Pam Harrison

June 18, 2014

Women are less likely to take antiretroviral therapy (ART) than men, and black people are less likely than Hispanic or white people to take ART, according to research conducted in the United States.

"Women make up one-quarter of all persons living with HIV in the United States, and most of these women are black or Hispanic/Latina," said Linda Beer, PhD, an epidemiologist from the Centers for Disease Control and Prevention (CDC) in Atlanta.

She and her colleagues "wanted to better understand which groups with HIV are doing well and which groups are doing less well," she told Medscape Medical News.

With that information, "clinical and prevention services can be better tailored to make sure people are receiving the care they need to stay healthy and reduce the risk of HIV transmission," she said.

Dr. Beer presented the study findings at the 9th International Conference on HIV Treatment and Prevention Adherence in Miami.

MMP Surveillance System

Data for this analysis came from the Medical Monitoring Project (MMP), which is an ongoing surveillance system for HIV-positive adults receiving care in the United States.

In the cohort of 8169 study participants, more men than women were taking ART (91% vs 85%; P < .0001).

And black people were significantly less likely to be on ART than Hispanic or white people (86% vs 91% vs 92%; P < .0001).

Overall, the rate of viral suppression — defined as a viral load below 200 copies/mL — was higher in men than in women (74% vs 69%; P < .0021).

In white participants, the rate of viral suppression was also significantly higher in men than in women (81% vs 74%; P < .05). However, when just people being treated with ART were considered, rates of viral suppression were the same in men and women of the same race.

There was no significant difference in viral suppression between men and women for the black and Hispanic participants.

Women in Care

"When we asked why women in care were less likely to take ART, we found that women and men were equally likely to report ever having taken ART," Dr. Beer reported.

However, the rate of ART discontinuation was higher in black women than in black men (7% vs 4%) and in white women than in white men (8% vs 3%). Because of the small numbers, the rate of discontinuation could not be compared in Hispanic participants.

"When we asked participants why they were not taking ART, most said it was based on advice from their providers," Dr. Beer explained. The reasons healthcare providers might have advised patients to discontinue ART could not be determined from the survey data, she added.

Overall, ART use in the United States is high. Nevertheless, 31% of women and 26% of men receiving medical care have not achieved viral suppression. In addition, there are disparities in rates of viral suppression between white men and white women and between racial/ethnic groups, she said.

"In general, improving care for all people with HIV is critical to reduce the impact of HIV," Dr. Beer told Medscape Medical News.

"To maximize treatment success for HIV-infected women, we need to make more of an effort to decrease racial and ethnic disparities in viral suppression, she explained, "and we need to better understand why women are less likely to take ART than men."

This study is "a call to action" to generate increased demand for HIV treatment by HIV-positive women, said José Zuniga, PhD, MPH, who is president and chief executive officer of the International Association of Physicians in AIDS Care (IAPAC).

"We can do so by enhancing HIV literacy and using gender-specific linkage to care and HIV treatment initiation interventions, including the use of peer educators," he told Medscape Medical News.

"There is no reason, in 2014, for any person living with HIV/AIDS to be denied or to abstain from starting ART, particularly given its therapeutic and preventative benefits," Dr. Zuniga said.

The study was funded by the CDC. Dr. Beer has disclosed no relevant financial relationships.

9th International Conference on HIV Treatment and Prevention Adherence: Abstract 283. Presented June 9, 2014.


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