Targeted clinical and public health interventions are needed to improve HIV care among older black men who have sex with men, young white women and middle-aged black men who have sex with women, researchers wrote in Clinical Infectious Diseases.
“Disparities between racial/ethnic groups have been a defining feature of the human immunodeficiency virus (HIV) epidemic in the United States,” Fidel A. Desir, PhD student in the department of epidemiology at Johns Hopkins Bloomberg School of Public Health, and colleagues wrote. “Given the disproportionate impact of HIV, targeted reductions in racial/ethnic disparities are one of the central tenets of the U.S. National HIV/AIDS Strategy (NHAS).”
According to Desir and colleagues, in 2015, the NHAS identified men who have sex with men (MSM), black and Hispanic men and women and young people with HIV as critical populations deserving special attention.
“Few studies, however, have sought to determine how sex, age, and sexual HIV acquisition risk interact to influence racial/ethnic disparities in the HIV care continuum,” they wrote.
For their study, Desir and colleagues included adults aged 18 years or older with HIV who initiated care between Jan. 1, 2004, and Dec. 31, 2014. Of the 19,521 patients entering HIV care in the North American AIDS Cohort Collaboration on Research and Design, 21.4% were women, 59% were MSM and 19.6% were men who have sex with women (MSW). Study participants were followed for 5 years, until the close of cohort observation or until the end of the study period, whichever came first.
Desir and colleagues found that white women aged 18 to 29 years spent 12% less person-time in care (95% CI, 1.1%-20.2%), 9.2% less time on ART (95% CI, 0.4%-20.4%) and 13.5% less time virally suppressed (95% CI, 2.7%-22.5%) compared with Hispanic women in the same age group. Among MSM aged 50 years or older, black men spent 6.3% less person-time in care (95% CI, 1.3%-11.7%), 11% less time on ART (95% CI, 4.6%-18.1%) and 9.7% less time virally suppressed (95% CI, 3.6%-16.8%) compared with white MSM. Additionally, compared with white MSM, black MSM aged 40 to 49 years spent 9.8% less person-time on ART (95% CI, 2.4%–16.5%) and 11.9% less person-time virally suppressed (95% CI, 3.8%-19.3%).
According to the study, black and white MSM spent a similar amount of person-time in care and on ART, but black MSM spent 4.7% less person-time virally suppressed. Hispanic and white MSM also spent a similar amount of person-time in care, on ART and virally suppressed, although Desir and colleagues observed that compared with black MSM, Hispanic MSM spent more time in each of the three stages. Furthermore, person-time spent in care and on ART was similar between black and white MSW, but black MSW experienced 6% less person-time virally suppressed.
When compared with white women, black women spent more person-time in care, on ART and virally suppressed. Specifically, black women spent 5.1% more person-time in care than white women. Although the differences were not statistically significant, among women aged 30 to 39 years, black and Hispanic women spent less person-time in care, on ART and virally suppressed than white women. Moreover, among women aged 18 to 29 years and 50 years and older, black and Hispanic women spent more person-time in care than white women.
Desir and colleagues said older black MSM, young white women and middle-aged black MSM as groups of people living with HIV “require special attention to ensure the NHAS goals of reducing racial/ethnic disparities are achieved.”
“Our findings demonstrate that age, sex, and sexual HIV acquisition risk are important modifiers of racial/ethnic differences in HIV care retention, ART use, and viral suppression among PWH entering HIV care,” they wrote. – by Marley Ghizzone