February 6, 2015
The results of these analyses indicate that black persons living with HIV experienced higher numbers and rates of deaths during 2008-2012 than other races/ethnicities. However, the numbers and rates of death declined consistently during the same period. The death rate per 1,000 persons living with HIV among blacks decreased 28% during 2008-2012, more than the overall decline (22%) seen among all persons living with HIV. Other than among blacks, such a consistent decline was observed only among Hispanics or Latinos.
Despite differences in the magnitude of the death rates, the mortality pattern among blacks by age, sex, and transmission category was similar to that seen in other races/ethnicities. In all three races/ethnicities, the highest rates of death were observed in the oldest persons living with HIV infection (aged ≥55 years), who might have been living longer with HIV and had more complications from HIV, and who also might have a higher all-cause mortality because of their age. By transmission category, in all races/ethnicities, men who have sex with men had lower death rates than persons in most other transmission categories; whereas persons who had their infection attributed to injection drug use had the highest death rate. This finding is consistent with reports that persons who use injection drugs are more likely to have comorbid conditions and an increased all-cause mortality than nonusers of injection drugs.6
Whereas the overall disparity in deaths per 1,000 blacks living with HIV compared with whites living with HIV has narrowed over the period covered by this analysis (from 37% in 2008 to 13% in 2012), in 2012, the death rate was still higher (20.5) among blacks compared with whites (18.1) and Hispanics or Latinos (13.9). In general, blacks with HIV are less likely to have their infection diagnosed, with 15% unaware of their infection in 2011 compared with 12% of whites.7 Among blacks whose HIV was diagnosed in 2012, 77% were linked to care, which was lower than the percentage among any other race/ethnicity; in 2011, the percentages of black persons living with HIV who were retained in care (48%) or who had a suppressed viral load (40%) were lower than the percentages among whites and Hispanics or Latinos.7
The findings in this report are subject to at least one limitation. The report evaluates all-cause mortality in persons living with HIV and does measure mortality resulting from HIV. Therefore, the report does not allow for any direct evaluation of possible differences in quality of care among persons living with HIV, by race/ethnicity. However, because HIV infection causes immune suppression, which in turn results in fatal comorbidities such as cancers and opportunistic infections, all-cause mortality likely is a better indicator of the actual mortality experience than cause-specific mortality.
CDC, with its partners, has been pursuing a high-impact prevention approach to advance the goals of the National HIV/AIDS Strategy and to maximize the effectiveness of current HIV prevention and care methods.3 CDC also supports projects focused on blacks aimed at optimizing outcomes along the continuum of care, such as HIV testing (the first essential step for entry into the continuum of care) and projects that support linkage to, retention in, and return to care for all persons infected with HIV.8 The results of the analyses in this report show that, although disparities in mortality by race/ethnicity persist, the overall outlook for all persons living with HIV has improved, and the gaps between different races/ethnicities have narrowed. Focusing prevention and care efforts on minority populations with a disproportionate HIV burden could lead to further reduction, if not elimination, of health disparities, such as higher mortality, and help achieve the goals of the National HIV/AIDS Strategy.
Azfar-e-Alam Siddiqi, M.D., Ph.D., Xiaohong Hu, M.S., and H. Irene Hall, Ph.D., are with the Division of HIVAIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC (Corresponding author: Azfar-e-Alam Siddiqi, firstname.lastname@example.org, 404-639-5353).
What is already known on this topic?
In 2012, blacks accounted for 47% of persons who received a human immunodeficiency virus (HIV) diagnosis, and in 2011, they accounted for 43% of persons living with HIV. During 2008-2011 more deaths among black persons living with HIV occurred each year than among any other race/ethnicity.
What is added by this report?
During 2009-2012, the number of deaths among black persons living with HIV declined 18%, and the rate of death per 1,000 persons living with HIV declined 28%. In 2012, the number of deaths per 1,000 black persons living with HIV was 20.5 among blacks compared with 18.1 among whites and 13.9 among Hispanics or Latinos.
What are the implications for public health practice?
To achieve the National HIV/AIDS strategy's objective of reducing health disparities, efforts are needed to increase entry into and retention in care of black persons living with diagnosed HIV. Rates of death caused by HIV infection vary by geographic area, and efforts tailored to each area's unique needs and situations might be needed to reduce the rates of early deaths among blacks.
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