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Black Americans and HIV/AIDS: The Basics

Key Facts

  • Black Americans have been disproportionately affected by HIV/AIDS since the epidemic’s beginning, and that disparity has deepened over time.1
  • Although they represent only 12% of the U.S. population, Blacks account for more new HIV diagnoses (44%), people estimated to be living with HIV disease (40%), and HIV-related deaths (44%) than any other racial/ethnic group in the U.S.2,3,4
  • Among Black Americans, Black women, youth, and gay and bisexual men have been especially hard hit.5,6
  • 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 diagnoses among Blacks overall, especially among women, and a leveling off of new diagnoses among Black gay and bisexual men.8,9 However, given the epidemic’s continued and disproportionate impact among Blacks, a continued focus is critical to addressing HIV in the United States.

Overview

  • Today, there are more than 1.2 million people living with HIV/AIDS in the U.S., including more than 498,400 who are Black.10,11
  • Although Black Americans represent only 12% of the U.S. population,12 they accounted for 44% of new HIV diagnoses in 2015 (see Figure 1) and an estimated 40% of people living with HIV.13,14
Figure 1: New HIV Diagnoses & U.S. Population, by Race/Ethnicity, 2015

Figure 1: New HIV Diagnoses & U.S. Population, by Race/Ethnicity, 2015

  • The rate of new HIV diagnoses per 100,000 among Black adults/adolescents (44.3) was nearly 8 times that of whites (5.3) and more than twice that of Latinos (16.4) in 2015 (see Figure 2).15 The rate for Black men (84.8) was the highest of any group, more than twice that of Latino men (37.4), the 2nd highest group. Black women (26.2) had the highest rate among women.16
Figure 2: Rates of New HIV Diagnoses per 100,000, by Race/Ethnicity, for Adults/Adolescents, 2015

Figure 2: Rates of New HIV Diagnoses per 100,000, by Race/Ethnicity, for Adults/Adolescents, 2015

  • The latest data indicate declines in both the number and rate of annual new diagnoses among Blacks between 2010 and 20117 Black women, as a subgroup, have experienced a sizable drop in new diagnoses over the years – by 42% between 2005 and 2014.18
  • Blacks accounted for more than 4 in 10 (44%) deaths among people with an HIV diagnosis in 2014.19 The number of deaths among Blacks with an HIV diagnosis decreased 17% between 2010 and 2014; deaths among Latinos and whites decreased as well (by about 8%, respectively).20 Despite these declines, HIV was the 6th leading cause of death for Black men overall and for Black women ages 25-34, and the 5th for Black men ages 35-44 and 4th for Black women ages 35-44 in 2014, ranking higher than for their respective counterparts in any other racial/ethnic group.21
  • HIV death rates are highest among Blacks. In 2014, Blacks had the highest age-adjusted HIV death rate per 100,000 – 8.3, compared to 1.1 per 100,000 whites.22

Transmission23

  • Transmission patterns vary by race/ethnicity. While male-to-male sexual contact accounts for the largest share of HIV cases among both Blacks and whites, fewer Blacks are infected this way and heterosexual sex plays a bigger role among Blacks compared with whites. Among Blacks, 58% of new HIV diagnoses in 2015 were attributable to male-to-male sexual contact and 34% were attributable to heterosexual sex; among whites, 72% of new HIV diagnoses in 2015 were attributable to male-to-male sexual contact and 13% were attributable to heterosexual sex. The remainder of HIV diagnoses in each group were attributable to other causes, including injection drug use.
  • HIV transmission patterns among Black men vary from those of white men as well. 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 accounts for a greater share of new diagnoses 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

  • Among all women, Black women account for the largest share of new HIV diagnoses (about 4,500, or 60% in 2015), and the rate of new diagnoses among Black women (26.2) is 16 times the rate among white women and nearly 5 times the rate among Latinas.24 Black women also account for the largest share of women living with an HIV diagnosis at the end of 2014 (59%).25
  • Although new HIV diagnoses continue to occur disproportionately among Black women, recent data show a 42% decrease in new diagnoses for Black women between 2005 and 2014.26
  • In 2015, Black women represented about one quarter (26%) of new HIV diagnoses among all Blacks – a higher share than Latinas and white women (who represented 12% and 14% of new diagnoses among their respective groups).27
  • In 2015, Black teens and young adults, ages 13-24, represented more than half (55%) of new HIV diagnoses in that age group.28

Gay and Bisexual Men

  • Among gay and bisexual men, Blacks have been disproportionately affected by HIV and Blacks account for 39% of HIV diagnoses attributable to male-to-make sexual contact.29
  • In 2015, male-to-male sexual contact accounted for more than half (58%) of new HIV diagnoses among Blacks overall and a majority (79%) of new diagnoses among Black men.30
  • Young Black men who have sex with men are particularly affected, with those ages 13-24 representing over half (54%) of new HIV diagnoses among all men who have sex with men in that age group.31
  • In addition, newly diagnosed Black men who have sex with men are younger than their white counterparts, with those ages 13-24 accounting for 38% of new HIV diagnoses among Black men who have sex with men in 2015, compared to 15% among whites.32
  • A study in 20 major U.S. cities found that 36% of Black gay and bisexual men in the study were infected with HIV, compared to 17% of Latino and 15% of white gay and bisexual men. Many of these men did not know they were infected.33

