Even though Blacks get tested for HIV (Human Immunodeficiency Virus), the virus that causes AIDS more than other group, health care providers continue to struggle to get Blacks into treatment and keep them there, according to a recent report by the Centers for Disease Control and Prevention.
During a three-year period, Blacks accounted for 60 percent of people tested for HIV When Blacks test positive for HIV, 75 percent get "linked to care" and 48 percent are retained in care, compared to 54 percent of Whites who stay in treatment after testing positive for HIV, according to the CDC.
Researchers for the CDC study considered a person "linked to care" if they receive "one or more CD4 (count or percentage) or Viral Load test performed within 3 months after HIV diagnosis during 2010."
According to the report, because of the low number of Blacks in care for HIV, only 35 percent have achieved viral suppression, compared to 39 percent in the total population of people living with HIV in the United States.
The numbers are lower for Black heterosexual males and Black MSMs (men who have sex with men). Thirty-seven percent of Black MSMs achieved viral suppression, followed by 29 percent of Black heterosexual men who achieved viral suppression.
Donna Hubbard McCree, associate director of Health Equity for the HIV/AIDS Prevention division at the National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention at the CDC said that viral suppression is the outcome of being in care, staying in care, being on meds and adhering to your meds. She added that achieving viral suppression allows patients to get the HIV virus levels low enough to be healthy and reduce transmission to others.
Some clinicians have said that the CDC report on linkage to HIV care for Blacks doesn’t tell the whole story.
Lisa Fitzpatrick, a CDC-trained medical epidemiologist and infectious diseases physician at the United Medical Center in Southeast, Washington, D.C., suggested that if CDC only used the pool of HIV-positive individuals who were in care instead of counting all people who tested positive for HIV, their numbers for "retained in care" and viral suppression would be higher. Fitzpatrick said that people who are HIV-positive and not in care can’t clinically achieve viral suppression, so it makes more sense to start from the pool of people that are in care.
Blacks account for 44 percent of the new HIV infections and 44 percent of people living with HIV in the United States. According to the CDC, there was a 21 percent drop in HIV infections among Black women, but McCree said that it was too early to call the decline in numbers a trend. Despite the decrease, Black women still accounted for nearly two-thirds of all new infections for women and suffer HIV infection rate that is 20 times higher than the rate for White women.
Black men account for 31 percent of all new HIV infections, according to the CDC report, and the rate of new infections is six times higher than the rate for White men.
The exponential growth of HIV infections among Black men is largely driven by the infection rates of Black men who have sex with men (MSMs). Black MSMs accounted for more than half (51 percent) of the new infections, followed by heterosexual females (25 percent) and heterosexual males (13 percent). In a 2008 study, 28 percent of Black MSMs were HIV positive compared to 16 percent of White MSMs.
Phill Wilson, the chief executive officer of the Black AIDS Institute, the only national HIV/AIDS think tank focused on Blacks, said that being a Black male and being gay can make it harder for people who need treatment to get it.
"It’s the double jeopardy at the nexus where racism, homophobia, and sexophobia – the fear of talking about sex – come together," said Wilson. "The combination has created barriers to the actual research on the [Black MSMs] or the desire to do research in this population."
Wilson noted that Black men also suffer higher rates of unemployment than their White counterparts. Not having a job can end up closing another door to health care for Black men.
According to the Labor Department, Black men 20 years old and over had a 12 percent unemployment rate in January, compared to White men in the same age group who had 5.2 percent unemployment rate.
The unemployment rate for Blacks teens (16-19 years old) is the highest in the nation at 38 percent, compared to White teen jobless rate was 17.5 percent.
Although Wilson said that the Affordable Care Act would help some Blacks get treatment for HIV/AIDS, most Blacks live in southern states where many Republican lawmakers refused to expand Medicaid, blocking millions of state residents from affordable health care.
In September 2011, the CDC awarded $55 million in grants to 34 community-based organizations to focus on HIV prevention, testing and education among gay, bisexual and transgender youth of color.
In a statement on the grant program, Jonathan Mermin, director of CDC’s Division of HIV/AIDS Prevention, said the AIDS "epidemic cannot be overcome without effectively addressing the severe and rising toll of HIV infections among gay and bisexual men of color, who continue to be hardest hit by this disease."
Under the program, CBOs in the South will receive 44 percent of the funds. In 2008, more than 40 percent of minority MSMs were diagnosed in the South.
McCree also touted The Care and Prevention in the United States (CAPUS) Demonstration Project designed to increase testing and prevention and improve the rate of that newly diagnosed minorities to were linked to and retained in care. Total funding for the CAPUS project is $44 million.
Wilson said that it is possible to break the back of the AIDS epidemic.
"What the Black community has to understand is that nobody is ever going to care about us as much as we care about ourselves," he said. "As long as we think that it’s okay for Black people to get infected, and to get sick, and to die from the AIDS, the rest of the world is going to think that it’s okay."
Phill Wilson suggested developing a cadre of Black MSMs that can be funded to do research on Black MSMs.
"The research agenda needs to be in alignment with the demographic of the epidemic," said Wilson. "You can’t stop the epidemic, if you ignore the most at-risk population."