Racial and ethnic disparities in HIV diagnoses among heterosexually active persons in the United States nationally and by state, 2018

Abstract

Background Despite declining HIV infection rates, persistent racial and ethnic disparities remain. Appropriate calculations of diagnosis rates by HIV transmission category, race and ethnicity, and geography are needed to monitor progress towards reducing systematic disparities in health outcomes. We estimated the number of heterosexually active adults (HAAs) by sex and state to calculate appropriate HIV diagnosis rates and disparity measures within subnational regions. Methods The analysis included all HIV diagnoses attributed to heterosexual transmission in 2018 in the United States, in 50 states and the District of Columbia. Logistic regression models estimated the probability of past-year heterosexual activity among adults in three national health surveys, by sex, age group, race and ethnicity, education category, and marital status. Model-based probabilities were applied to estimated counts of HAAs by state, which were synthesized through meta-analysis. HIV diagnoses were overlaid to calculate racial- and ethnic-specific rates, rate differences (RDs), and rate ratios (RRs) among HAAs by sex and state. Results Nationally, HAA women have a two-fold higher HIV diagnosis rate than HAA men (rate per 100,000 HAAs, women: 6.57; men: 3.09). Compared to White non-Hispanic HAAs, Black HAAs have a 20-fold higher HIV diagnosis rate (RR, men: 21.28, women: 19.55; RD, men: 15.40, women: 31.78) and Hispanic HAAs have a 4-fold higher HIV diagnosis rate (RR, men: 4.68, RD, women: 4.15; RD, men: 2.79, RD, women: 5.39). Disparities were ubiquitous across regions, with >75% of states in each region having Black-to-White RR ≥10. Conclusion The racial and ethnic disparities across regions suggests a system-wide failure particularly with respect to preventing HIV among Black and Hispanic women. Pervasive disparities emphasize the role for coordinated federal responses such as the current Ending the HIV Epidemic (EHE) initiative.

Variation in Patterns of Racial and Ethnic Disparities in Primary and Secondary Syphilis Diagnosis Rates Among Heterosexually Active Women by Region and Age Group in the United States

“…To estimate heterosexually active women by region and age group, we adapted the methodology from past work to estimate populations of heterosexually active men and women by state (see Appendix, http://links.lww.com/OLQ/A797 , for an analysis flowchart). 13 First, for each survey (National Health and Nutrition Examination Survey, National Survey of Family Growth, and GSS), we ran logistic regressions of past-year heterosexual activity among adults aged 18 to 44 years with the following independent variables: sex, age group (ages 18–24, 25–29, and 30–44 years), race and ethnicity (White, Black, Hispanic, and all other races combined), education category (high school and lower, some college, and college graduate and above), and marital status (never married; married; and widowed, separated, or divorced). We estimated a fourth logistic regression for adults 45 years or older in GSS, the only survey containing sexual activity questions for older adults.…”

HIV Care Meets Telehealth: a Review of Successes, Disparities, and Unresolved Challenges

“…This includes all aspects of HIV, such as prevention, access to management, and treatment outcomes. Racial, ethnic, and gender minority groups face the most significant burden of HIV compared to other groups [ 4 ]. Also, the intersectionality of social determinants of health such as economic stability, education access and quality, neighborhood, and built environment are the main contributors to access to telehealth services in this population [ 5 ].…”

Predictors of missed HIV screening opportunities among newly diagnosed individuals at an urban medical center in New York City, 2018–2022

“…The majority of those newly diagnosed with HIV identified as either Hispanic (49%) or non-Hispanic Black (42%). These groups of communities, who represent the majority of patients receiving care at our institution, have a disproportionately greater incidence of HIV in both New York State and nationally, and have disproportionately lower rates of PrEP coverage and viral suppression [ 27 , 28 ].…”