HIV/AIDS

HIV Infection in Minority Populations

Overview

HIV/AIDS continues to disproportionately affect minorities. Racial and ethnic minority populations in the United States, primarily African Americans and Hispanics, constitute 58 percent of the more than 928,188 cases of AIDS reported to the Centers for Disease Control and Prevention (CDC) since the epidemic began in 1981. African Americans make up 50 percent of all AIDS cases reported in the United States, yet according to the U.S. Census Bureau, they comprise only 12 percent of the U.S. population. Hispanics represent 15 percent of all AIDS cases in the United States and are approximately 13 percent of the U.S. population.

Injection drug use is a major factor in the spread of HIV in minority communities. Other factors contributing to the spread of HIV/AIDS in these communities include men who have sex with men (MSM) and increasingly, heterosexual transmission.

According to CDC

• As of December 2003, African Americans and Hispanics represented 64 percent of males living with AIDS and 83 percent of those in females.
• As of December 2003, 67 percent of all women reported with AIDS are African American and 16 percent are Hispanic.
• African-American children represent almost 71 percent of all pediatric AIDS cases.
• Of the 59 pediatric AIDS cases reported in 2003, 40 were in African Americans and 7 were in Hispanics.
• AIDS is the leading cause of death among African-American men ages 25-44.

NIAID Research on HIV Infection and AIDS

NIAID supports scientific research at universities, medical schools, hospitals, and research institutions, both in the United States and internationally. This research is aimed at preventing, diagnosing, and treating HIV/AIDS and other infectious diseases as well as allergic and other immune system disorders.

NIAID's HIV/AIDS research agenda includes conducting clinical trials that address the specific needs and concerns of minority populations, ensuring that all populations have access to clinical trials and the latest information on HIV/AIDS treatment and prevention. In addition, NIAID's Office of Special Populations Research and Training encourages research aimed at improving the health of minority populations and also works to increase the effectiveness of outreach and education programs.

NIAID works with community-based organizations to disseminate information about HIV infection, AIDS, and NIAID research activities, especially HIV vaccine development, to minority communities. NIAID is currently implementing an HIV Vaccine Communications Campaign (HVCC), which is aimed at increasing awareness of and support for HIV vaccine research, especially in at-risk populations. NIAID receives input and guidance for developing appropriate and culturally sensitive messages from its HIV Vaccine Communications Steering Group, which consists of representatives from community groups, other government agencies, pharmaceutical companies, and HIV vaccine advocacy groups. In addition, HVCC supports the Community Education and Outreach Partnership Program, which is designed to create local and national partnerships. The goal of these partnerships is to enhance NIAID's ability to provide messages on HIV vaccine, treatment, and prevention research to African Americans, Hispanic, and MSM populations.

Clinical Research

• Adult AIDS Clinical Trials Group (AACTG)
• Pediatric AIDS Clinical Trials Group (PACTG)
• Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA)
• HIV Prevention Trials Network (HPTN)
• HIV Vaccine Trials Network (HVTN)
• Acute Infection and Early Disease Research Program (AIEDRP)

NIAID's Vaccine Research Center (VRC) also conducts Phase I trials of HIV vaccines at the VRC Clinic housed in the NIH Clinical Center in Bethesda, Maryland.

Together, these programs represent the largest HIV/AIDS treatment and prevention initiative in the world. Recruiting minorities into clinical trials is a priority for NIAID to ensure that research results will apply to all populations affected by HIV. With the epidemic disproportionately affecting minority communities, inclusion of these populations is particularly urgent.

AACTG investigates therapeutic interventions for HIV infection, AIDS, complications of HIV-associated immune deficiency, and associated co-infections in adults. AACTG sites receive additional funding from the National Institute on Drug Abuse (NIDA) to increase participation of injection drug users, who are also disproportionably affected by the AIDS epidemic.

