In 2018, approximately half (43%) of all new diagnoses of HIV infection in the United States were among the Black population, indicating the need for effective strategies to decrease the risk for HIV transmission in communities with increased social vulnerability. These findings were published in the Morbidity and Mortality Weekly Report.
Data on HIV infection rates among the Black population in the US through December 2019 were obtained from the National HIV Surveillance System (NHSS). These data were cross referenced with data from the US Census Bureau to determine the residential location of Black individuals with HIV infection at the time of initial diagnosis. Researchers assessed Social Vulnerability Index (SVI) scores generated from 15 population-based measures to determine the level of social vulnerability among all individuals in this population. The SVI scores were categorized into quartiles to assess for differences in the rate of HIV diagnoses on the basis of sex, age, and region of residence. Individuals with SVI scores in quartile 1 and quartile 4 were considered to be the least and most vulnerable to HIV transmission, respectively.
The researchers found that a total of 13,807 individuals who are Black were diagnosed with HIV infection in 2018. After stratification of individuals’ SVI scores by quartile, 7.6% were in quartile 1, 13.6% were in quartile 2, 24.8% were in quartile 3, and 52.2% were in quartile 4. The researchers found there was a 1.5-fold increase in HIV diagnoses among individuals with an SVI score in quartile 4 compared with those with an SVI score in quartile 1 (rate ratio [RR], 1.5; 95% CI, 1.3-1.7).
Of individuals in this population who were men, the rate of HIV diagnoses was most increased among those aged 45 to 54 years (RR, 2.3; 95% CI, 1.8-3.0), those living in the Northeast (RR, 2.3; 95% CI, 1.8-2.9), and those living in the West (RR, 2.1; 95% CI, 1.6-2.8). Among a subset of individuals who were both men who have sex with men and injection drug users, there was an 11.6-fold increase in HIV diagnoses among those with an SVI score in quartile 4 vs those with an SVI score in quartile 1.
Of individuals in this population who were women, the rate of HIV diagnoses was most increased among those aged 18 to 24 years (RR, 2.0; 95% CI, 1.4-3.0), 35 to 44 years (RR, 2.4; 95% CI, 1.8-3.3), and 45 to 54 years (RR, 2.0; 95% CI, 1.5-2.7)), as well as those living in the Northeast (RR, 2.3; 95% CI, 1.5-3.4). In addition, there was a 12.3-fold increase in HIV diagnoses associated with injection drug use among women with an SVI score in quartile 4 compared with women with an SVI score in quartile 1.
This study was limited as it may not be representative all individuals with HIV infection within this population as not all individuals with HIV infection are aware of their diagnosis.
“The development and prioritization of interventions that address social determinants of health are critical to addressing the [increased] risk for HIV infection among [individuals who are] Black living in communities with increased levels of social vulnerability,” the researchers concluded.
Dailey AE, Grant Z, Hu X, Lyons SJ, Okello A, Johnson AS. Association between social vulnerability and rates of HIV diagnoses among black adults, by selected characteristics and region of residence — United States, 2018. MMWR Morb Mortal Wkly Rep. 2022;71(5):167-170. doi:10.15585/mmwr.mm7105a2