African-Americans and HIV/AIDS in the United States

African-Americans’ share of the U.S. AIDS burden has never been more disproportionate to their representation in the total population.

Surveillance

• In 2004, Blacks* accounted for just 12.2 percent of the U.S. population but 49.3 percent of estimated new AIDS cases.^{1, 2} 
• At the end of 2004, it was estimated that 42.9 percent of people living with AIDS in the United States were Black, reflecting a continued increase over previous years.³ The AIDS rate among adults (the number of people living with AIDS per 100,000 population) was 72.1 for Blacks, compared with 17.1 for the total U.S. population.⁴
• Black men and women account for an ever-growing number of U.S. deaths attributed to AIDS. Since the onset of the epidemic, an estimated 38 percent of deaths from AIDS have been among Blacks, and the proportion is increasing. In 2004, 50.5 percent of total AIDS mortality were among Blacks.⁵ 

Blacks accounted for one-third of all men estimated to be living with AIDS in the United States at the end of 2004. An estimated 29.2 percent of Black men with AIDS had acquired the disease through injection drug use (IDU), and 18.1 percent had become infected through heterosexual contact—a much higher proportion than that for all men (21.1 percent IDU and 11.2 percent heterosexual contact). Men who have sex with men (MSM) was less likely to have been the reported HIV exposure category for Black men (43.7 percent) than for all men (58.3 percent) and, especially, for White men (75.2 percent).⁶ 

Women

At the end of 2004, 60.3 percent of all women estimated to be living with AIDS were Black. Heterosexual contact was the HIV exposure category for 65.2 percent of those cases.⁶ The AIDS rate among adult Black women was 48.2, approximately 23 times that of White women (2.1).⁴

Children

One-half of all children under age 13 who were estimated to be living with AIDS at the end of 2004 were Black.⁴ Since the onset of the epidemic, perinatal (mother-to-child) transmission has been the exposure category in 91.4 percent of cases in children.⁷

CRITICAL ISSUES

Blacks are more likely to be uninsured than their White counterparts (19.7 percent versus 11.3 percent).⁸ Blacks have the highest poverty rate of all ethnic and racial groups.⁸

A study on infection patterns and risk behavior among young urban MSM found that HIV infection rates were high among Blacks (14 percent, compared with 3 percent for Whites).⁹

A correlation has been found between perceived discrimination in HIV treatment and the status of mental and physical health, medication adherence, and health care satisfaction. In a study of AIDS patient care, 71 percent of participants reported having experienced race-based discrimination in a health care setting, and 66 percent reported
experiencing discrimination on the basis of socioeconomic status, social class, or position.¹⁰

African-Americans constitute 40 percent of the incarcerated population. Men who are incarcerated are at greater risk for HIV infection, thereby increasing the risk of transmission into other populations upon their release.¹¹ Behavioral health risks associated with incarceration (and, thus, a greater incidence of HIV infection) include unprotected sexual contact, tattooing, and drug use.¹²

African-American men over age 50 are another group at increasingly high risk for HIV infection; they are a subpopulation often overlooked in preventive measures.¹¹

Although it is more important than ever to ensure access to treatment for African-Americans, they are less likely than Whites to participate in clinical drug trials as a result of continued distrust of the health care system.¹³

African-Americans and the Ryan White CARE Act

In 2004, more than one-half (52 percent) of all Ryan White Comprehensive AIDS Resources Emergency (CARE) Act clients were African-American. The proportion was much higher in some care settings.

To increase access to quality care for minorities and respond to the need for additional minority providers of state-of-the-art HIV/AIDS care in underserved communities, the CARE Act funds the National Minority AIDS Education and Training Center program to expand clinical expertise in minority communities. More information is available at www.nmaetc.org.

The Health Resources and Services Administration has supported a range of activities that address the epidemic among African-Americans. Highlights include the African-American Children’s Initiative, funded through the CARE Act Title IV program for Women, Infants, Children, Youth, and Families; community consultations and collaborations with community organizations such as the National Minority AIDS Council; and publication of study findings related to the search for increasingly effective means for reaching underserved populations.

Capacity-building and planning grants have been targeted to underserved communities to expand the number of service settings available to vulnerable minority populations.

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References

1.  U.S. Census Bureau. 2004 American Community Survey Data Profile Highlights. 2004. Accessed January 4, 2006, at:http://factfinder.census.gov.

2. Centers for Disease Control and Prevention (CDC). HIV/AIDS Surveillance Report. 2004;16(1):12. Table 3.
3. CDC. HIV/AIDS Surveillance Report. 2004;16(1): 20. Table 10.
4. CDC. HIV/AIDS Surveillance Report. 2004;16(1):14. Table 5a.
5. CDC. HIV/AIDS Surveillance Report. 2004;16(1): 16. Table 7.
6. CDC. HIV/AIDS Surveillance Report. 2004;16(1):21. Table 11.
7. CDC. HIV/AIDS Surveillance Report. 2004;16(1): 32. Table 17.
8. U.S. Census Bureau. Income, poverty, and health insurance in the United States: 2004. Washington, DC; 2005:16. Available at: www.census.gov/prod/
   2005pubs/p60-229.pdf. Accessed December 21, 2005.
9. Halpern CT, et al. Implications of racial and gender differences in patterns of adolescent risk behavior for HIV and other sexually transmitted diseases. Perspect Sex Reprod Health. 2004; 36(6):239-47.
10. Bird ST, et al. Health-related correlates of perceived discrimination in HIV care. AIDS Patient Care STDS. 2004;18(1):
    19-26.
11. Clarke-Tasker VA, et al. HIV risk behaviors in African American males. Assoc Black Nurs Faculty J. 2005;16:56-9.
12. Blankenship KM, et al. Black-white disparities in HIV/AIDS: the role of drug policy and the corrections system. J Health Care Poor Underserved. 2005; 16(4 suppl B):140-56.
13. Medina C, Johnson W. HIV/AIDS prevention in Latino and African-American communities. J Natl Med Assoc. 2004; 96(suppl 2):9S-11S.