CDC Study on Poverty and HIV Rates in Inner-City Neighborhoods: Familiar Story to Some, Still Unacceptable!

Sometimes the most interesting things aren't planned. On Monday, two intersecting events happened at the 2010 AIDS Conference. The CDC released an analysis of the HIV epidemic among heterosexuals in the United States, and to no one's surprise it revealed a strong link between poverty and HIV infection. At the same time, AIDS in America, a coalition of leaders of U.S. HIV/AIDS organizations held a news conference at the meeting in Vienna to focus attention on the HIV epidemic in the United States. We called attention to it as an ongoing urgent health concern and expressed the collective view that the recently released National HIV/AIDS Strategy is a platform to achieve better outcomes and results by July 2012 when the next international AIDS conference occurs in the United States. As the Executive Director of AIDS Alliance, I am a member of AIDS in America and I can tell you, we did not plan this synergy. Although, the CDC findings were not surprising to those of us that have worked in the field, they are still shocking and need to be understood by policy makers, funders and planners. The study showed that 2.1% of heterosexuals living in high-poverty urban areas in the United States are HIV positive. This data suggests that many low-income cities across the United States now have generalized HIV epidemics as defined by UNAIDS.

The study also reminded us of rates of new infections in the United States and helps to better define where prevention efforts need to be targeted. While MSM transmission remains highest at 53%, heterosexual transmission accounts for 31%, IDU 12% and MSM/IDU 4%.

From the study released: "The analysis also shows that poverty is the single most important demographic factor associated with HIV infection among inner-city heterosexuals. Contrary to severe racial disparities that characterize the overall U.S. epidemic, researchers found no differences in HIV prevalence by race/ethnicity in this population. Prevalence was especially high in those with the lowest socioeconomic status. Within the low-income urban areas included in the study, individuals living below the poverty line were at greater risk for HIV than those living above it (2.4% prevalence vs. 1.2%), though prevalence for both groups was far higher than the national average (0.45%). There were no significant differences in HIV prevalence by race or ethnicity in these low-income urban areas: prevalence was 2.1% among blacks, 2.1% among Hispanics, and 1.7% among whites. By contrast, the U.S. epidemic overall is characterized by severe racial/ethnic disparities: the HIV prevalence rate for blacks is almost eight times that of whites, and the HIV prevalence rate among Hispanics is nearly three times that of whites."

The AIDS in America press conference (click here to see the full press release) featured remarks by national leaders that spoke about the issues at large in the United States and in particular to the realities of gay men and African Americans living with and at risk for HIV. Carl Schmid, Deputy Executive Director of The AIDS Institute remarked "With over 1.1 million people living with HIV/AIDS and over 56,000 new infections every year, HIV remains a very serious health concern in the United States, just as it does in many other parts of the world," he continued "While we may have the resources to combat HIV at many levels, we still struggle with the ability to prevent new infections, provide adequate care and treatment, and address stigma and the wide disparities in which certain communities are affected by HIV." C. Virginia Fields, President and CEO of the National Black Leadership Commission on AIDS noted that "African-Americans, especially women and children, are also impacted by poverty, violence, inadequate housing, unemployment, illiteracy, and high rates of incarceration. These co-factors, combined with a lack of resources, have come together to create a perfect storm that is devastating Black communities nationwide." The CDC data confirms something we already know and C. Virginia Fields was pointing out. In inner city poor neighborhoods in many cities, Blacks make up a greater percentage of the population. The racial disparity in HIV infections reflect this -- 2.1% of a greater number is a greater number.

You can't always plan these things. If the CDC study had been released prior to our news conference, we would have used that data to drive home the message that we all know but need to keep shouting about. The risk of HIV, especially for poor women, is intimately tied to where you live and the link between HIV risk and the impact of poverty and the resultant inequalities in education, opportunities, resources, healthcare, etc. etc. etc., is all too familiar. We understand that convergence around the world and the CDC data gives us more evidence of that in the United States. Familiar yes; but I hope still shocking, disturbing, upsetting and the basis for all of us to redouble our efforts and show some progress by 2012.

Founded in 1994, AIDS Alliance for Children, Youth & Families (AACYF) is a national non-profit organization whose mission is to advance the partnership between consumers and providers -- they are the voice of women, children, youth and families living with and affected by HIV/AIDS. AACYF works to enhance and expand access to quality, comprehensive, family-centered care to America's women, children and youth affected by HIV/AIDS. For more information on AIDS Alliance, visit www.aids-alliance.org.