HIV and Black/African American People in the U.S.
Racism, longstanding systemic inequities, social and economic marginalization, residential segregation, and other ingrained barriers are among the factors that have led to Black or African American (hereafter referred to as Black) people accounting for a higher proportion of new HIV infections than other races and ethnicities.
More than 40% of new HIV infections in the United State occur among black people
A growing body of research also shows that centuries of racism in this country has had a profound and negative impact on communities of color. The impact is pervasive and deeply embedded in society—affecting where one lives, learns, works, worships, and plays and creating inequities in access to housing, education, wealth, employment, and a range of other social and economic benefits. These conditions—often referred to as social determinants of health—are key drivers of health inequities within communities of color, placing those within these populations at greater risk for poor health outcomes.
HIV disparities are not inevitable. With effective prevention and treatment tools at our disposal, the nation has a decades-in-the-making opportunity to end the domestic HIV epidemic and erase glaring disparities in HIV prevention and care. CDC is working with partners on many fronts, and through the federal Ending the HIV Epidemic in the U.S. (EHE) initiative to deliver and scale up key, science-based HIV treatment and prevention strategies in innovative ways that reach populations equitably.
40% of people with HIV in the United State are black, despite black people accounting for only 13% of the nation's population
CDC estimates that, as of 2019, about 1.2 million people in the U.S. have HIV. In 2019, Black people accounted for 13% of the U.S. population but 40% (479,300) of people with HIV. While new HIV infections declined 8% overall from 2015 to 2019, they remained stable among Black people during that timeframe.
New HIV Infections Disproportionately Affect Black Gay and Bisexual Men and Black Heterosexual Women
BLACK MEN accounted for three-quarters of new HIV infections among all Black people in the United States in 2019, with 82% of infections attributed to male-to-male sexual contact. Furthermore, data show Black gay and bisexual men were less likely to receive an HIV diagnosis, use pre-exposure prophylaxis (PrEP) to prevent HIV, and be virally suppressed, compared to gay and bisexual men overall.
FOR BLACK WOMEN, 91% of new HIV infections were attributed to heterosexual contact while the HIV infection rate among Black women was the highest compared to women of all other races and ethnicities.
Additionally, a recent CDC studypdf icon found that BLACK TRANSGENDER WOMEN accounted for 62% of HIV infections among transgender women with HIV living in seven major U.S. cities.
To end the HIV epidemic, HIV testing must be scaled-up; people with HIV must be linked to care and getting treatment; and equitable access to HIV prevention—including PrEP—must be ensured for everyone who could benefit.
Approximately 13% of Black people with HIV in the U.S. still do not know their status, and too few are receiving adequate HIV care and treatment that will help them live longer, healthier lives and get and keep viral suppression. Further, PrEP use is lowest among Black people relative to White and Hispanic/Latino people.
To achieve health equity and end the HIV epidemic, the nation must overcome systemic racism, homophobia, transphobia, HIV-related stigma, and other ingrained barriers that have contributed to disparities for far too long.
Innovation is also key. For example, a total-person approach to care integrates HIV prevention and treatment into health services that people are already seeking. This approach also addresses interconnected epidemics, such as sexually transmitted infections and hepatitis. HIV self-testing and mobile services should be maximized to reach people where they are—which, for many, is outside of traditional healthcare settings. And because the health system does not have the capacity to implement the most recent advances in HIV prevention and care in all communities, CDC is focusing EHE resources on delivering these services to the communities most in need.
CDC’s key efforts include:
- CDC monitors and reports HIV data by race and ethnicity, including diagnoses, linkage to care, viral suppression, and PrEP prescriptions. CDC shares these data publicly through various channels—including annual data reports and America’s HIV Epidemic Dashboard (AHEAD)external icon—so that federal, state, and local health authorities can use this information to equitably address HIV.
- CDC analyzes data to call urgent attention to concerning trends in racial and ethnic disparities. For example, recent CDC analyses have identified that despite overall progress, new HIV infections remained flat among Black gay and bisexual men in the decade leading up to the federal EHE; and that that nearly two in three Black transgender women surveyed in seven major U.S. cities have HIV.
- CDC awards $400 million per year to health departments for integrated HIV data collection and prevention efforts. Through these awards, health departments work to reach the populations and geographic areas of greatest need.
- The federal EHE initiative is also working to address disparities. In July 2020, CDC awarded approximately $109 million to state and local health departments within the 57 EHE jurisdictions to begin the first year of a five-year funding program. In July 2021, CDC awarded $117 million to those areas to help rebuild and begin to expand HIV prevention and treatment efforts as the U.S. continues to respond to COVID-19.
- CDC funds community-based organizations (CBOs), which are positioned to complement the HIV prevention work of health departments, in two ways: CDC provides direct funding to CBOs, as well as indirect funding to CBOs through health departments. CDC is providing up to $210 million in direct funding over five years, through 2026, to nearly 100 CBOs to implement comprehensive HIV prevention programs. These resources are focused on Black gay and bisexual men, transgender people, cisgender women and people who inject drugs.
- Since 2017, CDC has awarded nearly $11 million per year to 30 CBOs to provide comprehensive HIV prevention services to young gay and bisexual men of color and transgender youth of color with the goal of identifying undiagnosed HIV infections and linking people with HIV to care and prevention services.
- To help reduce stigma and encourage people at risk for and with HIV to seek out vital testing, treatment, and prevention services, CDC works with community partners to design and deliver education and awareness campaigns such as Let’s Stop HIV Together. Let’s Stop HIV Together reaches Black people with culturally appropriate messages about HIV testing, prevention, and treatment.
- CDC identifies evidence-based interventions and best practices through CDC’s HIV Prevention Research Synthesis (PRS) Project. The PRS Project has identified several interventions for Black people, including Centralized HIV Servicespdf icon, the PrEP Counseling Centerpdf icon, and Project IMAGEpdf icon.
- CDC centers its work on health equity by developing and implementing strategies and programs to address health disparities through the Office of Health Equity.
- CDC builds capacity for HIV epidemiologic and prevention research in Black communities through the Minority HIV/AIDS Research Initiative program.
To end the HIV epidemic once and for all, we all must work together to make the powerful HIV prevention and treatment tools accessed by some, accessible to all.