HIV in Blacks: Mortality Rate High but Declining, CDC Says

Beth Skwarecki

February 06, 2015

Black communities have higher HIV infection and mortality rates than other groups, but their mortality rates have declined by 28% from 2008 to 2012, Puja Seth, PhD, from the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, and colleagues report in an article published in the February 5 issue of the Morbidity and Mortality Weekly Report.

The 2012 rate is still 13% higher than the same statistic in whites, and 47% higher than for Hispanics, according to another article published in the same issue of the report by Azfar-e-Alam Siddiqi, MD, PhD, also from the Division of HIV/AIDS Prevention, and colleagues.

"CDC and its partners have been pursuing a high-impact prevention approach and supporting projects focusing on minorities to improve diagnosis, linkage to care, and retention in care, and to reduce disparities in HIV-related health outcomes," write Dr Siddiqi and colleagues. These relate to the National HIV/AIDS Strategy's three goals: reducing HIV incidence, improving access to care for those living with HIV, and reducing health disparities such as mortality rates.

HIV testing is a key part of that strategy. An estimated 15% of blacks with HIV are undiagnosed. Dr Seth and colleagues analyzed HIV testing among black populations. Blacks accounted for 45.0% of CDC-funded HIV tests in 2013, as well as 54.9% of people newly identified as HIV-positive. The data on HIV tests come from 61 US health departments, including departments in all 50 states and some large cities. Because they do not include all HIV tests done in the country, the authors caution that the results may underestimate the amount of testing that occurred, and because of self-reporting of previous tests, they may overestimate the number of new positives.

For the mortality reports, data came from the National HIV Surveillance System from 2008 to 2012 and included black people aged 13 years and older who had HIV at the time of death. During that period, the number of deaths decreased 18% and the rate per 100,000 blacks decreased 21%. In 2012, the last year studied, there were 8165 deaths among blacks living with HIV compared with 5426 among whites and 2586 among Hispanics or Latinos. The decreases were "greater and more consistent," write Dr Siddiqi and colleagues, in black populations compared with in others.

There also was geographic variation in disparity in mortality rates between blacks and other groups. In 2012, the highest rates per 1000 persons living with HIV were in West Virginia (28.9); the lowest rates were in Nebraska (9.3). Of the 10 states with the highest death rates per 1000 people living with HIV, seven were in the South. Calculated instead by 100,000 population, the highest mortality rates among blacks were in the District of Columbia (98.4 per 100,000), and the lowest was in Alaska (5.2). The highest total number of deaths occurred in Florida (1147).

In the HIV testing report, blacks made up 1,506,016 of the CDC-funded HIV testing events, with 42.5% of those occurring in people aged 20 to 29 years and 66.1% in persons living in the South. Slightly more females (52.7%) than males (46.9%) were tested. The highest rates of new positives were among men who have sex with men, who accounted for 8.8% of tests but 37.3% of new positives, according to Dr Seth and colleagues.

Among blacks newly identified as having HIV, 53.5% were linked to medical care at any time after diagnosis, and 44.5% within 90 days, according to Dr Seth and colleagues. Referrals to other services, important in preventing transmission, included 65.8% of new positives referred to HIV partner services and 53.6% referred to HIV prevention services. Rates of referral for these services were highest among men who had sex with men. The authors write that expanded screening programs and better linkage to care are needed to further reduce disparities.

Of the mortality data, Dr Siddiqi and colleagues write, "although disparities in mortality by race/ethnicity persist, the overall outlook for all persons living with HIV has improved, and the gaps between different races/ethnicities have narrowed."

The authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2015;64:81-90. Seth full text, Siddiqi full text

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