1 African Americans, 2003

○○○○○○○○○ ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○

HIV/AIDS Among

African Americans

The HIV/AIDS epidemic is a major health crisis

among African Americans, affecting men and women

of every age and sexual orientation.

The Cumulative Effect of HIV/AIDS:

• According to the 2000 Census, African Americans make up 12.3% of the population of the

United States. However, they have accounted for

39% — more than 347,000 — of the more than

886,000 estimated AIDS cases diagnosed since

the beginning of the epidemic.1 By the end of

December 2002, more than 185,000 African

Americans had died with AIDS.1

• For people diagnosed with AIDS since 1994,

African Americans had the poorest survival

rates of all racial and ethnic groups, with 55%

surviving after 9 years compared to 61% of

Hispanics, 64% of whites, and 69% of Asian/

Pacific Islanders.1

• In 2000, HIV/AIDS was among the top three

causes of death for African-American men

ages 25-54 and African-American women

ages 35-44.2

AIDS in 2002:

• African Americans accounted for about 21,000,

or 50 percent, of the more than 42,000 estimated

AIDS cases diagnosed among adults in the

United States.1

• The AIDS diagnosis rate among African Americans was almost 11 times the rate among whites.

African-American women had a 23 times greater

diagnoses rate than white women. AfricanAmerican men had almost a 9 times greater rate

of AIDS diagnosis than white men.1

• Over 162,000 African Americans were living with

AIDS in the United States. They accounted for

42% of all people in the United States living with

AIDS.1

HIV in 2002:

• African Americans accounted for over half of the

new HIV diagnoses reported in the United

States.1

• A study of people diagnosed with HIV found that

56% of “late testers,” i.e., those that were

Estimated Number of Diagnoses of HIV/AIDS

by Race, 20021

Estimated Number of Diagnoses of HIV/

AIDS by Race and Sex 1999-20024

*Based on 30 areas with confidential name-based HIV surveillance

*Based on 30 areas with confidential name-based HIV surveillance
 2 African Americans, 2003

○○○○○○○○○ ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○

diagnosed with AIDS within one year of their

HIV diagnosis, were African American.3 Late

testing represents missed opportunities in prevention and treatment of HIV.

• The leading cause of HIV infection among

• Partners at Risk. African American women are

most likely to be infected with HIV as a result of

sex with men.1 They may not be aware of their

male partners’ possible risks for HIV infection

such as unprotected sex with multiple partners,

bisexuality, or injection drug use.9 Women who

suspect that their partners are at risk for HIV

infection may be reluctant to try to negotiate

condom use. For example, some women may not

insist on condom use out of fear that the man will

leave them or withdraw financial support.10

• Substance Abuse. Injection drug use is the

second leading cause of HIV infection for both

African-American men and women. But sharing

needles is not the only HIV risk related to substance abuse. Both casual and chronic substance

abusers are more likely to engage in high-risk

behaviors, such as unprotected sex, when they

are under the influence of drugs or alcohol.11

• Sexually Transmitted Disease (STD) Connection. For many of the reasons noted above,

African Americans also have the highest STD

rates in the nation. Compared to whites, African

Americans are 24 times more likely to have

gonorrhea and 8 times more likely to have

syphilis.12 In part because of physical changes

caused by STDs, including genital lesions that can

serve as an entry point for HIV, the presence of

certain STDs can increase the chances of contracting HIV by three- to five-fold.13 Similarly,

because co-infection with HIV and another STD

can cause increased HIV shedding, a person who

is co-infected has a greater chance of spreading

HIV to others.13

Prevention

Research over the past decades shows that prevention works. Overall, the rate of HIV infection in the

United States has slowed from over 150,000 cases

per year in the mid 1980s to the current estimated

40,000 annually.14 In specific populations, collaborative prevention efforts have contributed to a 50%

decrease in HIV seroprevalence among white MSM

in the United States between 1988-1993, a more

than 40% decrease in the HIV seroprevalence among

African-American men is sexual contact with

other men, followed by injection drug use and

heterosexual contact.1

• The leading cause of HIV infection among

African-American women is heterosexual contact,

followed by injection drug use.1

• Sixty two percent of children born to HIVinfected mothers were African American.1

Risk Factors

Race and ethnicity are not, themselves, risk factors

for HIV infection. However, African Americans are

more likely to face challenges associated with risk for

HIV infection, including:

• Poverty. Nearly one in four African Americans

lives in poverty.5 Studies have found a direct

relationship between higher AIDS incidence and

lower income.6 A variety of socioeconomic

problems associated with poverty directly or

indirectly increase HIV risks, including limited

access to quality health care and HIV prevention

education.

