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Blacks 51% of New HIV/AIDS Cases, Racial/Ethnic Disparities in Diagnoses of HIV/AIDS --- 33 States, 2001--2005
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MMWR CDC March 99, 2007
During 2001--2004, blacks accounted for 51% of newly diagnosed human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) infections in the United States (1). This report updates HIV/AIDS diagnoses during 2001--2005 among black adults and adolescents and other racial/ethnic populations reported to CDC through June 2006 by 33 states that had used confidential, name-based reporting of HIV and AIDS cases since at least 2001. Of the estimated 184,991 adult and adolescent HIV infections diagnosed during 2001--2005, more (51%) occurred among blacks than among all other racial/ethnic populations combined. Most (62%) new HIV/AIDS diagnoses were among persons aged 25--44 years; in this age group, blacks accounted for 48% of new HIV/AIDS diagnoses. New interventions and mobilization of the broader community are needed to reduce the disproportionate impact of HIV/AIDS on blacks in the United States.
For this report, cases of HIV or AIDS were analyzed together as HIV/AIDS (i.e., HIV infection with or without AIDS) and counted by year of diagnosis. Cases were classified according to the following transmission categories: 1) male-to-male sexual contact (i.e., among men who have sex with men [MSM]); 2) injection-drug use (IDU); 3) MSM with IDU; 4) high-risk heterosexual contact (i.e., with a person of the opposite sex known to be HIV infected or at high risk for HIV/AIDS [e.g., MSM or injection-drug user]); and 5) other (e.g., hemophilia or blood transfusion) and all risk factors not reported or not identified. The estimated number of HIV/AIDS diagnoses for each racial/ethnic population by transmission category and selected characteristic was calculated. For 2005, estimated diagnosis rates per 100,000 population were calculated for each racial/ethnic population, and rate ratios (RRs) comparing other populations with whites were determined. In addition, estimated HIV prevalence and AIDS prevalence rates for blacks living with HIV or AIDS at the end of 2005 were calculated. Prevalence estimates were derived from reported cases and adjusted for delays in reporting and deaths (2). Estimated HIV and AIDS prevalence rates per 100,000 population were calculated for each state and the District of Columbia (DC).
Although adult and adolescent blacks accounted for 13% of the population in the 33 states during 2001--2005 (3), they accounted for 50.5% of the 184,991 new HIV/AIDS diagnoses; whites accounted for 72% of the population and 29.3% of diagnoses, and Hispanics accounted for 13% of the population and 18.2% of diagnoses. Among racial/ethnic populations, blacks accounted for the largest percentages of cases diagnosed in both males (43.9%) an dfemales (67.2%) (Table 1).
During 2001--2005, blacks had the largest percentage of HIV/AIDS diagnoses in all age groups and in the IDU and high-risk heterosexual transmission categories (Table 1). Among men and women with IDU and persons with high-risk heterosexual contact, more than half were black (men: 53.8% and 65.7%, respectively; women: 58.8% and 69.5%, respectively). More MSM with HIV/AIDS diagnoses were white (42.7%), with smaller proportions of blacks (36.2%) and Hispanics (19.0%).
During 2001--2005, adults aged 25--44 years accounted for a majority of HIV/AIDS diagnoses regardless of racial/ethnic population (Table 1). Among persons aged 25--34 and 35--44 years, blacks accounted for the greatest proportion of cases (48.0% and 47.5%, respectively). By region, blacks accounted for the majority of diagnoses in the South (54.3%) and Northeast (52.0%) (Table 1). Black males accounted for more new HIV/AIDS diagnoses than males of any other racial/ethnic population in the South (47.5%) and Northeast (46.1%). Among females, blacks accounted for the majority of HIV/AIDS diagnoses in the South (71.5%), Northeast (64.4%), and Midwest (63.5%), compared with other racial/ethnic populations.
