Deeper Look: HIV in Black Communities

The Current Landscape

The Black community in the United States continues to face profound and persistent disparities in HIV prevention, diagnosis, treatment, and care. These disparities are not the result of individual behaviors but stem from complex, interconnected structural and societal barriers that have been decades in the making. Historical and ongoing systemic inequities in healthcare access, housing stability, economic opportunity, and education create conditions that increase HIV vulnerability while limiting access to prevention and care services.

The numbers tell a stark story: In 2023, Black people represented 38% of new HIV diagnoses in the United States, despite comprising only 12% of the total population. Black people accounted for 14,754 of the 39,201 HIV diagnoses among persons aged 13 years and older, with a diagnosis rate of 41.9 per 100,000—about eight times higher than white Americans. The disparity is equally pronounced in HIV prevalence—39% of all people living with HIV in the U.S. (438,749 of 1,132,739 people) were Black in 2023, highlighting the cumulative impact of decades of unequal HIV burden.

These structural challenges create cascading effects throughout the HIV care continuum. At the end of 2022, 88% of Black people with HIV were diagnosed, 64% were linked to care, and 53% were virally suppressed, compared to 89% of White people with HIV who were diagnosed, 70% who were linked to care, and 63% who were virally suppressed. However, there are encouraging signs of progress, particularly in HIV testing awareness and uptake. In 2022, over half (57%) of Black adults reported ever having been tested for HIV, a greater share than among Latino or White adults (44% and 32%, respectively). This demonstrates both increased health awareness and the critical importance of community-based testing initiatives.

PrEP Access and Equity: Closing the Prevention Gap

Pre-exposure prophylaxis (PrEP) represents one of the most significant advances in HIV prevention, reducing the risk of HIV transmission by more than 99% when taken consistently. However, the benefits of this breakthrough have not been equitably distributed. Black people make up a much smaller proportion of PrEP users compared to their representation among new HIV diagnoses, demonstrating significant prevention inequity.

The PrEP-to-Need Ratio (PnR) provides a useful metric for understanding these disparities. This ratio compares the number of PrEP users to the number of people newly diagnosed with HIV within a population. While PrEP use has increased consistently since 2012 across all demographic groups, significant equity gaps persist, indicating dramatically higher unmet need for PrEP in Black communities.

Multiple factors contribute to low PrEP uptake in Black communities:

Provider-level barriers: Many healthcare providers, particularly in primary care settings, lack knowledge about PrEP or comfort discussing HIV prevention. This is particularly problematic in communities where specialized HIV care is limited.

Individual-level barriers: Concerns about side effects, stigma associated with HIV prevention medication, and mistrust of medical institutions rooted in historical and ongoing experiences of discrimination all contribute to lower uptake.

Structural barriers: High costs (even with insurance), prior authorization requirements, and the need for regular lab monitoring create practical obstacles to PrEP access. Geographic barriers are also significant, as many rural and under-resourced areas lack providers who prescribe PrEP.

Cultural factors: In some communities, discussing HIV risk and prevention may be challenging due to stigma around sexuality, particularly for women and LGBTQ+ individuals.

Addressing these disparities requires comprehensive approaches that go beyond simply increasing PrEP availability. Successful interventions have included community-based PrEP programs, peer navigation services, and initiatives that address structural barriers such as transportation and childcare.