HIV Prevalence Among U.S. Blacks Doubles Between 1991, 2001, CDC Study Shows

HIV prevalence among blacks in the United States nearly doubled between 1991 and 2001, while the rate remained steady among whites during the same period, according to a CDC report presented on Friday at the 12th Annual Conference on Retroviruses and Opportunistic Infections in Boston, the Washington Post reports (Brown, Washington Post, 2/26). CDC researchers examined data from the National Health and Nutrition Examinations Surveys, comparing data from 1988 to 1994 and 1999 to 2002 (Donn, AP/Las Vegas Sun, 2/26). The surveys asked a representative sample of U.S. households to answer questionnaires, give blood samples and undergo a modified physical examination. The surveys did not include U.S. residents in the military or in jails, prisons and hospitals. According to the analysis, HIV prevalence among U.S. blacks ages 18 to 59 was 1.1% in 1991. By 2001, that percentage had increased to 2.14%, about 13 times the prevalence among whites. The most affected group was black men ages 40 to 49, with 3.6% of survey participants in that group testing HIV-positive in 2001. Among blacks ages 19 to 39, the researchers found no change in HIV prevalence between 1991 and 2001, a finding that is "at odds with numerous other studies showing the AIDS epidemic growing with unusual speed" in young black men who have sex with men and women who are the sex partners of MSM or injection drug users, the Post reports (Washington Post, 2/26). Meanwhile, HIV prevalence among whites remained stable between 1991 and 2001 at 0.2%. Overall, HIV prevalence in the United States increased slightly from 0.33% to 0.43%, according to the data (AP/Las Vegas Sun, 2/26). Researchers attributed the difference between blacks' and whites' HIV prevalence rates to socio-economic factors, such as poverty, illicit drug use and access to health care, Agence France-Presse reports (Agence France-Presse, 2/26).

Reaction
Study lead author Geraldine McQuillan, a researcher at CDC's National Center for Health Statistics, said, "It is a disturbing trend," adding, "If anything, the findings are an underestimate" of the gap in HIV prevalence between blacks and whites (Washington Post, 2/26). The findings likely underestimate actual HIV prevalence rates in the United States because they do not account for HIV infection in the prison population or among the homeless, health officials said (AP/Las Vegas Sun, 2/26). However, McQuillan said, "Since we are not seeing increases in [the] youngest age groups, you feel comforted that prevention messages are at least being heard" (Reuters, 2/25). Terje Anderson, director of the National Association of People with AIDS, said, "It's incredibly disappointing. We just have a burgeoning epidemic in the African-American community that is not being dealt with effectively." Dr. Susan Buchbinder, director of HIV research for the San Francisco Department of Public Health, said, "I think it's very concerning. I think what we need to look at is how we can reduce these rates and get more people into treatment." She recommended that officials focus more on treating drug addiction (AP/Las Vegas Sun, 2/26).

Treatment Data
In related news, a separate CDC study presented at the conference Friday estimated that roughly 55% of HIV-positive U.S. residents for whom antiretroviral treatment is clinically recommended were receiving therapy in 2003, the Post (Washington Post, 2/26). National data analyzed by CDC showed that an estimated 480,000 HIV-positive U.S. residents ages 15 to 49 were eligible for treatment in 2003, but only 268,000 were receiving treatment (AP/Las Vegas Sun, 2/26). Federal guidelines recommend initiation of antiretroviral therapy when CD4+ T cell counts fall below 350 cells per microliter of blood (CDC release, 2/25). Of those who were not receiving treatment, an estimated 42% did not know they were HIV-positive, according to CDC. The remainder knew they were HIV-positive but were not under medical care or were in care but did not want or have access to antiretroviral therapy (Washington Post, 2/26). The findings indicate "a large unmet need for antiretroviral treatment and provide the clearest picture to date of the scope of the problem nationally," according to a CDC release (CDC release, 2/25).

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