• Denial. Although African Americans are

responding to the HIV/AIDS crisis in their

communities, many have been slow to join the

effort. One reason is that some African Americans are reluctant to acknowledge issues, such as

homosexuality and drug use, that are associated

with HIV infection. For example, studies show

that a significant number of African-American men

who have sex with men identify themselves as

heterosexual.7,8 As a result, they may not relate to

prevention messages crafted for openly gay men.

Without frank and open discussion of HIV risks,

many African Americans will not get the information and support they need to protect themselves

and their partners from HIV.
 3 African Americans, 2003

○○○○○○○○○ ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○

injection drug users in New York City in the 1990s,

and a 75% decrease in perinatal infections between

1992-1998.14 Even though these declines are remarkable, the number of annual new infections has

remained constant over the last decade and is still

unacceptably high. Therefore, CDC has set a national

goal of reducing the annual number of HIV infections

to 20,000 per year. In order to achieve this goal, the

CDC is approaching HIV prevention in a number of

ways.

• Prevention with persons who are at very high

risk for HIV infection. Persons who are HIV

negative but at high risk for HIV must be continuously educated and supported at different phases

of their lives. Since the beginning of the epidemic,

new at-risk groups have emerged in addition to

those that have been traditionally at highest risk,

i.e., men who have sex with men and injection

drug users. New populations increasingly at risk

for HIV infection include racial and ethnic minorities, women, and adolescents. Each of these

groups is the target of research and subsequent

prevention interventions, including demonstration

projects on using social networks for reaching

persons at high risk for HIV infection in communities of color.

• Encouraging people to know their HIV

status. Research shows that up to two-thirds of

new infections are transmitted by people who

don’t know they are infected.15 Efforts to reach

at-risk persons are enhanced by the availability of

rapid HIV testing, which allows the results to be

provided in minutes, rather than days; thus

reducing the chance that persons may miss

receiving their test results. Post-test counseling,

including resources for managing HIV infection, is

a part of this effort. Overall, CDC recommends

that HIV testing become a routine part of medical

care in high prevalence settings so that HIV

infections are detected early and persons who test

positive can quickly enter the medical care system

for prevention and treatment services. For those

who do not or cannot access typical medical

facilities, CDC recommends HIV testing in nontraditional settings, such as correctional facilities

or in areas where homeless youth congregate.

Demonstration projects focusing on rapid HIV

testing in these and other non-clinical settings are

ongoing.

• Preventing new infections by working with

persons who are HIV positive and their

partners. New treatments have helped HIVpositive people live longer with HIV before

progressing to AIDS. Therefore, persons living

with HIV are important partners in ongoing

educational and prevention interventions to

encourage safer sex and healthy behaviors over

the course of their lifetimes and reduce their risk

of transmitting HIV. To this end, CDC is funding

prevention interventions for people living with

HIV in a variety of settings across the country to

better reach this important group.

• Further decreasing perinatal HIV transmission. The reduction of HIV infection due to

perinatal transmission is a success story in HIV

prevention. The number of infants infected with

HIV through mother-to-child transmission has

decreased from an estimated peak of 1,760

infants born with HIV during 1991 to 280-320

per year today.16 To further reduce perinatal HIV

transmission, CDC recommends HIV screening

for all pregnant women using an opt-out approach

and routine rapid testing at labor and delivery for

women whose HIV status is unknown.17

The HIV epidemic differs among populations and

across communities. CDC’s community demonstration projects serve to evaluate broad interventions

and provide input from its partners in the community

(the state health departments and community-based

organizations) for tailoring proven interventions to the

specific needs of their populations. CDC also recognizes that there are overriding issues that must be

addressed if the rate of HIV infections is to be

reduced. The stigma associated with HIV infection,

as well as co-morbidities, such as alcohol and drug

abuse or mental health issues, and other needs, such

as adequate food and housing, cut across all populations when it comes to prevention. Therefore, other

federal agencies, such as the Health Resources and

Services Administration (HRSA) and the Substance

Abuse and Mental Health Services Administration

(SAMSHA) are also working with CDC to reduce

the rate of HIV infection in this country.
 4 African Americans, 2003

○○○○○○○○○ ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○

References

1. Centers for Disease Control and Prevention (CDC). HIV/

AIDS surveillance report 2002;14.

