Disparities in Incidence of Human Immunodeficiency Virus Infection Among Black and White Women - United States, 2010-2016.

Incident human immunodeficiency virus (HIV) infections among adolescent females and women declined during 2010-2016, with the largest decrease (21%) occurring among black women (1). However, in 2016, although black women accounted for 13% of the U.S. female population, 60% of new HIV infections among women were in black women, indicating persisting disparities (1). CDC used the population attributable proportion (PAP) disparity measure to describe the proportional decrease in HIV infection among black and white women combined that would be realized if the group with the higher rate (blacks) had the same rate as did the group with the lower rate (whites) (2). Analyses indicated that an estimated 3,900 of 4,200 (93%) incident HIV infections among black women in 2016 would not have occurred if rates were the same for black and white women. The PAP disparity measure decreased from 0.75 in 2010 to 0.70 in 2016, suggesting that if incidence rates for black women were the same as those for white women, the annual number of incident HIV infections among black and white women would have been 75% lower in 2010 and 70% lower in 2016. Continued efforts are needed to identify and address social and structural determinants associated with HIV-related disparities to eliminate these disparities and decrease HIV incidence among black women.

Trends in Geographic Rates of HIV Diagnoses Among Black Females in the United States, 2010-2015.

BACKGROUND: HIV diagnoses among females in the United States declined 22% from 2010 to 2015, including a 27% decline in diagnoses among black females. Despite this progress, disparities persist. Black females accounted for 60% of new HIV diagnoses among females in 2015. Geographic disparities also exist. This article describes geographic differences in HIV diagnoses among black females in the United States, from 2010 to 2015. MATERIALS AND METHODS: We examined HIV surveillance data from 2010 to 2015 to determine in which geographic areas decreases or increases in HIV diagnoses occurred. We used data from the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention's (NCHHSTP) AtlasPlus to calculate percent changes in HIV diagnosis rates by geographic region for black females ≥13 years of age. RESULTS: The number of new HIV diagnoses declined 27% among black females from 2010 to 2015. The highest rates of HIV diagnosis per 100,000 population of black females, from 2010 to 2015, were in the Northeast and the South. In 2015, five of the eight states reporting the highest rates of HIV diagnosis (i.e., the highest quartile) were in the South. CONCLUSIONS: HIV diagnosis rates decreased nationally among black females, but the decreases were not uniform within regions or across the United States. Some states experienced increases, and black females in the South and Northeast remain disproportionately affected. Additional research is needed to ascertain factors associated with the increases to continue progress toward reducing HIV-related disparities among females in the United States.

Effectively Addressing Human Immunodeficiency Virus Disparities Affecting US Black Women.

Black women have disproportionately higher rates of human immunodeficiency virus (HIV) infection, and low percentages being linked to care and becoming virally suppressed, compared with women of other races/ethnicities. To date, few evidence-based HIV prevention and care interventions tailored for black women exist. We highlight three essential factors to consider in designing culturally and gender-appropriate studies to address HIV-related disparities affecting black women: (1) social determinants of HIV risk, (2) determinants of equity, and (3) perceptions of black women's sexuality. Synergy between a strong evidence base and developing strong partnerships could accelerate progress toward HIV-related health equity for black women.

HIV Testing, Positivity, and Receipt of Services among Black, White, and Hispanic Women Participating in HIV Prevention Programs Funded by the Centers for Disease Control and Prevention, 2015.

BACKGROUND: Black women who are positive for human immunodeficiency virus (HIV) are more likely than other HIV-positive women to experience poor health outcomes. Given these disparities, we compared receipt of HIV testing and other preventive services among Black, White, and Hispanic women participating in HIV prevention programs funded by the Centers for Disease Control and Prevention in 2015. METHODS: Data came from 61 health department jurisdictions and 123 community-based organizations. Using Wald χ2 tests, we assessed racial/ethnic differences in HIV testing by demographic characteristics, risk factors, HIV status, HIV service delivery, and (using unlinked data) participation in evidence-based HIV prevention interventions among women. We also assessed temporal changes in Black women's receipt of preventive services (2012-2015). RESULTS: In 2015, there were 1,326,589 HIV testing events (single sessions in which one or more HIV tests are performed to determine HIV status) that occurred among Black, White, and Hispanic women, resulting in 4,868 positive diagnoses. Proportionally fewer Black (vs. White and Hispanic) women were linked to HIV medical care within 90 days (64.4% vs. 69.1% and 73.7%), interviewed for partner services (50.4% vs. 54.4% and 63.5%), and referred to risk reduction services (55.5% vs. 57.7% and 59.8%). From 2012 to 2015, HIV testing events among Black women decreased by 15.2%, but linkage to care within 90 days increased by 30.6% and participation in one or more evidence-based intervention increased by 46.8% among HIV-positive Black women. CONCLUSIONS: Black HIV-positive women were less likely than White and Hispanic women to receive services that prevent HIV-related morbidity and mortality. Additional programmatic efforts are needed to increase the proportion of HIV-positive Black women who are linked to services to reduce HIV disparities among women.

Protective behaviours among young African American women with non-monogamous sexual partners.

In the USA, partner non-monogamy is reported to be more common among African American women than White women and may contribute to African American women's increased risk for HIV and other sexually transmitted infections (STIs). Few studies have explicitly and comprehensively described the protective behaviours that African American women employ with non-monogamous partners to reduce their HIV risk. We conducted interviews to examine protective behaviours among 11 African American women aged 18-24 years who perceived that a partner in the preceding 12 months had another sex partner. Participants described three types of partnerships with 29 non-monogamous men; these partnerships clustered into three categories. Narrative analysis revealed an overall paucity of protective behaviours with non-monogamous partners. Protective behaviours (i.e. communication and condom use) were informed by partnership type, rather than perceptions of non-monogamy. There were few instances in which partner non-monogamy motivated women to terminate sex partnerships. Rather, these decisions were often motivated by changes in other relationship dynamics. To address HIV/STI risk related to partner non-monogamy, HIV prevention strategies for young African American women should emphasise the importance of condom use in all non-marital partnership types. Interventions where testing is available may be effective for women who frequently test for HIV/STIs but do not use condoms.

HIV acquisition and transmission among men who have sex with men and women: What we know and how to prevent it.

Men who have sex with men and women (MSMW) compose a subset of men who have sex with men (MSM) and represent an estimated 35% of MSM. Research on the HIV risk behaviors of MSMW has largely focused on their behaviors in comparison to men who have sex with men only (MSMO). Results suggest that compared to MSMO, MSMW are less likely to have ever had an HIV test, are at greater risk of being unaware of their HIV infection and are less likely to have encountered HIV prevention activities or materials. Additional research is needed to provide a more comprehensive understanding of the unique sexual behaviors and lived experience of MSMW as a group in order to better inform HIV prevention efforts. The purpose of this paper is to summarize existing data and discuss strategies to reduce HIV acquisition and transmission among MSMW.