HIV Care Gaps Largest among African Americans and Young People Interview with Dr. H. Irene Hall, PhD
Division of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention,
1600 Clifton Road, MS E-47, Atlanta, GA 30333 What are the main findings of the study?

Dr. Hall: Our research finds that, across all populations, far too few Americans with HIV receive the care they need to stay healthy and reduce risk of transmission. According to our research, gaps in care are the largest among African Americans and young people. Moving forward, improving care for all HIV-infected people will be critical to achieving the goal of an AIDS-free generation in America.

More specifically, some of the key findings of the study include:

  • Overall, only a quarter of all Americans with HIV have a suppressed viral load – meaning the level of HIV in their bodies is low enough to stay healthy and dramatically reduce the chance of transmitting to others.
  • By race/ethnicity, African-Americans and Hispanics or Latinos are less likely to be aware of their infection compared to whites.
  •  By age, younger Americans are less likely to be in ongoing care and have a suppressed viral load; HIV care and viral suppression generally improved with age. For example:
  • Fifteen percent of those aged 25-34 were virally suppressed, compared to 36 percent of those aged 55-64.
  • In terms of ongoing care, 28 percent of those 25-34 years old were retained in care, compared to 46 percent of those aged 55-64. Were any of the findings unexpected?

Dr. Hall: These data are concerning. Despite all of the progress we’ve made during the past 30 years, this study paints a stark picture: most people living with HIV in America today are not getting the care and treatment they need for their health and to protect their partners.

We know that testing and effective treatment offer powerful tools for HIV prevention, but to realize the full potential of using treatment as prevention, we must first overcome barriers to reaching those at greatest risk, including African Americans, Hispanics or Latinos, and youth. Increasing HIV testing, strengthening care for all people with HIV, and reducing these disparities in treatment are critical to achieving the goal of an AIDS-free generation in America. What should clinicians and patients take away from your report?

Dr. Hall: These data underscore the urgent need to overcome barriers to HIV testing and ongoing care among African Americans, Hispanics or Latinos, and younger people. By focusing intensively on confronting the underlying causes of these disparities, we can help more people living with HIV protect their health and reduce transmission to others.

Research suggests that many of the same social and environmental factors that fuel racial disparities in HIV infection also contribute to gaps in care and treatment, including poverty, stigma and poor access to health care. We also see that a combination of factors contributes to the disparities in HIV diagnosis among younger Americans, including lower rates of HIV testing, as well as a reduced sense of urgency about the need for care among those who are positive.

Healthcare providers can play a critical role in strengthening care among those living with HIV by implementing CDC’s recommendations for routine HIV testing in healthcare settings; prioritizing retention in care and treatment adherence; and providing critical prevention services. What recommendations do you have for future research as a result of this study?

Dr. Hall: Our study highlights an important gap in our nation’s response to HIV: too many people living with HIV in America today are not getting the care they need. Now that we have the research, the charge now is to close these gaps. This will require specific action on a number of fronts. CDC is pursuing a “High-Impact Prevention” approach, which will expand testing efforts to ensure people living with HIV are diagnosed and linked to care; develop and implement behavior-change programs to help youth, African Americans, and others reduce risk behaviors; and prioritize services for those living with HIV, including efforts to improve retention in care. However, CDC can’t do it alone – health departments, health care providers, and community-based organizations all play critical roles.


Differences in Human Immunodeficiency Virus Care and Treatment Among Subpopulations in the United States

Hall H, Frazier EL, Rhodes P, et al. Differences in Human Immunodeficiency Virus Care and Treatment Among Subpopulations in the United States. JAMA Intern Med. 2013;():1-7. doi:10.1001/jamainternmed.2013.6841.

Last Updated on September 19, 2013 by Marie Benz MD FAAD