HIV Infection in Minority Populations
Racial and ethnic minority populations in the United States, primarily African Americans and Hispanics, constitute 57 percent of the more than 800,000 cases of AIDS reported to the U.S. Centers for Disease Control and Prevention (CDC) since the epidemic began in 1981. African Americans make up almost 38 percent of all AIDS cases reported in the United States, yet according to the U.S. Census Bureau, they comprise only 12 percent of the U.S. population. Hispanics represent 18 percent of all AIDS cases and are approximately 13 percent of the U.S. population. Injection drug use is a major factor in the spread of HIV in minority communities. Other factors contributing to the spread of HIV/AIDS in these communities include men who have sex with men (MSM) and increasingly, heterosexual transmission.
According to CDC
NIAID Research on HIV Infection and AIDS
The National Institute of Allergy and Infectious Diseases (NIAID) is the lead component for AIDS research at the National Institutes of Health (NIH). NIAID is at the forefront of the war against this continuing health crisis, which disproportionately affects minority populations.
NIAID supports scientific research at universities, medical schools, hospitals, and research institutions, both in the United States and abroad, aimed at preventing, diagnosing, and treating HIV infection, AIDS, and other infectious diseases as well as allergic and other immune system disorders.
NIAIDs AIDS research agenda includes conducting clinical trials that address the specific needs and concerns of minority populations, ensuring that minority patients have access to all clinical trials and to the latest information on AIDS treatment and prevention. In addition, NIAIDs Office of Special Populations Research and Training encourages research aimed at improving the health of minority populations and also works to increase the effectiveness of outreach and education programs.
Through its Office of Communications and Public Liaison and the Dale and Betty Bumpers Vaccine Research Center, NIAID works with community-based organizations to disseminate information about HIV infection, AIDS, and NIAID research activities, especially HIV vaccine development, to minority communities.
NIAIDs programs and/or networks evaluate promising therapies to fight HIV infection and its associated complications, as well as approaches to reconstitute HIV damaged immune systems. These include:
Together, these programs represent the largest AIDS treatment and prevention initiative in the world. Recruiting minorities into clinical trials is a priority for NIAID to ensure that research results will apply to all populations affected by HIV. With the epidemic disproportionately affecting minority communities, inclusion of these populations is particularly urgent.
The AACTG investigates therapeutic interventions for HIV infection, AIDS, and complications of HIV-associated immune deficiency in adults. ACTG sites receive additional funding from the National Institute on Drug Abuse (NIDA) to increase participation of injection drug users, who are also hard-hit by the AIDS epidemic.
The PACTG evaluates clinical interventions for treating HIV infection and HIV-associated illnesses in neonates, infants, children, and adolescents. Both the PACTG and the HPTN are researching approaches to interrupt mother-to-infant transmission in pregnant women. In 2002, 6,191 and 7,764 participants were enrolled in AACTG and PACTG studies respectively. In the AACTG, 26 percent were African American, 19 percent Hispanic, and 3 percent Asian/Pacific Islander or Native American. In the PACTG, 47 percent were African American, 25 percent Hispanic, and less than 1 percent Asian/Pacific Islander or Native American.
CPCRA is a network of community-based health centers and clinics that support clinical research in community settings. CPCRA conducts large comparative studies that examine how to use available therapies more effectively as well as the long term consequences of different treatments. Currently, CPCRA trials are under way in 17 cities at 18 units. In 2002, 3,444 people participated in CPCRA studies. Of those, 49 percent were African American, 13 percent Hispanic, and 1 percent Native American or Asian/Pacific Islander.
NIAID also supports clinical research on vaccine and non-vaccine strategies to prevent HIV infection. Vaccine studies are carried out through the HVTN and non-vaccine prevention studies are conducted by the HPTN. The HVTN is a global network of clinical sites that evaluate preventive HIV vaccine in all phases of clinical trials. They allow for studies that examine differences in HIV diversity and genetic background, all of which may prove crucial to developing an effective vaccine for use around the world. Through close collaborations and education outreach programs with communities where vaccines will be tested, the HVTN hopes to enroll a diversified population in its clinical trials, ensuring access and representation of populations most affected by and vulnerable to HIV spread.
The HPTN is a global multicenter network dedicated to non-vaccine biomedical and behavioral interventions. The primary areas of research of the HPTN include mircrobicides, sexually transmitted disease prevention and treatment, behavioral and barrier interventions, antiretroviral drugs, interventions related to drug abuse, and modalities to decrease mother-to-infant transmission. They have directed their educational outreach efforts to minority communities working to increase trial volunteerism.
The HVTN and HPTN opened in 2000 and have since enrolled thousands of study participants. In FY 2002, 677 and 12,689 people participated in the HVTN and HPTN, respectively. Of those in the HVTN, 21 percent were African American, 3 percent Hispanic, and 2 percent Native American or Asian/Pacific Islander. In the HPTN, 57 percent of participants were African American, 5 percent Hispanic, and almost 9 percent Native American or Asian/Pacific Islander.
In addition, the Research Centers in Minority Institutions and the AIDS Clinical Trials Infrastructures in Minority Institutions are major programs to enhance basic and clinical HIV research performed at minority institutions.
NIAID conducts and supports research on HIV infection in a variety of population groups, including minority populations. These studies are conducted through the Women and Infants Transmission Study (WITS/WITS II), the Womens Interagency HIV Study (WIHS), and the Multicenter AIDS Cohort Study (MACS). Inner-city women, children, and injection drug users are the focus of WITS/WITS II. Ninety percent of the women in this study are from minority populations.
Similar populations of women are the focus of the WIHS, which NIAID established. The Institute awarded funds to six U.S. sites in 1993 to investigate primarily the impact of HIV infection on women. Several other NIH institutes also collaborate on WIHS and provide funds for various components. They include NIDA, National Cancer Institute, National Institute of Child Health and Human Development, and National Institute of Dental and Craniofacial Research.
Active community involvement through WIHS sites and the WIHS National Community Advisory Board helps encourage minority women to participate in the studies. More than 80 percent of the women currently enrolled in WIHS are from minority populations.
In the United States, the Multicenter AIDS Cohort Study (MACS) and WIHS are the two largest observational studies of HIV/AIDS in homosexual or bisexual men and in women, respectively. These studies have made major contributions to understanding how HIV is spread, how the disease progresses, and how it can best be treated. Over the past year, these studies expanded their enrollment to increase the size of the study groups by 60 percent and increase the number of minority participants. The enlarged groups will focus on contemporary questions regarding HIV infection and treatment.
AIDSinfo is a comprehensive resource for up-to-date information on government and industry sponsored HIV/AIDS treatment and prevention clinical trials. AIDSinfo also maintains the most current, federally approved guidelines for treating and preventing HIV/AIDS and AIDS-related illnesses in adults and children, for managing occupational exposure to HIV, and for preventing HIV transmission from mother-to-child during pregnancy. AIDSinfo has a great deal of information available in Spanish, and provides links to other Spanish language resources, which can be accessed through the home page.
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This article was provided by U.S. National Institute of Allergy and Infectious Diseases.