Report Highlights HIV Diagnosis Disparities Among Black Adults

Communities with the highest social vulnerability saw higher rates of new HIV diagnoses among Black adults, according to the CDC’s latest Morbidity and Mortality Weekly Report.

In 2018, 43% of all new US HIV diagnoses were among Black adults, defined as aged 18 and older. Further, the annual rate of HIV diagnoses for Black persons was quadruple that of all other racial or ethnic groups combined.

These disparities are especially seen in areas in the highest quartile (Quartile 4) of the Social Vulnerability Index (SVI), which are areas with the highest potential of negative health effects caused by external stressors. In Quartile 4 communities, Black adults are 1.5 times more likely to receive an HIV diagnosis vs people in communities in the lowest quartile (Quartile 1), and about half of Black adults with a HIV diagnosis live in these high SVI areas.

“Because of a history of racial discrimination and residential segregation, some Black persons in the United States reside in communities with the highest social vulnerability, and this finding is associated with experiencing increased risk for HIV infection,” the report authors wrote.

The data came from 13,807 Black adults with diagnosed HIV and was collected by the SVI and National HIV Surveillance System, with SVI scores unavailable for 253 (1.8%) persons. Disparity rates were analyzed by sex at birth and stratified by US region, age group at diagnosis, transmission category, and SVI Quartile. Rates were calculated per 100,000 persons.

The number and percentage of HIV diagnoses among Black adults by SVI quartile were as follows:

• Quartile 1: 1045 (7.6%)
• Quartile 2: 1881 (13.6%)
• Quartile 3: 3423 (24.8%)
• Quartile 4: 7205 (52.2%)

Overall, Black adults in Quartile 4 had a HIV diagnosis rate of 52.1 compared with Black adults in Quartile 1, which although lower, still had a high rate of 33.7.

Again when comparing Quartiles 4 and 1, Black males aged 45 to 54 years at diagnosis living in Quartile 4 were 2.3 times (rate ratio [RR], 2.3; 95% CI, 1.8-3.0) more likely to receive an HIV diagnosis compared with Quartile 1; this age group had the highest RR of male age groups in this comparison.

Black females also had an overall higher RR compared with males. Black females aged 35 to 44 at diagnosis were 2.4 times (95% CI, 1.8-3.3) more likely to receive a HIV diagnosis when living in Quartile 4 compared with Quartile 1. Black females aged 18 to 24 and 45 to 54 also were twice as likely to receive a diagnosis in Quartile 4 compared with Quartile 1.

Black males and females were both 2.3 times more likely to receive an HIV diagnosis in Quartile 4 if they lived in the Northeast, and Black males were also 2.1 times more likely if they lived in the West, compared with Quartile 1.

If HIV was transmitted by male-to-male sexual contact and injection drug use, the number of diagnoses in Quartile 4 was 11.6 times that in Quartile 1. The number of diagnoses for black females that were attributed to injection drug use in Quartile 4 was 12.3 times that of Quartile 1.

“Although social vulnerability does not explain all the disparity in HIV diagnosis, Black adults in communities with the highest social vulnerability might find it harder to obtain HIV prevention and care services because of various factors, such as poverty, limited access to health care, substance use disorder, transportation services, housing insecurity, HIV stigma, racism, discrimination, and high rates of sexually transmitted diseases,” the authors added.

They also noted 4 major limitations of the report that may underestimate the real number of HIV cases included in the report:

• HIV may not have been detectable and, therefore, not diagnosable at time of testing for many persons with HIV
• Anonymous and self-test results were not reported, so positive HIV tests may exist and are not reflected in these findings
• Lack of availability and access to medical care and testing services—among other factors—potentially leaves multiple people not knowing if they have HIV
• HIV infection may have occurred in a place other than the person’s residence at time of diagnosis

To solve these issues that lead to increasing disparities, the authors suggested the implementation of various HIV interventions in programs to address the needs of Black adults in high SVI areas.

“The development and prioritization of interventions that address social determinants of health (ie, the conditions in which persons are born, grow, live, work, and age) are critical to address the higher risk for HIV infection among Black adults living in communities with high levels of social vulnerability,” the authors said.

Reference

Dailey AF, Gant Z, Hu X, Lyons SJ, Okello A, Johnson AS. Association between social vulnerability and rates of HIV diagnoses among Black adults, by selected characteristics and region of residence — United States, 2018. MMWR Morb Mortal Wkly Rep. 2022;71(5):167-170. doi:10.15585/mmwr.mm7105a2