Falls in new HIV diagnoses among women in the USA masks racial inequalities

15 November 2017

Black women in the USA continue to be disproportionately affected by HIV, according to the latest US Centers for Disease Control and Prevention (CDC) statistics.

Group of women walking

CDC figures released in October show HIV infections among adolescent girls and women (aged 13 and above) in the USA fell by 17% between 2011 and 2015. While this decline is encouraging, the figures highlight that while overall progress is being made, some groups are getting left behind. According to the new figures, of the 7,500 women newly diagnosed in 2015, 60% were black women, despite this group accounting for just 12% of America’s female population.

These latest statistics, based on data from 61 health departments including in Puerto Rico, and the US Virgin Islands, put the number of women living with HIV by the end of 2014 at 255,900. It is estimated that 12% of women living with HIV are unaware of their status, and just 55% of women with a positive diagnosis are virally suppressed - highlighting the steep progress needed for the USA to reach the UNAIDS’ target of 90% viral suppression by 2020. 

In 2015, just under half of the 3 million CDC-funded HIV tests provided were given to women. The highest proportion of tests were given to women aged 20–29 years (41%), black women (49%) and women living in America’s southern states (62%) – the region most affected by HIV in the USA. 

Just 61% of all women newly diagnosed with HIV were linked to care within 90 days of receiving their diagnosis – meaning a large number were not receiving the early treatment and support they needed to achieve viral suppression and improved health outcomes. Opportunities to reduce onward transmission of HIV as a result of viral suppression are also being missed.  

In addition, some 61% of women were supported to notify their sexual or injecting partners of their potential risk, in line with current World Health Organization guidelines. But increasing these numbers could also support HIV prevention objectives in the country by increasing the number of people aware of their status.

Alarmingly, around 62% of women testing HIV-positive had received a positive diagnosis before, with black women making up the vast majority of this category (72%). Most women who had previously tested positive were not on HIV treatment when they were tested again. Furthermore, only 57% of black women testing positive again were then linked to care within 90 days, compared to 65% of white women – further highlighting the significant racial inequalities that currently exist in the USA. 

The statistics underscore the need for HIV prevention programmes in the USA to identify women who are not linked to care, and women with previously diagnosed HIV who are not in care, and particularly black women. Factors such as poverty, health literacy, healthcare coverage, mistrust of medical providers and wrongly held beliefs about the origin of HIV were cited by CDC as reasons why black women might be less likely to engage with HIV treatment. 

It should be noted that these findings describe CDC-funded HIV tests only and do not include data on transgender women.

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Written by Hester Phillips