The HIV/AIDS epidemic in African American communities is a continuing public health crisis for the United States. At the end of 2006 there were an estimated 1.1 million people living with HIV infection, of which almost half (46%) were black/African American.¹ While blacks represent approximately 12 percent of the U.S. population, they continue to account for a higher proportion of cases at all stages of HIV/AIDS -- from infection with HIV to death with AIDS -- compared with members of other races and ethnicities.^2,3

The Numbers

HIV/AIDS in 2007

• Blacks accounted for 51% of the 42,655 (including children) new HIV/AIDS diagnoses in 34 states with long-term, confidential name-based HIV reporting.³
• Blacks accounted for 48% of the 551,932 persons* (including children) living with HIV/AIDS in 34 states with long-term, confidential name-based HIV reporting.³
• For black women living with HIV/AIDS, the most common methods of transmission were high-risk heterosexual contact** and injection drug use.³
• For black men living with HIV/AIDS, the most common methods of HIV transmission were (in order):³
  
  • sexual contact with other men
  • injection drug use
  • high-risk heterosexual contact**.

Race/ethnicity of persons (including children) with HIV/AIDS diagnosed during 2007

Note. Based on data from 34 states with long-term, confidential name-based HIV reporting.

AIDS in 2007

• Blacks accounted for 49% of the estimated 35,962 AIDS cases diagnosed in the 50 states and the District of Columbia.³
• In 2007, the rates of AIDS diagnoses decreased among blacks but were still higher than the rates of any other race/ethnicity. The rate of AIDS diagnoses for black adults/adolescents were 10 times the rate for whites and nearly 3 times the rate for Hispanics. The rate of AIDS diagnoses for black women was 22 times the rate for white women. The rate of AIDS diagnoses for black men was almost 8 times the rate for white men.³
• Blacks accounted for 44% of the 455,636* people living with AIDS in the 50 states and District of Columbia.³
• By the end of 2007, 40% of the 562,793* persons with AIDS who died were black.³

Prevention Challenges

Like other communities, African Americans face a number of risk factors that contribute to the high rates of HIV infection:

• Sexual risk factors include high-risk sexual contact such as unprotected sex with multiple partners or unprotected sex with persons known to have or be at a high risk for HIV infection. People may be unaware of their partner's sexual risk factors or have incorrectly assessed them.
• Injection drug use may add to the higher rates of infection for African Americans. In addition to being at risk from sharing unclean needles, causal and chronic illegal substance users may be more likely to engage in unprotected sex under the influence of illegal drugs and/or alcohol.⁴
• Sexually transmitted diseases (STDs) continue to be experienced at higher rates within the African American community, more so than any other race/ethnicity in the United States. The presence of certain STDs can significantly increase one's chances of contracting HIV infection. A person who has both HIV infection and certain STDs has a greater chance of spreading HIV infection to others.⁵
• Lack of awareness of HIV serostatus is risky for African American men and women. In a recent study of men who have sex with men (MSM) in five cities, 46% of the black MSM were HIV-positive and 67% of those men were unaware of their infection.⁶
• Stigma, a "negative social label that identifies people as deviant",⁷ also puts too many African American communities at a high risk of infection. Any behavior deemed deviant (i.e. MSM) has been highly stigmatized. Many at risk for HIV infection fear stigma more than knowing their status, choosing instead to hide their high-risk behavior rather than seek counseling and testing. Therefore they continue to be at risk and may infect others.⁸
• The socioeconomic issues associated with poverty, including limited access to high quality healthcare, housing and HIV prevention education may directly or indirectly increase the risk factors for HIV infection.⁹

*Includes persons of unknown race or multiple races/other.
**Heterosexual contact with a person known to have or to be at risk for HIV infection.

What CDC is Doing

CDC has been working with a broad range of partners to accelerate progress in fighting HIV in African American communities, as this remains one of CDC's highest HIV prevention priorities.

• In the next few years, CDC will disseminate a range of African American interventions that are currently under development.
• CDC continues to work to increase the number of organizations throughout the country that effectively utilize current HIV prevention interventions proven to be most effective for African Americans; specifically training providers to use new interventions for; African American women, youth and a newly adapted intervention for black gay and bisexual men.
• CDC is working to develop new HIV prevention interventions including the evaluation of new prevention interventions for individuals at greatest risk (black women, heterosexual men, gay and bisexual men, and incarcerated individuals).
• CDC will investigate how to address deeper social and structural factors, such as poverty, that place many African Americans at risk and hinder access to prevention and care.
• In 2008, CDC doubled its investment ($70 million) in a new initiative launched in 2007 that is devoted to increasing testing among African Americans.
• CDC is working with African American leaders from every sector to mobilize the community against HIV.
  
  • In 2007 and 2008, CDC hosted leadership meetings bringing together more than 200 African American leaders from multiple sectors to discuss concrete actions that can be taken to reach all African Americans with the tools and knowledge they need to protect themselves and their loved ones from HIV.
• As part of CDC's new Act Against AIDS campaign, CDC has launched a $10 million, five-year partnership with 14 of the nation's leading African American organizations.

For more information, including details regarding the 34 states with long-term, confidential name-based HIV reporting, visit the CDC HIV/AIDS Statistics and Surveillance Web site.

References

1. CDC. HIV Prevalence Estimates -- United States, 2006.MMWR 2008; 57: 1073-1076.
2. U.S. Census Bureau Quick Facts.
3. CDC. HIV/AIDS Surveillance Report, 2007. Vol. 19. US Department of Health and Human Services, CDC: 2009:1–63.
4. Leigh BS, Stall R. Substance use and risky sexual behavior to HIV: issues in methodology, interpretation, and prevention. American Psychologist 1993; 48: 1035-1045.
5. CDC. HIV prevention through early detection and treatment of other sexually transmitted diseases -- United States. MMWR 1998; 47: 1-24.
6. CDC. HIV prevalence, unrecognized infection and HIV testing among men who sex with men-five U.S. cities, June 2004-April 2005 -- United States, 2005. MMWR 2005; 54: 597-601.
7. Johnson, A.G. (2000) Stigma. The Blackwell Dictionary of Sociology: A User's Guide to Sociological Language. Blackwell Publishers: Malden, MA.
8. Ford, Chandra L. et al. (March 2007) Black Sexuality, Social Construction, and Research Targeting 'The Down Low' ('The DL') Annals of Epidemiology, 17 (3), pp 209-216.
9. Barrow, R.Y., Newman, L.M., Douglas Jr., J.M. (December 2008) Taking Positive Steps to Address STD Disparities for African-American Communities. Sexually Transmitted Diseases. 35(12) Supplement pp S1-S3.