HIV Care Less Likely in Blacks vs Whites, Latinos

Laurie Barclay, MD

February 08, 2016

Despite progress in declining HIV incidence during the last decade, blacks remain less likely than whites or Hispanics to receive consistent, ongoing medical care, Centers for Disease Control and Prevention (CDC) researchers report in an article published in the February 5 issue of the Morbidity and Mortality Weekly Report.

"The racial/ethnic differences in HIV care retention are established during the first year after diagnosis, underscoring the importance of early engagement in care to reduce disparities in sustained retention in care and thus improve the resulting outcomes (e.g., initiation of treatment and viral suppression)," write Sharoda Dasgupta, PhD, from the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia, and colleagues.

"Consistent care matters. It enables people with HIV to live longer, healthier lives, and it prevents new infections," Jonathan Mermin, MD, director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said in a CDC news release. "And closing this gap in care will be essential if we are to see the narrowing racial divide in HIV diagnoses close completely."

Analyzing data from 11 states and the District of Columbia, Dr Dasgupta found that among adults diagnosed with HIV in 2010 and alive in 2013, only 38% of blacks with HIV received consistent care between 2011 and 2013 compared with 49% of whites and 50% of Hispanics/Latinos.

Among blacks, factors associated with HIV care retention, which was defined as having at least 2 CD4+ or viral load tests 3 or more months apart during a given calendar year, were female sex (44% vs 35% in males) and heterosexual transmission.

The authors also found that disparities in consistent retention in care, defined as retention in each of the 3 study years, were apparent during the first year after diagnosis and continued throughout the study.

"CDC has been working for many years to eliminate the HIV disparities that exist within the black community," said Eugene McCray, MD, director of CDC's Division of HIV/AIDS Prevention in the CDC release. "While we are seeing signs of success, we must continue our focus on prevention strategies that will have the greatest impact on African American communities and the nation overall. A key area of focus is ensuring that people living with HIV are diagnosed early, quickly linked to care and receive consistent care that improves their lives and protects the health of their partners."

Despite Progress, Racial Disparities Persist

  • Of 9824 persons diagnosed with HIV infection in 2010 and alive in December 2013, 54% were black, 17% were Hispanic, and 24% were white.

  • The proportion of patients lost to care during any of the 3 years was 28% in blacks, 23% in Hispanics, and 19% in whites.

  • Blacks are 12% of the US population but accounted for 44% of new HIV diagnoses in 2014, according to the CDC (73% of these were in men, mostly men who have sex with men).

  • Black women had the largest declines in new HIV diagnoses (42% since 2005; 25% since 2010), according to the news release, but annual HIV diagnosis rate for black women (30.0/100,000) remains 18 times that in white women and five times that in Hispanic/Latino women.

  • HIV diagnoses among black men who have sex with men increased 22% over the past 10 years but have plateaued recently, according to the news release.

Care Retention Reduces Transmission

The authors note that care retention not only benefits individual patients but also improves public health, by reducing healthcare burden and costs and decreasing viral transmission.

The CDC estimates that 90% of HIV transmission can be attributed to persons diagnosed with HIV but not retained in care (69%) and to those with undiagnosed infection (23%). Better antiretroviral therapy adherence and early diagnosis and treatment of comorbidities for those retained in care not only enhance survival but also reduce transmission.

However, the authors note that blacks are particularly likely to experience barriers to care retention, including lack of health insurance, limited access to health services, and stigma of HIV positivity.

"Continued collaboration among health care providers, community-based organizations, and state and local health departments can strengthen programs that support both early linkage to care after HIV diagnosis across all racial/ethnic groups and expansion of proven methods for improving retention in care (e.g., HIV case management, patient navigation systems, and co-location of medical services)," the report authors conclude.

The CDC highlighted several strategies in the press release that aim to improve care retention among minorities, including a $216 million, 5 year-project that supports prevention and preexposure prophylaxis programs in community-based organizations and state health departments.

The authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2016;65:77-82. Full text

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