Pronounced Racial HIV Disparities Persist in the US

At a plenary session at the recent CROI 2021, Professor James Hildreth, President of Meharry Medical College in Nashville, Tennessee, and a member of President Biden’s COVID-19 Health Equity Taskforce, presented the case for paying attention to social determinants of health in order to address the racial disparities in both the HIV and COVID-19 pandemics in the U.S.

Black people living in the U.S. have been and continue to be disproportionately affected by HIV. In 2018, despite only comprising 13% of the US population, Black Americans made up 43% of all new HIV diagnoses, while Black men who have sex with men (MSM) alone made up a quarter of all new HIV diagnoses. Although transmissions in white MSM have decreased in recent years, there were significant increases in new diagnoses among Black MSM aged twenty-five to thirty-four from 2014 to 2018. Hildreth also pointed out that the number of Black people presenting with AIDS (stage 3, or a CD4 count below 200) continued to increase even when antiretroviral therapy (ART) become more widely available in the mid-1990s, while AIDS diagnoses in white people were steeply declining. He pointed to a “chasm’”in health status between white people and those of other races in the U.S. that has once again been exposed by stark COVID-19 racial disparities.

Hildreth identified poor access to health information, delayed medical care, poorly managed chronic conditions, mass incarceration, and economic instability as some of the factors which act as social determinants of health. He pointed out that although Black PLHIV were less likely to be put on ART in a timely manner than their white counterparts, that gap has been closing since 2012. Still, Black PLHIV lag when it comes to viral suppression.
As for interventions to reduce these racial disparities and their related negative outcomes, Dr Kashif Iqbal from the CDC presented results from the five-year THRIVE demonstration project. THRIVE provided increased funding to jurisdictions with high numbers of Black or Latino men living with HIV, to enable health departments to develop community-based HIV prevention and care services in tandem with healthcare, behavioral health, and social service providers. The program sponsored various activities to support PrEP implementation, ranging from increased HIV testing, supporting community-based organizations to provide services such as PrEP screening and counselling, social media campaigns, healthcare provider training, and ongoing evaluation to improve the quality of services.

“The goal should be for each person to achieve their personal best health and wellness,” Hildreth concluded. “Achieving health equity means recognizing and meeting individual and community needs—the same approach cannot be assumed to work for all.”

—Reporting by Hank Trout

Hank Trout, Senior Editor, edited Drummer, Malebox, and Folsom magazines in the early 1980s. A long-term survivor of HIV/AIDS (diagnosed in 1989), he is a forty-year resident of San Francisco, where he lives with his husband Rick.