The HIV Epidemic Among Black Americans Requires Action

Cato T. Laurencin MD, PhD

A report on the state of HIV/AIDS in the African-American community highlighted an alarming health disparity gap—while Black Americans represent 12% of the population, they now account for close to 50% of the total reported HIV/AIDS cases in the US.

The paper, “HIV/AIDS and the African-American Community 2018: a Decade Call to Action,” was led by Cato T. Laurencin MD, PhD, Chief Executive Officer, Connecticut Institute for Clinical and Translational Science (CICATS), and director of the Institute for Regenerative Engineering.

Laurencin and his co-authors call for a more assertive approach to the HIV/AIDS epidemic in the African-American community, noting that their call to action a decade ago has not successfully addressed the situation. In fact, some aspects have worsened: the number of African-American males diagnosed with HIV increased 29% from 2005 to 2016.

From 2005 to 2016, the number of cases of HIV/AIDS in Black women and female adolescents from heterosexual contact increased 75% from 2,392 to 4,189 and during the same time, there was a 76% increase in diagnoses of heterosexual Black men.

A more dramatic increase occurred among Black men who have sex with men (MSM), who had a 154% increase in HIV incidence from 4,020 in 2005 to 10,223 in 2016. The paper called attention to the stigmatization of homosexuality, particularly in the African-American Church, and suggested that the importance of the Church in the Black community could account for the high incidence of HIV among Black MSM who may be more likely to hide sexual activities and less likely to get tested.

"It is clear that much more needs to be done to address the fact that African-Americans continue to be overrepresented across all categories of transmission," said Laurencin in a statement.

Incarceration also exerts outsized influence on the African-American population—in 2016, 32% of US state and federal prisoners were Black. African-Americans are over 5 times as likely to be imprisoned as white Americans, and prisoners are 5 times more likely to be diagnosed with HIV/AIDS as those not incarcerated. The authors state that many prisons refuse to “test, prevent and treat” HIV among prisoners, contributing to the “virus that fuels the epidemic in African-American communities.”

Access to healthcare outside of the prison system is challenging as well. In 2013, 87% of African-Americans were aware of their positive HIV status, but just 49% had achieved viral suppression. “The barriers to access to healthcare and treatment such as lack of availability of services and the deficiency of culturally competent care must be addressed,” wrote the authors.

The study authors emphasized the need for an intersectional approach to the wide array of factors involved in order to find a solution that will eradicate HIV/AIDS in the US.

“While higher rates of poverty and prevalence of negative socio-economic determinants in African-Americans are important underlying factors, we believe that a concerted, re-dedicated effort (as can be seen with other national health emergencies such as opioid addiction) can create meaningful change in the decade to come,” wrote the authors.

The study authors recommend a 5-step action plan calling upon medical professionals and public health leaders to immerse themselves in African-American communities, eliminate their prejudices and unconscious biases, become knowledgeable about HIV treatment options and other issues, advocate for an end to the epidemic and for the eradication of secondary factors such as incarceration rates, poverty, and STDs, and proactively create solutions that fit the changing needs of affected populations.

“This must be an “all hands” effort,” concluded the authors. “We are hopeful that with renewed vigor and re-dedication, the next 10 years will demonstrate dramatic progress towards reversing this disease in the African-American community.