2. National Center for Health Statistics. National vital

statistics report. 2002;50(16).

3. CDC. Late versus early testing of HIV—16 Sites, Unites

States, 2002-2003. MMWR 2003:52(25)581-586.

4. CDC. Increases in HIV diagnoses — 29 States—1999-

2002. MMWR 2003:52(47);1145-1148.

5. US Census Bureau. Poverty status of the population in

1999 by age, sex, and race and Hispanic origin;

March 2000.

6. Diaz T, Chu S, Buehler J, et al. Socioeconomic differ

ences among people with AIDS: Results from a

multistate surveillance project. Am J Prev Med

1994;10(4):217-222.

7. CDC. HIV/AIDS among racial/ethnic minority men who

have sex with men—United States, 1989-1998.

MMWR 2000; 49:4-11.

8. CDC. HIV/STD risks in young men who have sex with

men who do not disclose their sexual orientation—six

US cities, 1994-2000. MMWR 2003; 52;81-100.

9. Hader S, Smith D, Moore J, Holmberg S. HIV infection

in women in the United States: Status at the millennium. JAMA 2001;285(9):1186-1192.

10. Amaro H. Love, sex, and power: Considering women’s

realities in HIV prevention. Am Psychol

1995;50(6):437-447.

11. Leigh B, Stall R. Substance use and risky sexual

behavior for exposure to HIV: Issues in methodology,

interpretation, and prevention. Am Psychol 1993;

48(10):1035-1045.

12. CDC. Sexually transmitted disease surveillance report.

2002.

13. Fleming DT, Wasserheit JN. From epidemiological

synergy to public health policy and practice: The

contribution of other sexually transmitted diseases to

sexual transmission of HIV infection. Sex Transm

Infect1999;75:3-17.

14. CDC. HIV prevention strategic plan through 2005.

January 2001.

15. Fleming PL, Byers, RH, Sweeney PA, Daniels D, Karon

JM, Janssen RS. HIV prevalence in the United States,

2000. 9th Conference on Retroviruses and Opportunistic Infections, 2002. Available at ww.retroconference.

org//2002/Abstract/13996.htm.

16. CDC. HIV prevention in the third decade.Atlanta,

Georgia. 2003.[CDC internal report]

17. Public Health Service Task Force. Recommendations for

use of antiretroviral drugs in pregnant HIV-1-infected

women for maternal health and intervention to reduce

perinatal HIV-1 transmission in the United States.

November 26, 2003. http://AIDS info.nih.gov.

Understanding HIV and AIDS Data

Two sets of data are used to track the HIV/AIDS

epidemic in the United States.

HIV surveillance: Twenty-nine states and the U.S.

Virgin Islands have conducted confidential HIV

infection reporting by name for at least 5 years,

providing sufficient data to monitor HIV trends over

time and estimate risk behaviors for HIV infection.

These data are statistically adjusted for reporting

delays and are used to look at trends among the 30

areas with HIV surveillance reporting at least since

1998. Nine additional areas more recently began

confidential, name-based HIV surveillance. Data

from all of these areas can be used to describe the

more recent epidemiology of HIV cases in the United

States and its territories.

AIDS surveillance: AIDS diagnoses are reported to

CDC by all U.S. states and territories. Because of the

lengthy interval between HIV infection and an AIDS

diagnosis, AIDS data cannot be used to show trends in

new HIV infections. AIDS data can show the continuing toll of HIV disease. These data are statistically

adjusted for reporting delays and are used to look at

AIDS trends in the United States.

HIV/AIDS: This term refers to persons with a diagnosis of HIV infection only, a diagnosis of HIV infection

and a later AIDS diagnosis, and concurrent diagnosis

of HIV infection and AIDS.

For more information...

CDC National STD & AIDS Hotlines:

1-800-342-AIDS

Spanish: 1-800-344-SIDA

Deaf: 1-800-243-7889

CDC National Prevention

Information Network:

P.O. Box 6003

Rockville, Maryland 20849-6003

1-800-458-5231

Internet Resources:

NCHSTP: http://www.cdc.gov/nchstp/od/

nchstp.html

DHAP: http://www.cdc.gov/hiv

NPIN: http://www.cdcnpin.org