Despite HIV diagnosis rates decreasing among black women as a whole, disparities in diagnosis rates persist among US- and non–US-born black women.
A slew of research has demonstrated disparities in HIV diagnoses and outcomes across racial groups in the United States. Now, new research points to disparities within racial groups, with significant disparities in HIV diagnoses between US- and non—US-born black women.
These disparities persist even while HIV diagnosis rates decrease among black women as a whole and while disparities narrow between black women and other racial groups.
“The annual rate of HIV diagnosis among US black females declined from 38.7 per 100,000 population in 2010 to 30.0 per 100,000 population in 2014,” wrote the researchers. “Encouraging progress has also been made in reducing annual HIV diagnosis rates and narrowing absolute and relative disparities in HIV diagnosis rates between black women and women of other racial groups.”
The disparities among black women were observed in a study of 39,333 black women and 10,531 white women who received an HIV diagnosis between 2008 and 2016. The researchers analyzed data reported to the CDC from the United States and its 6 dependent areas—American Samoa, Guam, Northern Mariana Islands, Puerto Rico, the Republic of Palau, and the US Virgin Islands—for black and white women 18 years and older.
While just 4% of white women were born outside of the United States, 21.4% of black women were born outside of the United States. Among black women born outside of the United States, 61.9% were born in Africa and 33.9% were born in the Caribbean.
During the study period, the HIV diagnosis rate declined for all white women from 1.7 to 1.1 per 100,000 and for all black women from 42.7 to 20.4 per 100,000. Among both racial groups, rates of HIV diagnoses declined for US- and non—US-born women, with the largest decline observed among US-born black women (from 39.8 to 15.8 per 100,000).
However, the decline in rates among non—US-born black women was smaller, falling from 67.5 to 54.4 per 100,000. Rates for Africa-born black women dropped from 134.6 to 92.1 per 100,000 and rates for Caribbean-born black women dropped from 45.6 to 35.5 per 100,000.
“The relative disparity in HIV diagnosis rates between US-born black women and all US white women declined from 22.9 in 2008 to 14.5 in 2016,” noted the researchers. “By contrast, an increase occurred in relative disparities in diagnosis rates for non—US, Caribbean-, and Africa-born black women. The relative disparity in HIV diagnoses rates increased from 28.8 in 2008 to 50.0 in 2016 for all non–US-born black women.”
The researchers noted that the US black population has become increasingly heterogeneous in recent years, with a 135% increase in African immigrants since 2000. The HIV diagnosis rate and the disparities highlighted among Africa-born women bears a resemblance to the HIV epidemic profiles of certain African counties from which the majority of black women immigrated, according to the researchers.
Demeke H, Johnson A, Wu B, Moonesinghe R, Dean H. Unequal declines in absolute and relative disparities in HIV diagnoses among black women, United States, 2008 to 2016 [published online November 1, 2018]. Am J Public Health. doi: 10.2105/AJPH.2018.304641.