This Week in HIV Research: Disparities Drive the Epidemic

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We're probably not telling you anything you don't already know when we point out that the trends of the HIV epidemic in the U.S. often line up with the ways in which our country systemically treats its most marginalized communities, particularly people of color. But today's set of featured HIV-related publications drive that idea home with new data and new calls to action. They include:

  • The higher the level of stigmatization African-American women with HIV feel, the higher their viral load appears to be.
  • Annual U.S. HIV incidence would be reduced by more than half if we could eliminate racial disparities among men who have sex with men (MSM).
  • Even when they're engaged in care, young men who have sex with men fare unusually poorly when it comes to viral suppression.
  • We're overdue for a reckoning -- and a new approach -- in combating the rising tide of HIV among U.S. youth, leaders in the field contend.

Read onward for more regarding each of these important stories. To beat HIV, you have to follow the science!

Barbara Jungwirth is a freelance writer and translator based in New York. Follow Barbara on Twitter: @reliabletran.

Myles Helfand is the executive editor and general manager of TheBody and TheBodyPRO. Follow Myles on Twitter: @MylesatTheBody.

Greater Stigma Associated With Higher Viral Load in African-American Women

African-American women who experience greater HIV-related stigma have higher viral loads, a study published in AIDS found.

Researchers analyzed longitudinal data on 234 women, assessing internalized, enacted, and overall HIV-related stigma over the course of 14 months and relating that data to the women's viral loads over the same period. All participants took part in a stigma intervention.

At baseline, the participants scored a mean of 33 (on a scale of 14 to 70) in an assessment of overall HIV stigma. Higher levels of overall HIV stigma were linked to a higher viral load and lower odds of durable viral suppression.

While the study established an association, the direction of that relationship is not clear, study authors noted. For instance, rather than stigma leading to worse HIV outcomes, changes associated with uncontrolled HIV may give rise to greater stigma, they hypothesized. Based on other research, they also noted that stigmatization by health care professionals may have a greater impact on HIV treatment results than that from other sources. They recommended that interventions focus not just on the person being stigmatized, but also on the sources of their stigma.

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HIV Incidence Would Drop Substantially If Racial and Ethnic Disparities Were Eliminated

Overall HIV incidence in the U.S. would be 55% to 61% lower if rates among Latino and African-American MSM matched those of white MSM, researchers estimated in the Journal of Acquired Immune Deficiency Syndromes.

Based on several statistical measures, the authors calculated the disparity in HIV incidence rates among MSM between 2010-2015 for the three major U.S. ethnic/racial groups. All but one measure showed that disparities increased during the study period. For example, the Latino-to-White incidence rate ratio -- the relative difference in seroconversion rates between the two groups -- rose by 29%, while the African-American-to-White ratio rose by 14%. Despite the U.S. Centers for Disease Control and Prevention's high-impact prevention efforts, levels of African-American-to-white disparity have plateaued, study authors noted.

Especially concerning is the large proportion of young men in these estimates, they added. In 2015, 40% of incident seroconversions in African American MSM were among males 13-24 years old.

While published literature shows some factors associated with these disparities, research into the specific factor(s) that would reduce them is needed, the authors concluded.

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Viral Suppression Rates Much Lower in Young African-American Men Than the General Population

Even when young African-American men are engaged in HIV care, their viral suppression rates are significantly lower than in the general population of people living with HIV, a small study published in the Journal of Acquired Immune Deficiency Syndromes found.

Data on 336 HIV-positive African-American men between the ages of 18 and 24 -- all of whom were receiving HIV care -- showed that 36% were virally suppressed in 2013, compared to 68% in the general population. Within the cohort, participants receiving Ryan White HIV/AIDS Program services were more likely to have an undetectable viral load than those who did not get such assistance.

About 54 percent of participants reported a household income around the poverty level, and 12% were homeless. Self-reported treatment adherence was 73% overall, but was lower for people who reported being depressed (53%), smoking cigarettes (68%), or using street drugs (68%).

Study authors noted that some of their estimates should be interpreted with caution due to small sample sizes yielding large statistical variation.

The researchers suggested the following measures for raising viral suppression rates in this population: "Training providers on techniques for promoting trust in patient–provider relationships, addressing structural discrimination and racism in clinical settings, and delivering treatment and implementing CDC-recommended high-impact HIV prevention methods for young black men may help to increase [treatment] adherence and viral suppression."

To Lower HIV Rates Among Youths, Provide Comprehensive Sex Ed, Researchers Demand

In a comment published in The Lancet, a group of leading U.S. adolescent HIV providers and scientists called for comprehensive sex education in U.S. schools, among other measures, to help curb rising HIV rates among young people.

Donna Futterman, M.D., of Albert Einstein College of Medicine, Vincent Guilamo-Ramos, Ph.D., of New York University, and colleagues also recommended novel HIV testing approaches that target youths with limited access to health care and HIV care delivery systems geared toward teenagers and young adults.

Despite declining HIV diagnosis rates among the general population, HIV diagnoses increased 6% between 2012 and 2016 among all young people, and even more among Latino (+17%) and African-American (+9%) MSM, the authors said.

They noted that 18-29-year-olds are less likely to have health insurance than older people, and younger people's health records may be shared with their parents. For those under 18, parental consent may be required, e.g., for pre-exposure prophylaxis (PrEP).

Furthermore, the authors warned that experiences of racist, homophobic, or transphobic stigma and discrimination may cause LGBTQ people of color to distrust the health care system. "National efforts should prioritise differentiated and youth-friendly HIV prevention models, and address social determinants shaping engagement and retention in prevention services among adolescents and young adults," they concluded.