Journal Article

Racial Disparities in HIV Care

THE BOTTOM LINE:

A large study of about 20,000 individuals with HIV including women, men who have sex with women, and men who have sex with men (MSM) was done over 5 years. The goal was to assess the contribution of gender, age, and sexual orientation on person-time spent in: retention in care, ART use, and viral suppression. As an example of the results, Black MSM aged 50 years or older spent 6.3%, 11.0% and 9.7% less person-time respectively in these stages than a comparable group of white MSM. The authors suggest that the observation of racial and ethnic differences in this study provides a basis for alerting clinicians to increase their awareness of the impact of racial and ethnic differences when providing care.  Increased awareness should improve the HIV care continuum.

ABSTRACT

BACKGROUND: The United States National HIV/AIDS Strategy established goals to reduce disparities iin retention in human immunodeficiency virus (HIV) care, antiretroviral therapy (ART) use, and viral suppression. The impact of sex, age, and sexual HIV acquisition risk (ie, heterosexual vs same-sex contact) on the magnitude of HIV-related racial/ethnic disparities is not well understood.

METHODS: We estimated age-stratified racial/ethnic differences in the 5-year restricted mean percentage of person-time spent in care, on ART, and virally suppressed among 19 521 women (21.4%), men who have sex with men (MSM; 59.0%), and men who have sex with women (MSW; 19.6%) entering HIV care in the North American AIDS Cohort Collaboration on Research and Design between 2004 and 2014.

RESULTS: Among women aged 18-29 years, whites spent 12.0% (95% confidence interval [CI], 1.1%-20.2%), 9.2% (95% CI, .4%-20.4%), and 13.5% (95% CI, 2.7%-22.5%) less person-time in care, on ART, and virally suppressed, respectively, than Hispanics. Black MSM aged >/=50 years spent 6.3% (95% CI, 1.3%-11.7%), 11.0% (95% CI, 4.6%-18.1%), and 9.7% (95% CI, 3.6%-16.8%) less person-time in these stages, respectively, than white MSM >/=50 years of age. Among MSM aged 40-49 years, blacks spent 9.8% (95% CI, 2.4%-16.5%) and 11.9% (95% CI, 3.8%-19.3%) less person-time on ART and virally suppressed, respectively, than whites.

CONCLUSIONS: Racial/ethnic differences in HIV care persist in specific populations defined by sex, age, and sexual HIV acquisition risk. Clinical and public health interventions that jointly target these demographic factors are needed.

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