women seeking treatment. They want to know that insurance covers it. Insurance coverage for Prep is also important,” Angarone said.

Ultimately, the health of black women has to be made a priority, Angarone said.

“We have to ask ourselves as a community, how do we get all of the testing strategies that have been working for other populations in place to bring about similar outcomes to the African American female community?”

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