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African Americans and HIV/AIDS in the United States

January 2005

Improvements have been made in linking African Americans with HIV prevention, counseling and testing, and treatment services. Nonetheless, African Americans' share of the U.S. AIDS burden has never been more disproportionate to their representation in the total U.S. population.


Surveillance

In 2003, the most recent year for which national census estimates are available, Blacks* accounted for just 12.8 percent of the U.S. population but 49.3 percent of estimated AIDS cases.1,2

At the end of 2003, it was estimated that 42.4 percent of people living with AIDS in the United States were Black, reflecting a continued increase over previous years.3 The AIDS rate (the number of people living with AIDS per 100,000 individuals) was 58.2 for Blacks, compared with 14.5 for the total U.S. population.4

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In addition to representing a growing share of new reported AIDS cases and of people living with AIDS, Black men and women account for an ever-growing number of U.S. deaths attributable to AIDS. Over the course of the epidemic, 37.4 percent of deaths from AIDS have been among Blacks, but the proportion for 2003 was 50.2 percent.5

In 2001, HIV was the third leading cause of death among African Americans between ages 25 and 34. Among African American females in this age group, HIV was the number one cause of death.6

Of all males living with AIDS in the United States at the end of 2003, more than one-third (37.2 percent) were Black. Thirty percent of Black males with HIV had acquired the disease through injection drug use and 17 percent had become infected through heterosexual contact -- a much higher proportion than among all males (22 percent and 11 percent, respectively). Conversely, male-to-male sexual contact was much less likely to have been the reported HIV exposure category for Black men (44 percent) than for all men (58 percent) and, especially, for White men (75 percent).7

59.9 percent of all females living with AIDS at the end of 2003 were Black. Heterosexual contact was the HIV exposure category for 64 percent of those cases.7

Blacks accounted for 62.7 percent of children under age 13 who were living with AIDS at the end of 2003.7


Critical Issues

In a recent study involving 16 HIV testing sites, the majority (56 percent) of "late testers" (i.e., those who were diagnosed with AIDS within 1 year of their HIV diagnosis) were African American.8

Contributing to poor access to health prevention and care services for some African Americans is the experience of racism in health care settings and mistrust of the health care system in general.9

Nearly 1 in 4 African Americans live in poverty. Research suggests a direct relationship between higher AIDS incidence and lower income.2,10

The HIV Cost and Services Utilization Study, a nationally representative study of people with HIV/AIDS in care in 1996, found that African Americans with HIV/AIDS were more likely to be uninsured than their white counterparts (22 percent vs. 17 percent). Moreover, 59 percent of African Americans with HIV/AIDS relied on Medicaid, compared with 32 percent of whites.11,12


African Americans and the Ryan White CARE Act

In 2002, almost half (46 percent) of all Ryan White Comprehensive AIDS Resources Emergency (CARE) Act clients were African American. The proportion was much higher in some care settings. Capacity-building and planning grants have been targeted to underserved communities in order to expand the number of service settings available to vulnerable populations.

In another effort to increase access to quality care for minorities, the National Minority AIDS Education and Training Center is funded through the CARE Act AIDS Education and Training Center Program to expand clinical expertise in minority communities (www.nmaetc.org).

The Health Resources and Services Administration has supported a range of activities that address the epidemic among African Americans. Highlights include the African American Children's Initiative, funded through the CARE Act Title IV program for Women, Infants, Children, Youth, and Families; community consultations and collaborations with community organizations such as the National Minority AIDS Council; and publication of studies and findings on the search for increasingly effective means for reaching underserved populations.


HIV/AIDS and African Americans, 20031,2
Proportion of estimated new AIDS cases, 49.3%. Proportion of U.S. population, 12.8%


References

  1. Centers for Disease Control and Prevention (CDC). HIV/AIDS Surveillance Report. 2003;15:12. Table 3.
  2. U.S. Census Bureau. Annual estimates of the population by race alone and Hispanic or Latino origin for the United States: July 1, 2003. (SC-EST2003-04). Table 4. Available at: www.census.gov.
  3. CDC. HIV/AIDS Surveillance Report. 2003;15:20. Table 10.
  4. CDC. HIV/AIDS Surveillance Report. 2003;15:14. Table 5.
  5. CDC. HIV/AIDS Surveillance Report. 2003;15:16. Table 7.
  6. Kaiser Family Foundation. The HIV/AIDS Epidemic in the United States. Fact sheet. Washington, DC: Author; 2004. Available at: www.kff.org.
  7. CDC. HIV/AIDS Surveillance Report. 2003;15:21. Table 11.
  8. CDC. Late versus early testing of HIV -- 16 sites, United States, 2002-2003. MMWR. 2003;52(25):581-6.
  9. LaVeist TA, et al. Attitudes about racism, medical mistrust, and satisfaction with care among African American and white cardiac patients. J Natl Med Assn. 2003;95(11):1057-65.
  10. Diaz T, et al. Socioeconomic differences among people with AIDS: results from a multistate surveillance project. Am J Prev Med. 1994;10(4):217-22.
  11. Fleishman J. Personal communication on analysis of HCSUS data, January 2002, cited in Ruiz S. African Americans and HIV/AIDS. Fact sheet. Washington, DC: Kaiser Family Foundation; 2003. Available at: www.kff.org.
  12. Ruiz S. African Americans and HIV/AIDS. Fact sheet. Washington, DC: Kaiser Family Foundation; 2003. Available at: www.kff.org.


  
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See Also
Purpose of the CARE Act
Guiding Principles for CARE Act Programs
More on Populations Served by the Ryan White CARE Act

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