African-Americans are far more likely than other Americans to be infected with HIV but far less likely to get life-saving treatments that stop the virus’ spread, a new US Centers for Disease Control and Prevention report finds.
“It’s a very sobering analysis that shows we are not out of the woods yet in getting a handle on the domestic HIV epidemic,” said Greg Millett, director of public policy at AmfAR, The Foundation for AIDS Research, in Washington, D.C.
He called the study – published in advance of the 18th annual National Black HIV/AIDS Awareness Day on February 7 – “groundbreaking” and “damning.”
CDC researchers analyzed 2014 surveillance data from more than 650,000 people living with HIV in 37 states and the District of Columbia. While 56 per cent of whites and 50 per cent of Hispanics consistently had the virus under control with antiretroviral medications, less than 41 per cent of blacks had sustained viral suppression, according to the CDC’s Morbidity and Mortality Weekly Report.
The analysis painted the grimmest picture for young African-Americans. Only 29 per cent of HIV-infected blacks between 13 and 24 years old were receiving the medication they needed to suppress the virus.
Since the late 1990s, antiretroviral drugs have lifted the death sentence off people with HIV. In addition to improving their health and survival, the drugs also curb transmission. Newly infected patients can cease to be contagious within a few months of starting antiretroviral drugs, raising hope of ending the epidemic.
But the new report shows that African-Americans’ inability to reap the benefits of the life-saving drugs threatens to slow efforts to thwart the virus. Blacks represented 12 per cent of the U.S. population and 44 of new HIV diagnoses in 2016.
“If we’re not able to get African-Americans diagnosed with HIV, to link them to care and keep them in care, then HIV is going to be part of the American landscape for some time to come,” said Millett, an epidemiologist who was a senior policy advisor on HIV/AIDS strategy for the Obama administration. He was not involved with the new study.
Dr. Eugene McCray, director of CDC’s Division of HIV/AIDS Prevention, told Reuters Health by email, “These findings underscore the importance of provider and public health efforts to reach all Americans living with HIV with effective treatment and care, including strategies to assist with adherence as needed. Addressing barriers to HIV care and treatment is critical to eliminating health disparities.”
“Recent progress - including steep declines in HIV diagnoses among African-American women - is encouraging. But we clearly have more work to do to ensure that testing and treatment are within reach of all people living with HIV,” McCray said.
Some 36.7 million people around the world are infected with HIV, and more than half are getting the antiretroviral therapy medicines they need to suppress the virus and keep their disease in check, UNAIDS data shows.
With 48 per cent of HIV-infected Americans having achieved viral suppression, patients in the U.S. were on average slightly less likely than patients elsewhere to have the infection under control. But African-Americans in every category - regardless of gender or how they contracted the virus - were far less likely to have sustained viral suppression, the CDC report showed.
The report’s authors cite lack of health insurance, limited access to health services, stigma and distrust of health providers as possible contributors to racial disparities in American HIV care. “Addressing barriers to HIV care and treatment is critical to reducing health disparities,” a CDC statement said.
Millett noted that most HIV-infected African-Americans live in southern states that failed to take advantage of Affordable Care Act allowances to expand healthcare to lower-income people.
“There’s a very clear through line between our healthcare policies - meaning the lack of Medicaid expansion in the southern U.S. - and the outcomes among African-Americans living with HIV in the United States,” he said.
“We’re not going to be able to end HIV in the United States if we’re not going to keep African-Americans in care and virally suppressed,” he said.