Black Americans and HIV/AIDS
Black Americans have been disproportionately affected by HIV/AIDS since the epidemic’s beginning, and that disparity has deepened over time.1, 2 Blacks account for more new HIV infections, people estimated to be living with HIV disease, and HIV-related deaths than any other racial/ethnic group in the U.S.3, 4, 5, 6 The epidemic has also had a disproportionate impact on Black women, youth, and gay and bisexual men, and its impact varies across the country. Moreover, a number of challenges contribute to the epidemic among Blacks, including poverty, lack of access to health care, higher rates of some sexually transmitted infections, lack of awareness of HIV status, and stigma.7 Despite this impact, recent data indicate some encouraging trends, including declining new HIV infections among Black women.3 However, given the epidemic’s continued and disproportionate impact among Blacks, a continued focus is critical to addressing HIV in the United States.
Snapshot of the Epidemic
- Today, there are more than 1.1 million people living with HIV/AIDS in the U.S., including more than 510,000 who are Black.5
- Although Black Americans represent only 12% of the U.S. population,8 they accounted for 44% of new HIV infections in 20103 (Figure 1) and an estimated 44% of people living with HIV in 2009.4, 5 Blacks also accounted for almost half of new AIDS diagnoses (49%) in 2011 (AIDS being the most advanced form of HIV disease).1
- The rate of new HIV infections per 100,000 among Black adults/adolescents (68.9) was nearly 8 times that of whites (8.7) and more than twice that of Latinos (27.5) in 2010 (Figure 2). The rate for Black men (103.6) was the highest of any group, more than twice that of Latino men (45.5), the 2nd highest group. Black women (38.1) had the 3rd highest rate overall, and the highest among women.3
- HIV was the 4th leading cause of death for both Black men and Black women, ages 25-44, in 2009, ranking higher than for their respective counterparts in any other racial/ethnic group.9
Key Trends and Current Cases
- The number of new HIV infections per year among Blacks is down from its peak in the late 1980s, but has exceeded the number of infections among whites since that time.10 While new infections among Blacks overall and among Black men have remained stable in recent years, the latest data indicate a drop in incidence among Black women, driving an overall decline in new infections among women.3
- The number of Blacks living with an HIV diagnosis increased by 7% between 2008 and 2010, compared to a 5% increase among whites.1
- Blacks accounted for about half (48%) of deaths among people with an HIV diagnosis in 2010. The number of deaths among Blacks with an HIV diagnosis decreased 8% between 2008 and 2010; deaths among Latinos decreased as well (by 3%), and deaths among whites remained stable.1
- HIV-related deaths and HIV death rates are highest among Blacks. Blacks accounted for 56% of deaths due to HIV in 20096 and their survival time after an AIDS diagnosis is lower on average than it is for most other racial/ethnic groups.1 In 2008, Black men had the highest HIV death rate per 100,000 men ages 25-44; the HIV death rate among Black women in the same age group was also the highest among women.11
- HIV transmission patterns among Black men vary from those of white men. Although both groups are most likely to have been infected through sex with other men, white men are more likely to have been infected this way. Heterosexual transmission and injection drug use account for a greater share of new infections among Black men than white men.
- Black women are most likely to have been infected through heterosexual transmission, the most common transmission route for women overall. White women are more likely to have been infected through injection drug use than Black women.
Women and Young People
- Black women account for the largest share of new HIV infections among women (6,100, or 64% in 2010), and the incidence rate among Black women is 20 times the rate among white women and over 4 times the rate among Latinas.3 Black women also account for the largest share of women living with an HIV diagnosis at the end of 2010 (60%).1
- Although new HIV infections continue to occur disproportionately among Black women, recent data show a 21% decrease in incidence for Black women between 2008 and 2010.3
- In 2010, Black women represented 3 in 10 (29%) new HIV infections among all Blacks – a higher share than Latinas and white women (who, respectively, represent 14% of new infections among Latinos and 11% of new infections among whites).3
- In 2010, Black teens and young adults, ages 13-24, represented more than half (57%) of new HIV infections in that age group.3
Gay and Bisexual Men
- Among gay and bisexual men, Blacks have been disproportionately affected.
