February 3rd, 2011

Disparities in HIV Diagnoses, and Interpreting CDC-ese

In anticipation of National Black HIV/AIDS Awareness Day (February 7), the CDC has issued a new report on the disparities in HIV diagnoses in the United States.

During 2005–2008, blacks/African Americans accounted for 13.6% of the population in the 37 states and 50.3% of the 156,812 diagnoses of HIV infection during that period … HIV transmissions in black/African American males were classified most frequently as male-to-male sexual contact (61.1%), followed by heterosexual contact (23.1%), injection drug use (IDU) (11.9%), and both male-to-male sexual contact and IDU (3.6%)… Among females, blacks/African Americans accounted for the largest percentage of diagnoses of HIV infection (65.9%) during 2005–2008. Most black/African American females diagnosed with HIV were exposed through heterosexual contact (85.2%), and the next greatest percentage by IDU (14.0%).

Some additional findings in this report:

  • From 2005-2008, new diagnoses increased in black/African American Males; in all other groups, it was stable (see figure)
  • The disparity between racial/ethnic groups was highest among persons aged 13–24 years, women, and persons with infection attributed to heterosexual contact
  • In 2008, black/African American males and females were diagnosed with HIV infection at 8 and 19 times the rates for white males and females; 2 and 4 times the rates for Hispanic/Latino males and females, respectively

The authors of this report comment that  “the higher rates of diagnoses among blacks/African Americans suggest that adolescents and adults from this population who are at higher risk for HIV infection might benefit [emphasis mine] from more frequent testing to facilitate earlier diagnosis.”

As usual, this is an outstanding report from the kind folks from Atlanta (who must feel this year like they’ve been tricked into living in New England).

But one of the things I’ve learned to recognize over the years of reading MMWR and other CDC reports, is that when they bring out the word “might” — a classic word from the CDC Manual of Style — what they really mean is:  “We think you should do this but something is keeping us from stating it so bluntly.”

So let me be so bold:  More frequent HIV testing is recommended for people at high risk for HIV — and the risk is high in certain black/African American communities, regardless of “risk factors”, as my colleague Kim Smith has wisely stated. Clinicians should be aware of the data presented here so that they can implement these recommendations appropriately.

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HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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