Abstract
* However, in 2014 an estimated 43% (471,500) of persons living with diagnosed and undiagnosed human immunodeficiency virus (HIV) infection were blacks (1). In 2016, blacks accounted for 44% of all new HIV diagnoses (2). Although antiretroviral therapy (ART) prescriptions among persons in HIV care increased overall from 89% in 2009 to 94% in 2013, fewer blacks than Hispanics or Latinos (Hispanics) and non-Hispanic whites (whites) were on ART and had a suppressed viral load (<200 HIV RNA copies/mL) in their most recent viral load test result (3). Blacks also might be less likely to have sustained viral suppression over time and to experience longer periods with viral loads >1,500 HIV RNA copies/mL, a level that increases the risk for transmitting HIV (4-7). National HIV Surveillance System (NHSS) data are among those used to monitor progress toward reaching the national goal of reducing health disparities. CDC analyzed NHSS data to describe sustained viral suppression and transmission risk potential by race/ethnicity. Among 651,811 persons with HIV infection diagnosed through 2013 and who were alive through 2014 in 38 jurisdictions with complete laboratory reporting, a lower percentage of blacks had sustained viral suppression (40.8%), than had Hispanics (50.1%) and whites (56.3%). Among persons who were in care (i.e., had at least one viral load test in 2014) and had not achieved sustained viral suppression in 2014, blacks experienced longer periods (52.1% of the 12-month period) with viral loads >1,500 copies/mL, than did Hispanics (47.2%) and white (40.8%). Blacks aged 13-24 years had the lowest prevalence of sustained viral suppression, a circumstance that might increase transmission risk potential. Strengthening interventions that improve access to ART, promote adherence, and address barriers to clinical care and supportive services for all persons with diagnosed HIV infection is important for achieving the national goal of reducing health disparities.
Highlights
Lower viral suppression, combined with the higher prevalences of human immunodeficiency virus (HIV) among blacks compared with other racial/ethnic groups, could lead to a higher HIV transmission risk potential. Barriers such as lack of health insurance, limited access to health services, stigma, health literacy, and lack of trust in providers and the care system might be contributing to these disparities (9)
30.6% of 651,811 persons living with a diagnosis of HIV did not have any viral load test in 2014 and were not included in the analysis for transmission risk potential
High-impact prevention: CDC’s approach to reducing human immunodeficiency virus (HIV) infections in the United States
Summary
MD, PhD Robin Ikeda, MD, MPH Rima F. The percentage of persons without a viral load test in 2014 was 33.9% among blacks, 29.9% among Hispanics, and 28.2% among whites. A lower proportion of blacks had sustained viral suppression (40.8%), than did Hispanics (50.1%) and whites (56.3%). Age, and transmission category subgroups, the proportion of blacks with sustained viral suppression was lower than that of Hispanics and whites (Table 1). Among 136,759 persons who were in care in 2014, but did not achieve sustained viral suppression, 89,245 (65%) had at least one viral load test result of >1,500 copies/mL in 2014. The mean number of days with a viral load >1,500 copies/mL was higher among blacks (190 days, 52.1% of the 12-month period) than among Hispanics (172 days, 47.2%) and whites (149 days, 40.8%) (Table 2).
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