- In 2010, male-to-male sexual contact accounted for half (51%) of new HIV infections among Blacks overall and a majority (72%) of new infections among Black men.3
- Young, Black men who have sex with men are particularly affected, with those ages 13-24 representing over half (55%) of new HIV infections among all men who have sex with men in that age group.3
- In addition, newly infected Black men who have sex with men are younger than their white counterparts, with those ages 13-24 accounting for 45% of new HIV infections among Black men who have sex with men in 2010, compared to 16% among whites.3
- A study in 21 major U.S. cities found that 28% of Black gay and bisexual men in the study were infected with HIV, compared to 18% of Latino and 16% of white gay and bisexual men. Many of these men did not know they were infected.12
Although HIV diagnoses among Blacks have been reported throughout the country, the impact of the epidemic is not uniformly distributed:
- Regionally, the South accounts for the majority of Blacks newly diagnosed with HIV (61% in 2011) and Blacks living with an HIV diagnosis at the end of 2010 (55%).1
- HIV diagnoses among Blacks are clustered in a handful of states, with 10 states accounting for the majority (68%) of Blacks living with an HIV diagnosis at the end of 2010. New York and Florida top the list (Figure 3). While the District of Columbia had fewer Blacks living with an HIV diagnosis in 2010 (10,995), it had the highest rate of Blacks living with an HIV diagnosis at the end of 2010 (4,260.3 per 100,000); a rate more than 3 times the national rate for Blacks (1,242.4).13
- Ten large metropolitan areas accounted for over half (59%) of Blacks living with an HIV diagnosis at the end of 2009. The New York and Miami metropolitan areas had the greatest numbers of Blacks living with an HIV diagnosis.14
HIV Testing and Access to Prevention & Care
- Three quarters (75%) of Blacks, ages 18-64, report ever having been tested for HIV. Blacks in this age group are more likely than Latinos or whites to report having been tested for HIV in the last 12 months (45% compared to 30% and 14%, respectively).15 Furthermore, estimates indicate that about 1 in 5 (19%) Blacks living with HIV do not know they are infected.5
- Among those who are HIV positive, CDC data indicate that 31% of Blacks were tested for HIV late in their illness – that is, were diagnosed with AIDS within one year of testing positive for HIV; by comparison, 32% of whites and 36% of Latinos were tested late.1
- Looking across the spectrum of access to care, from HIV diagnosis to viral suppression, reveals missed opportunities for reaching Blacks. While many Blacks (81%) are diagnosed and linked to care (62%), only 34% remain in regular care and fewer are prescribed antiretroviral therapy (29%). Only 1 in 5 (21%) Blacks are virally suppressed, compared with 26% of Latinos and 30% of whites.16
Concern About HIV/AIDS15
- A recent survey found that Black Americans express concern about HIV/AIDS. One in 6 Black Americans surveyed name HIV/AIDS as the number one health problem in the U.S.
- While the proportion of Blacks saying they are personally concerned about becoming infected with HIV has declined since the mid-1990s, concern among Blacks is higher than among other racial and ethnic groups, with 33% saying they are very concerned, compared with 19% of Latinos and 6% of whites. Blacks are also more likely to express concern about an immediate family member becoming infected.
CDC. HIV Surveillance Report, Vol. 23; February 2013. HIV diagnosis data are estimates from all 50 states, the District of Columbia, and 6 U.S. dependent areas. Rates do not include U.S. dependent areas.
CDC. Special Data Request; 2006.
CDC. HIV Surveillance Supplemental Report, Vol. 17, No. 4; December 2012. Data are estimates and do not include U.S. dependent areas.
CDC. Fact Sheet: New HIV Infections in the United States; December 2012.
CDC. HIV Surveillance Supplemental Report 2012, Vol. 17, No. 3 (Part A); June 2012. Data are estimates and do not include U.S. dependent areas.
NCHS. "Deaths: Final Data for 2009," NVSR, Vol. 60, No. 3; December 2011.
CDC. Fact Sheet: HIV among African Americans; February 2013.
U.S. Census Bureau. 2010 Population Estimates.
CDC. Slide Set: HIV Mortality (through 2009); January 2013.
Hall HI et al. “Estimation of HIV Incidence in the United States.” JAMA, Vol. 300, No. 5; August 2008.
NCHS. Health, United States, 2011; May 2012.
CDC. MMWR, Vol. 59, No. 37; September 2010.
CDC. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Atlas. Data are estimates from all 50 states, the District of Columbia, and Puerto Rico. Rate is not available for Puerto Rico.
CDC. HIV Surveillance Supplemental Report, Vol. 18, No. 1; January 2013. Data are estimates from 46 states and Puerto Rico. Estimates are not available for all metropolitan statistical areas.
The Washington Post/KFF. 2012 Survey of Americans on HIV/AIDS; July 2012.
CDC. Fact Sheet: HIV in the United States: The Stages of Care; July 2012.