PACTG evaluates clinical interventions for treating HIV infection and HIV-associated illnesses in neonates, infants, children, and adolescents. Both PACTG and HPTN are researching approaches to interrupt mother-to-child transmission (MTCT) of HIV. In 2004, 6,367 and 2,815 participants were enrolled in AACTG and PACTG studies respectively. In AACTG, 30 percent were African American, 19 percent Hispanic, 2 percent Asian/Pacific Islander, and less than one percent American Indian/Alaska Native. In PACTG, 58 percent were African American, 27 percent Hispanic, 1 percent Asian/Pacific Islander, and less than 1 percent American Indian/Alaska Native.

CPCRA is a network of community-based health centers and clinics that support clinical research in community settings. CPCRA conducts large comparative studies that examine how to use available therapies more effectively as well as the long term consequences of different treatments. Currently, CPCRA trials are under way in 17 cities at 18 units. In 2004, 4,869 people participated in CPCRA studies. Of those, 45 percent were African American, 13 percent Hispanic, 1 percent American Indian/Alaska Native, and 1 percent Asian/Pacific Islander.

NIAID also supports clinical research on vaccine and non-vaccine strategies to prevent HIV infection. Vaccine studies are carried out through HVTN, and non-vaccine prevention studies are conducted by HPTN. HVTN is a global network of clinical sites that evaluate preventive HIV vaccine in all phases of clinical trials. They allow for studies that examine differences in HIV diversity and genetic background, all of which may prove crucial to developing an effective vaccine for use around the world.

HPTN is a global multicenter network dedicated to non-vaccine biomedical and behavioral interventions. The primary areas of research of HPTN include topical microbicides, sexually transmitted infection prevention and treatment, behavioral and barrier interventions, antiretroviral drugs, interventions related to drug abuse, and modalities to decrease MTCT. HPTN is also funded by the National Institute of Child Health and Human Development (NICHD), NIDA, and the National Institute of Mental Health.

Through close collaborations and education outreach programs with communities where vaccines will be tested, HVTN and HPTN hope to enroll a diversified population in their clinical trials, ensuring access and representation of populations most affected by and vulnerable to HIV spread.

HVTN and HPTN opened in 2000 and have since enrolled thousands of study participants. In FY 2004, 1,348 and 11,091 people participated in HVTN and HPTN, respectively. Of those in the HVTN, 29 percent were African American, 44 percent Hispanic, 1 percent Asian/Pacific Islander, and less than 1 percent American Indian/Alaska Native. In HPTN, 64 percent of participants were African American, 8 percent Hispanic, 15 percent Asian/Pacific Islander, and less than 1 percent American Indian/Alaska Native.

AIEDRP is a multisite network that studies how HIV causes disease in adults. Each AIEDRP site works with universities or hospitals that conduct research with people who have been recently infected with HIV. In FY 2004, AIDERP enrolled 726 patients. Of those patients enrolled, 5 percent were Black, 12 percent Hispanic, 4 percent Asian, and less than 1 percent American Indian/Alaska Native.

Epidemiologic Research

Similar populations of women are the focus of WIHS. NIAID awarded funds to six U.S. sites in 1993 to investigate primarily the impact of HIV infection on women. Several other NIH institutes also collaborate on WIHS and provide funds for various components. They include NIDA, the National Cancer Institute, NICHD, and the National Institute of Dental and Craniofacial Research.

Active community involvement through WIHS sites and the WIHS National Community Advisory Board helps encourage minority women to participate in the studies. More than 80 percent of the women currently enrolled in WIHS are from minority populations.

In the United States, MACS and WIHS are the two largest observational studies of HIV/AIDS in homosexual or bisexual men and in women, respectively. These studies have made major contributions to understanding how HIV is spread, how the disease progresses, and how it can best be treated. Over the past year, these studies expanded their enrollment to increase the size of the study groups by 60 percent and increase the number of minority participants. The enlarged groups will focus on contemporary questions regarding HIV infection and treatment.

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