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The US Epidemic - Disparities in HIV Disease for African-Americans
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Reported by Jules Levin
17th CROI Feb 16-19 2010 SF
AIDS in America Forgotten - what's new - Rome Burns As the Emperor Fiddles - (02/12/10) New England Journal of Medicine
Talk broken up into 3 parts:
Blacks in US make up 12% of population but 50% of AIDS cases, same if not moreso is true for new HIV cases, Hispanics make up 15% of US population but 19% of AIDS cases.
1995: famous rap artist
By 1993 Blacks overtook Whites in the percentage of AIDS cases and over the last 15 years the numbers have continued to rise and the gap between the percent whites and blacks has increased.
Rates of HIV in the USA: <1% in USA; 3% in DC, 6% among Blacks in DC; in Newark 2%, 3% among Blacks; in NYC, a little less than 2% but 3% among Blacks, and strikingly among MSM in NYC nearly 14%. This should be alarming and grab our attention. Smith added although these numbers reflect urban populations we could find equally striking numbers in the South in the USA. And I will add there are many other cities like Chicago, Houston, Dallas, Miami and LA where the numbers are similar, these numbers reflect on the entire US epidemic where I might add HCV/HIV coinfectin lives, in patient populations of color, and HCV has been for years the leading cause of death and hospitalization in HIV.
HIV Prevalence in Adults from Selected Countries in Sub-Saharan Africa and Subpopulations in the United States. Data are from the Centers for Disease Control and Prevention, the District of Columbia Department of Health, the New Jersey Department of Health, the New York City Department of Health and Mental Hygiene, and the Joint United Nations Program on HIV/AIDS (UNAIDS). MSM denotes men who have sex with men.
Women I DC: 3 or less sex partners in last year, 46% of women had one partner, 71% last vaginal intercourse unprotected
Higher Rates of STDs Among Black MSM and Lower Rates of Receiving ART
Fig. 2. Study-specific and overall effect size estimates for unprotected anal intercourse (UAI), number of sex partners, and sexually transmitted disease history in comparative studies of black and white men who have sex with men (MSM). Odds ratios >1 indicate a greater likelihood of an outcome among black MSM than white MSM. Bars indicate the 95% confidence intervals.
Reference sources given by first author and year only.
In Chicago, 30% of Black MSM are HIV+, Black men <35 yrs old 7 times more likely to be HIV+ than white MSM in same age group. In Wash DC 20% HIV+ among Black MSM.
20% of HIV+ patients at Grady in Atlanta & Jackson Memorial in Miami never saw a provider despite having HIV for > 5 yrs: risk factors - drug use and Black race.
Blacks show worse survival but key in this study was that the percent of time on HAART was significantly less for Blacks (47% vs 76%) and after adjusting for this Black race was no longer significant for lower survival rate.
Missed visits to provider more common among Blacks and also among women. AAs more likely to experience viral failure. Higher mortality in persons with missed visits.
Patients trusted primary care provider.
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