10 Feb HIV Continues To Disproportionately Affect African Americans
MedicalResearch.com Interview with:
Sharoda Dasgupta, PhD, MPH
US Public Health Service and Epidemic Intelligence Service Officer
Medical Research: What is the background for this study?
Dr. Dasgupta: Roughly 1.2 million people in the United States are living with HIV, and about 40,000 diagnoses occur each year, according to the most recent CDC data.
According to national estimates published by CDC, African Americans remain disproportionately affected by the virus. African Americans represent 12 percent of the U.S. population but accounted for almost 50 percent of HIV diagnoses in 2014. Some signs have emerged that HIV is loosening its grip on the African American community, but persistent disparities are prolonging HIV transmission.
Antiretroviral therapy (ART) improves clinical outcomes for people living with HIV and reduces their risk of transmitting the virus to others. Racial and ethnic disparities in HIV care, however, limit access to ART, which perpetuates disparities in survival and HIV transmission.
Although previous studies have mostly analyzed HIV care by race and ethnicity during a single year, the purpose of this study was to better understand how people living with HIV remain in care over a longer period in time – and whether their retention in care differed by race and ethnicity.
Medical Research: What are the main findings?
Dr. Dasgupta: This analysis focused on 12 U.S. jurisdictions that reported comprehensive HIV lab results to CDC from January 2010 – December 2013. They represent approximately 25 percent of HIV diagnoses in 2010.
The findings demonstrate yet another persistent disparity that prolongs the epidemic among African Americans. Only 38 percent of African Americans received consistent HIV care from 2011 – 2013, compared with 49% of whites and 50% of Latinos. Additionally, African American males were less likely to receive consistent medical care than African American females (35 percent and 44 percent, respectively).
Among African Americans, receiving consistent HIV care was highest among those whose HIV infections were attributable to heterosexual contact. Those who received consistent HIV medical care for three years were considered consistently retained in care.
Medical Research: What should clinicians and patients take away from your report?
Dr. Dasgupta: African Americans do not engage in risky behavior more than other races and ethnicities, yet they remain disproportionately affected by HIV. This high community prevalence of HIV puts African Americans at increased risk of exposure with every sexual encounter.
CDC recommends everyone age 13 – 65 be tested for HIV at least once, and that some groups who are at higher risk for HIV infection be tested more frequently. Physicians play an important role in connecting people to testing options – and linking those who are living with HIV to care. In addition, physicians and communities are important partners in providing the support that keeps people living with HIV in care over time.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Dasgupta: Given that retention in HIV care differs by race and ethnicity, CDC acknowledges the importance of working with healthcare providers, community-based organizations, state and local health departments, and other partners on projects that promote early diagnosis of HIV infection and early establishment of HIV care.
As a part of these efforts, CDC supports projects that: seek to identify barriers to HIV care; aim to increase the number of people with HIV infection who begin and continue receiving medical care; and use surveillance data to identify those not currently receiving HIV care to link them back into care.
Medical Research: Is there anything else you would like to add?
Dr. Dasgupta: These data show there are challenges for all people living with HIV to remain in care over time. Those challenges can include socioeconomic factors like limited access to health services and stigma. Continuing to identify barriers to HIV care engagement – including those that lead to prolonged lack of care – can inform development of effective interventions that might narrow racial/ethnic disparities in clinical outcomes.
Dasgupta S, Oster AM, Li J, Hall HI. Disparities in Consistent Retention in HIV Care — 11 States and the District of Columbia, 2011–2013. MMWR Morb Mortal Wkly Rep 2016;65:77–82.
Sharoda Dasgupta, PhD, MPH (2016). HIV Continues To Disproportionately Affect African Americans