July 2010, Week 3


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Mon, 19 Jul 2010 21:24:55 -0400
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HIV Devastates Minorities

Minority News
July 19, 2010

VIENNA - The Centers for Disease Control and Prevention
today released a first-of-its-kind analysis showing
that 2.1 percent of heterosexuals living in
high-poverty urban areas in the United States are
infected with HIV. This analysis suggests that many
low-income cities across the United States now have
generalized HIV epidemics as defined by the United
Nations Joint Program on HIV/AIDS (UNAIDS).

UNAIDS defines a generalized epidemic as one that is
firmly established in the general population, with an
overall HIV prevalence in the general population of
more than 1 percent. While subpopulations with higher
risk (such as men who have sex with men and injection
drug users) may still contribute disproportionately to
the spread of HIV in these areas, heterosexual
transmission is also sufficient to sustain an epidemic
independent of those groups.

The analysis also shows that poverty is the single most
important demographic factor associated with HIV
infection among inner-city heterosexuals. Contrary to
severe racial disparities that characterize the overall
U.S. epidemic, researchers found no differences in HIV
prevalence by race/ethnicity in this population. The
analysis will be presented at the XVIII International
AIDS Conference in Vienna, Austria.

"This study reveals a powerful link between poverty and
HIV risk, and a widespread HIV epidemic in America's
inner cities," said Kevin Fenton, M.D., Ph.D., director
of CDC's National Center for HIV/AIDS, Viral Hepatitis,
STD, and TB Prevention. "In this country, HIV clearly
strikes the economically disadvantaged in a devastating

The analysis, led by Paul Denning, M.D., a medical
epidemiologist in CDC's Division of HIV/AIDS
Prevention, included more than 9,000 heterosexual
adults (aged 18-50) in high-poverty areas of 23 cities
who participated in the 2006-2007 heterosexual cycle of
the CDC's National HIV Behavioral Surveillance System.
This system monitors HIV risk behaviors, HIV testing
patterns, and use of HIV prevention services among U.S.
populations at risk.

High-poverty areas were defined according to the U.S.
Census Bureau, and included areas in which at least 20
percent of residents have household incomes below the
poverty line.

Nationally, the United States is considered to have a
concentrated HIV epidemic, meaning that it is confined
mainly to individuals who engage in high-risk
behaviors, which in the United States are primarily gay
and bisexual men and injection drug users.

For this analysis, researchers followed UNAIDS criteria
for determining a generalized epidemic, and excluded
groups at highest risk for becoming HIV infected. Those
groups not included in this analysis were gay and
bisexual men - who continue to represent the majority
of new HIV infections in the United States - injection
drug users, and sex workers and their clients.

"These findings have significant implications for how
we think about HIV prevention. We can't look at HIV in
isolation from the environment in which people live,"
said Jonathan Mermin, M.D., director of CDC's Division
of HIV/AIDS Prevention. "This analysis points to an
urgent need to prioritize HIV prevention efforts in
disadvantaged communities. We are pleased that
President Obama's new National HIV/AIDS Strategy
reflects this type of approach, in terms of targeting
HIV prevention resources to those in greatest need."

Prevalence was especially high in those with the lowest
socioeconomic status. Within the low income urban areas
included in the study, individuals living below the
poverty line were at greater risk for HIV than those
living above it (2.4 percent prevalence vs. 1.2
percent), though prevalence for both groups was far
higher than the national average (0.45 percent). There
were no significant differences in HIV prevalence by
race or ethnicity in these low income urban areas:
prevalence was 2.1 percent among blacks, 2.1 percent
among Hispanics, and 1.7 percent among whites. By
contrast, the U.S. epidemic overall is characterized by
severe racial/ethnic disparities: the HIV prevalence
rate for blacks is almost 8 times that of whites, and
the HIV prevalence rate among Hispanics is nearly 3
times that of whites.

The absence of race-based differences in this analysis
is likely due to existing high prevalence of HIV in
poor urban areas, which - regardless of race or
ethnicity - places individuals living in these areas at
greater risk for exposure to HIV with each sexual

Authors note that other factors associated with poverty
also likely contribute to high HIV prevalence in these
settings. Some of these factors include limited health
care access, which can reduce utilization of HIV
testing and prevention services; substance abuse, which
can increase sexual risk behavior; and high rates of
incarceration, which can disrupt the stability of

This analysis provides greater insight into factors
that may be driving heterosexual HIV transmission in
the United States, which accounts for 31 percent of new
infections each year. This study did not examine HIV
prevalence among groups at higher risk for HIV in these
areas, including MSM and IDU. Nationally, MSM account
for 53 percent of new infections, IDU account for 12
percent, and those exposed through both MSM and IDU
account for 4 percent.

For more information on HIV in the United States,
please visit http://www.cdc.gov/hiv, or


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