3. Promoting HIV Testing in Diverse Populations
African American Populations
A complex set of factors—including racism and discrimination, poverty, denial, stigma, homophobia, and limited access to healthcare services—mean that African Americans are more vulnerable to HIV infection.
By the end of 2008, an estimated 240,627 African Americans had died of AIDS. In 2007, HIV was the ninth-leading cause of death for all African Americans and the third-leading cause of death for African American women and men 35 to 44 years of age. In 2009, an estimated 16,741 African Americans were diagnosed with AIDS. At some point in their lifetimes, an estimated 1 in 16 African American men and 1 in 32 African American women will be diagnosed with HIV infection. [CDC African American fact sheet 2012]
- In 2009, the estimated rate of new HIV infection for African American men was > 6.5 times that of white men, and 2.5 times that of Latino men or African American women.
- In 2009, African American MSM represented an estimated 73% of new infections among all African American men, and 37% among all MSM. More new HIV infections occurred among young African American MSM (ages 13 to 29) than any other MSM age and racial group.
- In 2009, approximately 85% of African American women with HIV became infected through heterosexual sex. The estimated rate of new HIV infections for African American women was > 15 times the rate among white women and > 3 times that among Latina women. [CDC African American fact sheet]
Prevention and Access to Care Issues
With a higher HIV prevalence in African American communities, each new sexual encounter brings a greater risk of HIV infection. Moreover, African American communities experience higher rates of other sexually transmitted infections (STIs) vs other US racial/ethnic communities. The presence of certain STIs can significantly increase the chance of contracting HIV, and coinfection with HIV and an STI can increase the risk of transmitting HIV infections to others. [CDC STD Surveillance 2010]
Furthermore, poverty-related socioeconomic issues—eg, limited access to high-quality healthcare, housing, and HIV prevention education—directly and indirectly increase the risk for HIV infection and affect the health of people both living with and at risk for HIV infection.
The estimated 1 in 5 HIV-infected US adults and adolescents who are unaware of their status includes approximately 117,000 African Americans. Late HIV diagnosis leads to missed opportunities both to access early medical care and to prevent transmission. CDC studies show that undiagnosed HIV infection is responsible for > 50% of new sexually transmitted HIV infections annually. [Marks 2006]
Stigma, fear, discrimination, homophobia, and negative perceptions about HIV testing can also increase risk among African Americans. Many at risk for infection fear stigma more than infection and may choose to conceal high-risk behaviors rather than seek counseling and testing. [Prevention Challenges] Issues such as substance abuse (including injection drug use), mental health problems, childhood sexual abuse, and other psychological stressors may make it difficult for people to protect themselves and their partners. [African American fact sheet CDC 2012]