Geography

  • 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 (63% in 2015) and Blacks living with an HIV diagnosis at the end of 2014 (57%).34
  • As with the nation as a whole, 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 2014 (See Figure 3). New York and Florida top the list. While the District of Columbia had fewer Blacks living with an HIV diagnosis in 2014 (11,012), it had the highest rate of Blacks living with an HIV diagnosis at the end of 2014 (4,186.8 per 100,000).35
Figure 3: Number of Black Adults/Adolescents Estimated to be Living with an HIV Diagnosis, Top 10 States, year-end 2014

Figure 3: Number of Black Adults/Adolescents Estimated to be Living with an HIV Diagnosis, Top 10 States, year-end 2014

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).36 Estimates indicate that about 13% of Blacks living with HIV do not know they are infected.37
  • Among those who are HIV positive, 22% of Blacks were tested for HIV late in their illness – that is, were diagnosed with AIDS within 3 months of testing positive for HIV, suggesting that they were tested for HIV late in their illness; by comparison, 23% of whites and 24% of Latinos were tested late.38
  • Looking across the spectrum of access to care, from HIV diagnosis to viral suppression, reveals missed opportunities for reaching Blacks. While many Blacks (87%) are diagnosed and linked to care within one month of diagnosis (72%), only 54% remain in regular care and fewer are virally suppressed (49%).39
Endnotes
  1. CDC. Special Data Request; 2006.

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  2. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2015, Vol. 27; November 2016. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas. Estimates for 2015 are preliminary and are not included in trend calculations.

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  3. CDC. HIV in the United States: At a Glance; December 2016.

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  4. CDC. HIV Surveillance Supplemental Report, Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data, Vol. 21, No. 4; July 2016.

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  5. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2015, Vol. 27; November 2016. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas. Estimates for 2015 are preliminary and are not included in trend calculations.

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  6. CDC. Fact Sheet: HIV Among African Americans; September 2016.

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  7. CDC. Fact Sheet: HIV Among African Americans; September 2016.

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  8. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2015, Vol. 27; November 2016. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas. Estimates for 2015 are preliminary and are not included in trend calculations.

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  9. CDC. HIV in the United States: At a Glance; December 2016.

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  10. CDC. HIV Surveillance Supplemental Report, Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data, Vol. 21, No. 4; July 2016.

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  11. Includes those diagnosed as well as estimates for those undiagnosed.

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  12. KFF. State Health Facts; accessed January 2017.

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  13. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2015, Vol. 27; November 2016. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas. Estimates for 2015 are preliminary and are not included in trend calculations.

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  14. CDC. HIV Surveillance Supplemental Report, Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data, Vol. 21, No. 4; July 2016.

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  15. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2015, Vol. 27; November 2016. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas, except for rates, which exclude the territories. Estimates for 2015 are preliminary and are not included in trend calculations.

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  16. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2015, Vol. 27; November 2016. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas, except for rates, which exclude the territories. Estimates for 2015 are preliminary and are not included in trend calculations.

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  17. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2015, Vol. 27; November 2016. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas. Estimates for 2015 are preliminary and are not included in trend calculations.

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  18. CDC. HIV in the United States: At a Glance; December 2016.

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  19. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2015, Vol. 27; November 2016. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas. Estimates for 2015 are preliminary and are not included in trend calculations.

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  20. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2015, Vol. 27; November 2016. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas. Estimates for 2015 are preliminary and are not included in trend calculations.

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  21. CDC. NCHS. Deaths: Leading Causes for 2014; June 2016.

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  22. CDC. NCHS. Deaths: Final Data for 2014; June 2016.

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  23. CDC. Slide Set: HIV Surveillance by Race/Ethnicity (through 2015).

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  24. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2015, Vol. 27; November 2016. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas. Estimates for 2015 are preliminary and are not included in trend calculations.

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  25. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2015, Vol. 27; November 2016. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas. Estimates for 2015 are preliminary and are not included in trend calculations.

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  26. CDC. HIV in the United States: At a Glance; December 2016.

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  27. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2015, Vol. 27; November 2016. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas. Estimates for 2015 are preliminary and are not included in trend calculations.

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  28. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2015, Vol. 27; November 2016. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas. Estimates for 2015 are preliminary and are not included in trend calculations.

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  29. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2015, Vol. 27; November 2016. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas. Estimates for 2015 are preliminary and are not included in trend calculations.

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  30. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2015, Vol. 27; November 2016. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas. Estimates for 2015 are preliminary and are not included in trend calculations.

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  31. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2015, Vol. 27; November 2016. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas. Estimates for 2015 are preliminary and are not included in trend calculations.

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  32. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2015, Vol. 27; November 2016. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas. Estimates for 2015 are preliminary and are not included in trend calculations.

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  33. CDC. HIV Infection Risk, Prevention, and Testing Behaviors among Men Who Have Sex with Men National HIV Behavioral Surveillance 20 U.S. Cities, 2014

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  34. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2015, Vol. 27; November 2016. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas. Estimates for 2015 are preliminary and are not included in trend calculations.

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  35. CDC. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Atlas Plus. Data are estimates from all 50 states, the District of Columbia, and Puerto Rico. Rate is not available for Puerto Rico.

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  36. The Washington Post/KFF. Survey of Americans on HIV/AIDS; July 2012.

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  37. CDC. National Black HIV/AIDS Awareness Day Social Media Resources; accessed February 2017.

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  38. CDC. HIV Surveillance Supplemental Report, Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data, Vol. 21, No. 4; July 2016.

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  39. CDC. HIV Surveillance Supplemental Report, Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data, Vol. 21, No. 4; July 2016.

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