Disparities in HIV care outcomes exist for Black people diagnosed with HIV, and access to care and treatment services differs by residence area. These findings were published in the Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report. Study authors evaluated care outcomes among Black persons diagnosed with HIV during 2018 in rural, urban, and metropolitan areas.

Among those diagnosed with HIV infections in Black rural neighborhoods, 25.2% received a late-stage diagnosis, which was higher than both urban neighborhoods (21.9%) and metropolitan areas (19.0%). All areas saw similar numbers of patients who received care within 1 month of diagnosis. Less patients in rural areas had viral suppression within 6 months of diagnosis (59.6%) compared with urban (59.7%) and metropolitan areas (63.8%).

In all areas, the highest percentages of late-stage diagnoses were among males with infection attributed to heterosexual contact. The subgroup with the lowest linkage to care is males in rural areas with HIV infection attributed to male-to-male contact and injection drug use (IDU), and males in rural urban areas with infection attributed to IDU. Viral suppression within 6 months of diagnosis was least common in all areas among males aged at least 13 years with infection attributed to IDU. 

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The authors found that the levels of care for Blacks in all areas do not reach the target goals for the Ending the HIV Epidemic initiative, which aims to increase the percentages of persons who were linked to care within 1 month of diagnosis and who had viral suppression within 6 months of diagnosis to 95%. This is likely due to the ongoing differences in health-related behaviors, socioeconomic differences, and overall access to health care systems in predominantly Black urban and rural neighborhoods. 

There were multiple limitations attributed to this study. Analyses were limited to 42 jurisdictions, which might not be representative of all Black people living with diagnosed HIV in the United States. Also, CD4 and viral load laboratory tests might not have been obtained at all care visits.


Lyons SJ, Dailey AF, Yu C, Johnson AS. Care outcomes among black or african american persons with diagnosed hiv in rural, urban, and metropolitan statistical areas — 42 U.S. jurisdictions, 2018. Morb Mortal Wkly Rep. 2021;70:229-235.