In the United States, HIV prevalence and incidence for African Americans (Blacks) are much higher than for non-Hispanic Whites. This is especially so for women. Differences remain unexplained more than 35 years after they were recognized in the 1980s. The Centers for Disease Control and Prevention (CDC) collects information on risks for persons diagnosed with HIV in Adult HIV Confidential Case Report Forms. In 2014, the last year the CDC reported raw data from collected Forms, more than half of Black women and more than a quarter of Black men were reported with no identified risk. Moreover, in 2007, the last year the CDC disclosed information about partners of cases reported with heterosexual risk, more than a third of HIV-positive Black women were reported with heterosexual risk despite limited and questionable evidence about partners. Currently, the CDC estimates percentages of HIV-positive adults with various risks using a model that assigns men and women to risks based on factors such as ethnicity. Such estimates hide the CDC’s ignorance about risks. Multiple risks, including, for example, contaminated instruments in healthcare and cosmetic services and sex with bisexual males may be contributing to high HIV prevalence among Blacks, especially women. Research is warranted.
High HIV prevalence and low sex ratio of infections in US Blacks
The CDC reports 1.27% of Black and 0.18% of White adults (aged ≥13 years) living with reported HIV infection at end-2019 (Table 1). Much higher HIV prevalence for Blacks compared to Whites was due to decades of higher incidence among Blacks. For women, differences have narrowed: the percentage of Black women with new infections in 2019 was 12.5 times the percentage of White women with new infections, whereas HIV prevalence (old and new infections) among Black women was 17.2 times greater than for White women. For Black men, differences may be increasing: in 2019, the percentage of Black men reported with new infections was 8.1 times greater than for White men, whereas HIV prevalence among Black men was 5.6 times greater than for White men.…
To compare HIV prevalence in US Blacks to prevalence in other countries, CDC’s reports of Blacks living with reported infections must be adjusted to include persons not diagnosed and reported. In 2019, CDC estimated 13.4% of HIV-positive Black adults in the US were unreported (Table 9 in reference).
Adjusting for unreported infections, an estimated 1.47% (= 1.27/0.866) of Black adults were HIV-positive in 2019. Estimated 1.47% HIV prevalence among Blacks aged ≥13 years exceeds UNAIDS’ estimated 2021 HIV prevalence in adults (aged ≥15 years) in all regions except Eastern and Southern Africa with 6.2% HIV prevalence: Asia and Pacific, 0.2%; Middle East and North Africa.
Based on the CDC’s latest reports of raw data from submitted Case Report Forms, the CDC’s estimated risks for more than half or even two-thirds of HIV-positive Black women are based on no or insufficient evidence (Tables 3 and 4, above). As for Black men, the CDC’s estimates may be assigning more than a third of infected men to risks despite no or insufficient evidence. Because the CDC stopped reporting raw data from Case Report Forms in 2007 (heterosexual risks) and 2014 (no identified risks), raw data reported in Tables 3 and 4 may have changed. In any case, research is required to explain (and thereby prevent) HIV risks among Blacks, especially Black women. One recent ray of hope is that the thousands of HIV sequences generated every year (to find antiretroviral escape mutations) may also help to track epidemiologic linkages.
The abstract that begins this post is available from SSRN at: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4317106. The several paragraphs after the abstract are quotes from the paper posted and available at SSRN through the above link. This link might work as well: https://deliverypdf.ssrn.com/delivery.php?ID=020102027024077106120117072094019014122017071012062030101001070122113064067007121029056029020062102033001068100026093113121114015072091036076110092001004019068066067085066040013005067075003108113106119077101110124121072000101089094127090093020074003072&EXT=pdf&INDEX=TRUE