HIV Infection Higher Among Blacks and Latinos for Decades

By Eric Brus

Blacks and Hispanics are disproportionally affected by HIV infection in the U.S. Compared to whites, the rate of new HIV infection is about eight times higher among Blacks and about three times higher among Hispanics. Although funding and interventions to prevent and control HIV infection in Black and Hispanic communities have substantially increased since the late 1990s, these disparities have persisted. In an effort to explain these continuing disparities, researchers from the New York City Department of Health and Human Hygiene and Yale University School of Public Health developed a mathematical model to project trends in HIV prevalence, incidence, and mortality from a baseline year of 2009 to 2030.

"Significantly reducing racial disparities will require a long period, not just a substantial reduction in HIV incidence rate among Blacks and Hispanics," the researchers wrote. "The small impact of successful intervention programs on reduction of HIV PR and MRR was demonstrated by the almost negligible differences in the projected PR and MRR between a very successful program (scenario no. 2) and the current projection (scenario no. 1) in our model."

In particular, the researchers modeled three measures: HIV prevalence ratio (PR), incidence rate ratio (IRR), and HIV-specific mortality rate ratio (MRR) among Blacks and Hispanics compared to Whites. In 2009, Blacks were nearly eight times as likely as Whites to be living with HIV (PR = 7.6) and acquire HIV infection (IRR = 7.9) and 11 times as likely to die of HIV-specific diseases (MRR = 11.3). Hispanics were about 3 times as likely to be living with HIV (PR = 2.8) and acquire HIV infection (IRR = 3.1) and more than twice as likely to die of HIV-specific diseases (MRR = 2.3), compared to Whites.

The researchers used their model to calculate changes in these ratios under two scenarios: 1) a continued annual reduction in HIV incidence at the rate that occurred in the U.S. between 2007 and 2010; and 2) an annual reduction in HIV incidence at the 2007 to 2010 rate among Whites (4.2 percent) and twice that of Whites (8.4 percent) among Blacks and Hispanics. The authors note that Scenario 2 might correspond to the results of a very successful program to reduce new infections specifically among Blacks and Hispanics.

The researchers noted that, even if HIV incidence among Blacks and Hispanics can be substantially reduced, racial/ethnic disparities in HIV prevalence (PR) are likely to persist for decades. In particular, the number of people currently living with HIV is much greater than the number of new infections. In addition, infected persons can now live long, relatively healthy lives for decades, thanks to advances in HIV care and treatment.

"Trends in racial disparities should thus be interpreted with caution," write researchers. "First, we should avoid automatically interpreting reductions in PR, IRR, and MRR among Blacks and Hispanics versus Whites as the results of successful HIV interventions, since they may be mainly the results of larger population growth among Blacks and Hispanics. Second, we should avoid automatically interpreting persistently high HIV RR, IRR, and MRR as results of failed HIV interventions, since they may be attributable to higher HIV prevalence among Blacks and Hispanics."

They concluded that, "The public health community should continue its efforts to reduce racial disparities, but also need to set realistic goals and measure progress with sensitive indicators."

Needs of MSM in HIV Research

"An ambitious research agenda targeting MSM is urgently needed to develop new and combined preventive interventions, markedly improve access to antiretroviral treatment, and evaluate the role of existing and potentially efficacious prevention tools," according to the authors of a recent report, Respect, Protect, Fulfill: Best Practices Guidance in Conducting HIV Research with Gay, Bisexual, and Other Men Who Have Sex with Men (MSM) in Rights-Constrained Environments.

However, those engaged in such HIV research face enormous challenges, because "in much of the world MSM and other sexual and gender minorities still face violence and discrimination, including discrimination while seeking healthcare, denial of their existence by some states [nations], criminal sanctions, lack of mental health and psychosocial support networks, and social exclusion."

This 40-page publication examines the role of research institutions, community organizations, and other stakeholders in HIV research involving MSM. It provides a series of case studies as well as specific recommendations for working effectively and respectfully with MSM. The report and its best practice guidance are the result of collaboration involving the Foundation for AIDS Research, International AIDS Vaccine Initiative, Johns Hopkins University's Center for Public Health and Human Rights, and the United Nations Development Program.

Eric Brus is the Director of Health Information at AIDS Action Committee. This report is produced by the Health Library of the AIDS Action Committee in collaboration with the New England AIDS Education and Training Center Minority AIDS Initiative Project. The full version is available online.