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Racial Disparities in Sustained Viral Suppression; Transmission Risk; HIV


On February 2, 2018, the CDC published a report that found fewer blacks living with diagnosed human immunodeficiency virus (HIV) infection had sustained viral suppression compared with Hispanics and whites. Among those who were in care and did not achieve sustained viral suppression, blacks had higher viral loads for approximately half of the 12-month period studied; this circumstance can adversely affect health outcomes and pose a risk for further transmission. Blacks aged 13 to 24 years had the lowest prevalence of sustained viral suppression.

 

Non-Hispanic blacks/African Americans (blacks) represent 12 percent of the U.S. population. However, in 2014 an estimated 43 percent (471,500) of persons living with diagnosed and undiagnosed HIV infection were blacks. In 2016, blacks accounted for 44 percent of all new HIV diagnoses. Although antiretroviral therapy (ART) prescriptions among persons in HIV care increased overall from 89 percent in 2009 to 94 percent in 2013, fewer blacks than Hispanics or Latinos (Hispanics) and non-Hispanic whites (whites) were on ART and had a suppressed viral load in their most recent viral load test result. 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 percent of the 12-month period) with viral loads above the level that increases the risk for transmitting HIV, than did Hispanics (47.2 percent) and whites (40.8 percent). Blacks aged 13 to 24 years had the lowest prevalence of sustained viral suppression, a circumstance which can adversely affect health outcomes and pose a risk for further transmission.  

 

Viral suppression is essential to maintaining the health of persons living with HIV infection and reducing the likelihood of HIV transmission. National treatment guidelines recommend that all persons with diagnosed HIV infection, regardless of their viral load, take ART to achieve viral suppression. However, only 40.8 percent of blacks living with diagnosed HIV infection in 38 jurisdictions with complete laboratory reporting had sustained viral suppression in 2014, a percentage lower than that among Hispanics (50.1 percent) and whites (56.3 percent). The remaining 59.2 percent of blacks included 25.3 percent who were in care but did not have sustained viral suppression in 2014 (i.e., partial suppression or not suppressed) and 33.9 percent with no viral load tests in 2014. The latter is an indication of not receiving adequate HIV care and presumably not having suppressed viral load. Although prescription of ART increased among blacks who received HIV clinical care between 2009 and 2013, fewer blacks received an ART prescription (92.9 percent) than did Hispanics (95.2 percent) and whites (95.2 percent). These findings highlight areas for improvement in care retention and offering of ART to all persons with HIV infection according to the national treatment guidelines.

 

The racial/ethnic differences in sustained viral suppression were present across all sex, age, and transmission categories. Lower viral suppression, combined with the higher prevalence of 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. Addressing barriers to care and treatment is important to improving the health of persons living with HIV and reducing disparities.

 

See the CDC Report

 

See also Medical Law Perspectives Report: Drugs, Dosage, and Damage: Physician Liability for Prescribing or Administering Medication

 

 

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