HIV/AIDS among Minority Races and Ethnicities in the United States: DISCUSSION
These data show that minority races and ethnicities continue to be disproportionately affected by the HIV epidemic. We found notably higher numbers and rates of HIV/AIDS and AIDS diagnoses among the black population. Race and ethnicity are not risk factors for HIV infection but may be markers for socioeconomic factors, such as poverty, underemployment and limited access to high-quality healthcare. According to a recent comparison of black women who had been given a diagnosis of HIV infection (treating HIV infection) during 2003-2004 and black women who were not infected, the infected women were more likely to be receiving public assistance. Also, larger proportions of infected women had lower incomes or were unemployed.
The use of illegal substances (injected and not injected) has also contributed to the increased risk for HIV infection (treating HIV infection when used in combination with other medicines) among minority races and ethnicities. Most persons who have acquired HIV through injection drug use are black or Hispanic. In the mid-1980s, an epidemic of crack cocaine (an addictive, smokable form of cocaine) use swept through American inner-city neighborhoods and particularly affected black communities. Several investigators have documented the association between crack cocaine use and high rates of risky sexual behaviors (e.g., prostitution, high number of sex partners and infrequent condom use) and high rates of sexually transmitted diseases, including HIV infection, among inner-city blacks.
Men who have sex with men (MSM) who are members of minority races and ethnicities are also at higher risk for HIV infection than are MSM who are white. In a study of young MSM aged 15-22 years in seven U.S. cities, the prevalence and incidence of HIV infection (treating HIV infection when used along with other medicines) were higher among MSM who were black, Hispanic or mixed race/ethnicity than among MSM who were white. According to a recent study comparing black MSM who were college students and black MSM who were not students, the rates of HIV risk behaviors were high for both groups.
Because of the high prevalence of HIV/AIDS in the black community, even low levels of risk behav iors pose a higher threat of HIV exposure than in communities with a lower prevalence of infection. Studies of sexual networks have shown that blacks are more likely than persons of other races and ethnicities to have sex partners of the same race.
Our results are subject to several limitations. To examine diagnoses of HIV/AIDS, we used data from 32 states with name-based HIV infection reporting. In 2003, these states accounted for 57% of the U.S. population but for 44% of all AIDS diagnoses in the United States. Therefore, the data may not be gener-alizable to the entire nation. The data also do not represent all HIV-infected persons in the 32 states because not all persons have been tested, and of those who were, some chose to be tested anonymously. Anonymous test results are not reportable; therefore, cases determined on the basis of the results of anonymous tests are not reflected in the surveillance system. The analysis also does not include HIV/AIDS data from Illinois, New York and California—states with large populations of minority races and ethnicities. Additionally, the data presented in this report represent recent diagnoses of HIV/AIDS and AIDS, some of which may not represent new (i.e., incident) infections. CDC is working with 33 areas to develop an incidence-based surveillance system to monitor trends in HIV incidence.
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Our data may be used to direct prevention activities to populations at greater risk for infection. HIV prevention interventions designed for white men and women, however, may not be as effective when applied to minority racial and ethnic populations. To encourage increased prevention research that meets the needs of minority races and ethnicities, CDC established two programs: the Minority HIV/AIDS Research Initiative (MARI) and Research Fellowships on HIV Prevention in Communities of Color. Both programs mentor junior scientists in the field and at CDC to conduct intervention research focused on minority races and ethnicities. This research will help CDC to develop interventions and programs that consider the social and cultural contexts of minority racial and ethnic communities. An example of a CDC-funded, scientifically based HIV prevention intervention that was developed for such a specific group is the Sisters Informing Sisters about Topics on AIDS (SISTA) project, which is based on a study conducted in 1993 by DiClemente and Wingood. SISTA is a social skills training intervention aimed at reducing HIV sexual risk behavior among black women at highest risk. CDC has also funded community-based organizations to adapt and tailor, for MSM of minority races and ethnicities, some of the interventions that are known to be effective for the general public.
Developing and supporting partnerships with nongovernmental, community- and faith-based organizations in communities of minority races and ethnicities is critical to reducing the numbers of HIV infections in these populations. CDC directly funds 179 community-based organizations and 27 providers of capacity-building assistance focused on populations of minority races and ethnicities. Of these, 165 are focused on blacks, 145 on Hispanics, 73 on Asians/Pacific Islanders and 48 on American Indians/Alaska Natives. Community-based organizations deliver prevention services, including counseling and testing, care and treatment messages, in ways that are culturally appropriate for communities composed of minority races and ethnicities. Capacity building in these communities is also important to strengthen and sustain the delivery of effective HIV prevention services and interventions for populations of minority races and ethnicities who are at high risk for HIV infection. In addition to funding provided to community-based organizations, CDC provides guidance, funding and technical assistance to support state and local HIV prevention programs. State and local health departments have also developed creative approaches for directing programs and healthcare services to populations that are disproportionately affected by the HIV epidemic.
In 2003, CDC announced the Advancing HIV Prevention (AHP) initiative. This initiative is focused on reducing the annual number of new HIV infections in the United States through four strategies:
1) making HIV testing a routine part of medical care
2) implementing new models for diagnosing HIV infections outside medical settings
3) preventing new infections by working with HIV-infected persons and their partners, and
4) further decreasing perinatal HIV transmission.
Initiatives, such as AHP, along with the work of community-based organizations and state and local health departments are expanding HIV prevention strategies and developing new approaches to reduce the number of new infections in persons of minority races and ethnicities.