Among black males and females, the age distribution of persons who had HIV/AIDS diagnosed varied by transmission category (Table 2). By transmission category, most HIV/AIDS diagnoses of black male adults and adolescents were classified as MSM (30,154 [51.7%]), followed by high-risk heterosexual contact (14,698 [25.2%]), IDU (10,415 [17.9%]), MSM with IDU (2,698 [4.6%]), and other (322 [0.6%]). Most HIV/AIDS diagnoses among black female adults and adolescents were classified as high-risk heterosexual contact (28,283 [80.4%]), followed by IDU (6,412 [18.2%]), and other (465 [1.3%]) (Table 2).
In 2005, the estimated annual HIV/AIDS diagnosis rate among black males was 127.6 per 100,000 population and among black females was 61.4 per 100,000, both higher than the rates for all other racial/ethnic populations. Among males, the annual HIV/AIDS diagnosis black/white RR of 6.9 was higher than the Hispanic/white RR of 3.1. Among females, the black/white RR was 20.5, and the Hispanic/white RR was 5.4.
In 2005, overall estimated HIV (i.e., without AIDS) and AIDS prevalences were higher among blacks than among all other racial/ethnic populations. Among blacks, the estimated HIV prevalence (in 33 states) was 515 per 100,000 population, ranging from 109 (Alaska) to 858 (New Jersey); the estimated AIDS prevalence (in the 50 states and DC) was 639 per 100,000 population and ranged from 79 (Wyoming) to 3,179 (DC) (Table 3).
Reported by: T Durant, PhD, K McDavid, PhD, X Hu, MS, P Sullivan, DVM, PhD, R Janssen, MD, Div of HIV/AIDS Prevention; K Fenton, MD, PhD, Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (proposed), CDC.
Editorial Note:
During 2001--2005, HIV/AIDS diagnoses, diagnosis rates, and RRs were higher among black males and females than among any other racial/ethnic population in the United States. In 2005, the annual rates of HIV/AIDS diagnosis among black men and women were seven and 21 times higher than rates among white men and women, respectively. For black men, sexual contact with men was the primary mode of HIV infection; for black women, high-risk heterosexual contact was the primary mode. In a recent study of MSM in five cities, 46% of blacks were infected with HIV, compared with 21% of whites and 17% of Hispanics (4). In 2004, HIV/AIDS was the fourth-leading cause of death among blacks aged 25--44 years in the United States (5).
During 2001--2004, HIV diagnosis rates among black males and females declined by 4.4% and 6.8%, respectively (1). A 2007 study reported similar declines among blacks in Florida (6). These declines were observed among black heterosexuals and injection-drug users but not among MSM. Although these declines in rates of new HIV diagnoses are encouraging, they might not directly reflect trends in HIV incidence because they are also affected by changes in testing behavior and surveillance practices. Regardless of the trends, blacks remain disproportionately affected by high rates of HIV/AIDS. Several factors might contribute to these higher rates (e.g., higher overall prevalence of infection and undiagnosed infection among MSM or greater likelihood among females of high-risk heterosexual contact) (7).
The findings in this report are subject to at least two limitations. First, the data were reported from states with confidential, name-based HIV/AIDS surveillance systems and are not necessarily representative of all persons in the United States testing positive for HIV. Diagnoses of HIV/AIDS from areas with historically high AIDS morbidity that do not conduct confidential, name-based surveillance (e.g., California, Illinois, and DC) were not included. However, the racial/ethnic disparities described in this report are similar to disparities observed among persons with AIDS from all 50 states (8). Second, the findings might be affected by statistical adjustments made for reporting delays and for cases reported with no identified risk factor. Such cases were reclassified based on data obtained from follow-up investigations and were assumed to constitute a representative sample of all cases initially reported without a risk factor. However, this assumption might not be valid, potentially affecting the accuracy of the estimated distribution of cases by transmission category.
