The Black community in the United States faces unique structural and societal barriers to accessing HIV prevention services. As a result, HIV has a disproportionate impact on the Black population. In 2021, Black people represented 40% of new HIV diagnoses, despite making up only 14% of the U.S. population. The disparity is clear in HIV prevalence as well—in 2021, 40% of all people living with HIV in the U.S. were Black.
These challenges can also hinder access to HIV testing and necessary treatment. In 2021, a smaller percentage of Black Americans diagnosed with HIV were virally suppressed than either Hispanic/Latinx or white Americans living with diagnosed HIV.
Progress has been made, however, especially in testing. In 2021, Black people had the highest percentage of people that have ever tested for HIV (56%) of any group. In comparison, the national average was just 35%.
Black Women and HIV
Black women continue to be disproportionately impacted by HIV, accounting for 54% of new HIV infections in U.S. women, despite making up less than 15% of the female population
Among Black women, 91% of new HIV infections were attributed to heterosexual contact. The HIV infection rate among Black women was the highest compared to women of all other races and ethnicities.
Additionally, a recent CDC study found that Black transgender women accounted for 62% of HIV infections among transgender women with HIV living in seven major U.S. cities.
Black women are also underserved by prevention methods such as PrEP relative to their need. Among all PrEP users in the U.S. in 2021, 92% were male and only 8% were female, despite the fact that women comprised 18% of new HIV diagnoses.
Social Determinants of Health
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PrEP Use in Black Communities
PrEP, or pre-exposure prophylaxis, is when people at risk for HIV take or receive HIV medicine regularly to lower their chances of getting infected with HIV. In 2022, Black people made up only 14% of PrEP users, despite accounting for 40% of new HIV diagnoses.
One measure of the relative need for PrEP in a population is the PrEP-to-Need Ratio (PnR). This is the ratio of the number of PrEP users to the number of people newly diagnosed with HIV. Overall, despite a consistent increase in PrEP use since 2012 among all groups, the gap in PrEP equity between Black Americans and white Americans continues to widen. In 2022, The PnR among Black people was eight times lower than for white people, demonstrating a higher unmet need for PrEP in the Black community.
These disparities also vary by region. In all U.S. regions in 2021, Black people had a higher unmet need for PrEP than white people. In the Northeast, for example, the PrEP-to-Need Ratio among Black people (PnR: 4.5) was over several times lower than among white people (PnR: 36).
These disparities in PrEP use mirror broader HIV-related health trends in Black communities. Across multiple metrics—prevalence, new diagnoses, PrEP equity, and social determinants of health—there is a clear pattern of poorer health outcomes in Black communities. While these disparities are being addressed, there is still more to be done.
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