African Americans have highest HIV incidence, lowest rate of consistent care

African Americans in the US have the highest rate of new HIV infections, but black people living with HIV are less likely than white or Latino Americans to receive consistent, ongoing medical care, according to a new Centers for Disease Control and Prevention (CDC) report published in the February 5 Morbidity and Mortality Weekly Report in advance of National Black HIV/AIDS Awareness Day. These findings, the CDC said, "demonstrate yet another persistent disparity that prolongs the epidemic among African Americans."

New diagnoses

As first reported at the National HIV Prevention Conference this past December, annual HIV diagnoses fell by 19% overall between 2005 and 2014, from 48,795 to 39,718. The largest decline was seen among African-American women: 42% over the decade and 25% during the most recent five-year period (2010 to 2014).

New diagnoses among men who have sex with men – the group that accounts for nearly two-thirds of all new HIV infections in the US – rose by 6% overall during the decade as a whole, before stabilising in recent years at less than a 1% increase. But trends differed according to race/ethnicity. While white gay and bisexual men saw an 18% decline over the decade, new diagnoses among black and Latino gay and bi men rose by 22% and by 24%, respectively.

Looking specifically at young gay and bi men (age 13 to 24), newly diagnosed infections rose by about 87% among both black and Latino young men, and by 56% among white young men, over the entire decade. Encouragingly, during the more recent period new diagnoses fell by 2% among young black men and remained steady among young white men, though they continued to rise (by 16%) among young Latino men.

"While we are seeing signs of success, we must continue our focus on prevention strategies that will have the greatest impact on African American communities and the nation overall," Eugene McCray, MD, director of CDC’s Division of HIV/AIDS Prevention, said in a press statement. "A key area of focus is ensuring that people living with HIV are diagnosed early, quickly linked to care and receive consistent care that improves their lives and protects the health of their partners."

Consistent care

According to the recent Morbidity and Mortality Weekly Report, Sharoda Dasgupta from the CDC and colleagues used data from the National HIV Surveillance System to monitor progress toward the goals of the National HIV/AIDS Strategy, focusing on retention in HIV care over three years. Retention in care was defined as receiving two or more CD4 or viral load tests at least three months apart during a calendar year.

Among adults (age 13 or older) diagnosed with HIV in 2010 and still alive in 2013, 61% overall were retained in HIV care in 2011, 50% in both 2011 and 2012, and 43% from 2011 to 2013.

However, just 38% of African Americans received consistent HIV care during the period of 2011 to 2013, compared with 49% of whites and 50% of Latinos living with HIV. Black men were less likely to receive consistent HIV care over three years than black women (35% vs 44%, respectively), and African Americans whose HIV was attributable to heterosexual contact were more likely to remain in care than gay men and people who inject drugs. Furthermore, a larger proportion of blacks (28%), compared with whites (19%) and Latinos (23%) were not retained in care during any of the three years.

"A substantial percentage of persons with HIV infection (39%) were not retained in care in the year after their diagnosis," the report authors wrote. "However, among persons retained during earlier years after diagnosis, the proportion not retained during subsequent years was low (18% in 2012 and 15% in 2013, respectively)."

These findings, they noted, "are consistent with previous reports on racial/ethnic differences in HIV care engagement and demonstrate that these disparities remain over multiple years. The racial/ethnic differences in HIV care retention are established during the first year after diagnosis, underscoring the importance of early engagement in care to reduce disparities in sustained retention in care and thus improve the resulting outcomes (e.g., initiation of treatment and viral suppression)."

People with HIV who receive ongoing care and effective antiretroviral therapy not only remain healthier than those who go untreated, but they also have a dramatically lower risk of transmitting the virus to others.

"Consistent care matters," said Jonathan Mermin, MD, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. "It enables people with HIV to live longer, healthier lives, and it prevents new infections. And closing this gap in care will be essential if we are to see the narrowing racial divide in HIV diagnoses close completely."