The high rate of infection among blacks highlights the need to scale up known, effective HIV-prevention interventions and to implement new, improved, and culturally appropriate HIV/AIDS strategies. CDC, along with public health partners and community leaders, is announcing its Heightened National Response to the HIV/AIDS Crisis among African Americans to reduce the toll of this disease. This response will focus on four main areas: 1) expanding the reach of prevention services, including ensuring that federal prevention resources are expended where the need is greatest; 2) increasing opportunities for diagnosing and treating HIV, including encouraging more blacks to know their HIV serostatus; 3) developing new, effective, prevention interventions, including behavioral, social, and structural interventions; and 4) mobilizing broader action within communities to help change community perceptions about HIV/AIDS, to motivate blacks to seek early HIV diagnosis and treatment, and to encourage healthy behaviors and community norms that prevent the spread of HIV.
CDC will expand its partnerships with other federal agencies, state and local health departments, academic institutions, and community-based organizations to enhance research, policy, prevention services, testing, and linkage to care for blacks. CDC and public health partners will work with black faith, entertainment, media, civic, education, and business leaders and others who have not been historically involved in HIV prevention to address community awareness, perceptions, testing, and behavior. A collective response involving multiple sectors of society is required to reduce transmission of HIV/AIDS among blacks in the United States. Additional information regarding CDC's Heightened National Response to the HIV/AIDS Crisis among African Americans is available at http://www.cdc.gov/hiv/topics/aa.
References
1. CDC. Racial/ethnic disparities in diagnoses of HIV/AIDS---33 states, 2001--2004. MMWR 2006;55:121--5.
2. Green T. Using surveillance data to monitor trends in the AIDS epidemic. Stat Med 1998;17:143--54.
3. US Census Bureau. Population estimates: entire data set. Washington, DC: US Census Bureau; 2001--2005. Available at http://www.census.gov.
4. CDC. HIV prevalence, unrecognized infection, and HIV testing among men who have sex with men---five U.S. cities, June 2004--April 2005. MMWR 2005;54:597--601.
5. CDC. Web-based Injury Statistics Query and Reporting System (WISQARS). Atlanta, GA: US Department of Health and Human Services, CDC. Available at http://www.cdc.gov/ncipc/wisqars.
6. CDC. HIV/AIDS among blacks---Florida, 1999--2004. MMWR 2007; 56:69--73.
7. Millett G, Malebranche D, Mason B, Spikes P. Focusing "down low": bisexual black men, HIV risk and heterosexual transmission. J Natl Med Assoc 2005;97(7 Suppl):52S--59S.
8. CDC. HIV/AIDS surveillance report, 2005. Vol. 17. Atlanta, GA: US Department of Health and Human Services, CDC; 2006. Available at http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2005report/default.htm.
For this report, persons identified as white, black, Asian/Pacific Islander, American Indian/Alaska Native, or of other/unknown race are all non-Hispanic. Persons identified as Hispanic might be of any race.
Alabama, Alaska, Arizona, Arkansas, Colorado, Florida, Idaho, Indiana, Iowa, Kansas, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.
Includes only persons living with HIV that had not progressed to AIDS. These data were reported by the 33 U.S. states with confidential, name-based HIV reporting since at least 2001. Because HIV can be diagnosed at any time in the disease spectrum, the time between HIV and AIDS diagnoses varies.
Includes only persons living with AIDS. Cases were from the 50 U.S. states and the District of Columbia (DC). Because DC is not a state, caution should be exercised when comparing DC AIDS rates with those of the states.
Reporting delays (i.e., time between diagnosis and report) can differ by geographic location, age, sex, transmission category, and racial/ethnic population. Adjustments for reporting time were calculated for HIV and AIDS cases using a maximum likelihood statistical procedure that accounts for differences in reporting time for the preceding characteristics while assuming the reporting delay has remained constant over time. Adjustments also were made for cases initially reported without transmission category information. Adjustments for adults and adolescents were based on the redistribution of cases across transmission categories by sex, race/ethnicity, and geographic region for cases diagnosed 3--10 years earlier and initially classified as reported without risk factor information but later reclassified.
Northeast: New Jersey and New York. Midwest: Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin. South: Alabama, Arkansas, Florida, Louisiana, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia. West: Alaska, Arizona, Colorado, Idaho, Nevada, New Mexico, Utah, and Wyoming.
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