Gains in HIV Prevention Unequal Among Black Women

Hanna Demeke, RN, PhD

Fewer black women are being diagnosed with HIV, but new research finds the gains are not equally distributed among all black women.

Hanna Demeke, RN, PhD, the lead author of the study, said while the overall news for black women is good when it comes to HIV, foreign-born black women aren’t benefiting from HIV prevention programs at the same rates as other women.

“The analysis of annual diagnosis among black women in the US from 2008 to 2016 found that while diagnosis rates declined among all black women during this time period, the smallest decline was among non-US-born groups of black women,” Demeke told MD Magazine®. “When looking at disparities, absolute disparities declined for both US-born and non-US-born black women, however the relative disparity increased for non-US-born black women.”

Demeke works at the Centers for Disease Control and Prevention’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.

Between 2008 and 2016, 10,531 white women were diagnosed with HIV, and 39,333 black women were diagnosed with the virus. Those numbers are based on the National HIV Surveillance System and are limited to women for whom complete country-of-birth information was known. Of the white women diagnosed with HIV, just 4% were born in another country.

However, among the black women diagnosed with HIV, more than 1 in 5 (21.4%) were foreign born. Of the latter group, 61.9% were born in Africa, and 33.9% were born in the Caribbean.

Demeke said better HIV therapies are 1 likely reason overall HIV diagnoses are dropping.

Those include antiretroviral therapies that can suppress the virus to the point where it’s undetectable and untransmittable —as well as pre-exposure prophylaxis (PrEP)—which can be taken by an HIV-negative partner to prevent transmission.

Demeke also noted other research has shown factors, such as an overall drop in STDs among black women and a drop in HIV infections among black men, are also likely at play.

As for why foreign-born women seem to be lagging behind, Demeke said the data in the study were not focused on determining such causes. She said it’s also not known whether these women were contracting HIV before or after coming to the US.

However, she said there’s some evidence that non-US-born women may be less aware of their personal risk regarding HIV.

“Additionally, wariness of initiating HIV care due to fears related to immigration status and HIV-related stigma may prevent non-US-born women from accessing basic HIV prevention services, such as HIV counseling and testing,” she noted.

Though the exact causes of the disparity are unknown, Demeke said the takeaways are not. One key takeaway: black women shouldn’t be treated like a monolithic group.

“Accounting for the heterogeneity of the US black women’s populations is crucial in measuring and monitoring progress toward eliminating health disparities and helping tailor strategies, interventions, and programs aimed at reducing disparities in HIV diagnosis,” she said.

Among the strategies to tackle the problem, Demeke suggested expanding access to biomedical and behavioral interventions, as well as “culturally sensitive research guided by social and structural determinants frameworks.”

Demeke added that public health agencies need to ensure their prevention programs are appropriately tailored and targeted to include foreign-born women.

“Public health officials in communities with large female non-US-born populations should consider developing HIV prevention messages that are culturally and linguistically appropriate and deliver them through venues where foreign-born populations have reported feeling secure, such as schools, churches, and community centers,” she said.

The same holds true for providers who see patients with HIV, she said.

The study is titled, “Unequal Declines in Absolute and Relative Disparities in HIV Diagnoses Among Black Women, United States, 2008 to 2016.” It was published last month in the American Journal of Public Health.