Comments on Racial Disparities that Affect Black Americans with HIV/AIDS in the United States
- Ashley Carvalho, MD, MSc, AAHIVS
- 6 hours ago
- 4 min read
February 7 is National Black HIV/AIDS Awareness Day, which aims to bring awareness to the existing racial disparities that affect the care of Black Americans with HIV/AIDS (PWHIVA). Profound racial disparities exist and persist in HIV testing and care in the United States, with Black Americans bearing a disproportionate burden of the epidemic. In 2018, Black individuals accounted for 43% of all new HIV diagnoses despite representing only 13% of the U.S. population, with diagnosis rates four times higher than all other racial/ethnic groups combined. [1-3] These disparities extend beyond incidence to encompass the entire continuum of care, from testing through viral suppression.
Inequities to Access to HIV/AIDS Test and Care for Black Americans
Access to HIV testing and linkage to care remains inequitable for Black Americans. Among Black individuals with newly diagnosed HIV infection in 2017, only 79% were linked to HIV medical care within 90 days—falling short of the National HIV/AIDS Strategy goal of 85%.[2] Furthermore, Black persons are less likely than White persons to be linked to care, retained in care, or achieve viral suppression.[2] In 2021, an estimated 153,500 persons had undiagnosed HIV infection, with Black individuals having rates 8.3 times higher than White persons.[4] These gaps in diagnosis and linkage perpetuate ongoing transmission and worsen health outcomes.
Geography and Service Deserts
Geographic and structural factors compound racial disparities, particularly in the Southern United States. The South accounts for 52% of all new HIV diagnoses, with states in this region having more intense epidemics, higher proportions of Black residents, and significant barriers to care.[1] Most Southern states have not expanded Medicaid, creating gaps in health insurance coverage that limit access to HIV screening, treatment, and prevention services including pre-exposure prophylaxis (PrEP).[1] Additional barriers include healthcare provider shortages (with less than half of provider needs met in the South), lower health literacy, transportation challenges in both rural and urban areas, and PrEP service deserts in rural regions.[1] Black adults living in communities with the highest social vulnerability are 1.5 times more likely to receive an HIV diagnosis than those in the least vulnerable communities.[3]
Social Determinants of Health
Intersecting identities create even more profound disparities requiring targeted interventions. Black men who have sex with men and Black women in the South face compounded risks, with 38% of new HIV diagnoses among MSM and 58% among women occurring in Black populations, with approximately two-thirds of these diagnoses in the South.[1] Rural Black persons face unique challenges, receiving a higher percentage of late-stage diagnoses (25.2%) compared to those in urban (21.9%) and metropolitan (19.0%) areas, though viral suppression rates are highest in metropolitan areas (63.8%).[5]
Ending the HIV Epidemic
Addressing these disparities requires comprehensive approaches that tackle social determinants of health—including poverty, housing instability, HIV-related stigma, and medical mistrust rooted in historical structural racism.[6-8] The Ending the HIV Epidemic initiative aims to reduce new infections by 90% by 2030, but achieving this goal necessitates explicit focus on reducing racial disparities through equitable resource allocation, culturally competent care, expanded Medicaid coverage, and interventions that address the underlying structural inequities perpetuating these profound health disparities.[2][6][8]
Resources for HIV testing and PrEP
There are a variety of resources for HIV testing and PrEP both locally and nationally. Locally, these include the Full Circle Health Wellness Center, which provides comprehensive care for PWHIV, including gender affirming care, as well as HIV PrEP services. Allies Linked for the Prevention of HIV and AIDS (a.l.p.h.a.) also provide HIV testing and linkage to care for PWHIV. National resources include MISTR, which provides access to HIV testing and PrEP services. HIV.gov is a helpful resource to locate HIV and PrEP providers in your area.
Acronym Footnotes
HIV — Human Immunodeficiency Virus
AIDS — Acquired Immunodeficiency Syndrome
PWHIVA — People With HIV/AIDS
PWHIV — People With HIV
MSM — Men who have Sex with Men
PrEP — Pre‑Exposure Prophylaxis
NHAS — National HIV/AIDS Strategy
EHE — Ending the HIV Epidemic (federal initiative to reduce new HIV infections by 90% by 2030)
a.l.p.h.a. — Allies Linked for the Prevention of HIV and AIDS
HIV.gov — U.S. government’s centralized HIV information and provider locator portal
References:
Lancet. 2021. Sullivan PS, Satcher Johnson A, Pembleton ES, et al.
MMWR. Morbidity and Mortality Weekly Report. 2020. Essuon AD, Zhao H, Wang G, et al.
MMWR. Morbidity and Mortality Weekly Report. 2022. Dailey AF, Gant Z, Hu X, et al.
AIDS. 2023. Townes A, Kota KK, Dailey AF, Henny KD.
Care Outcomes Among Black or African American Persons With Diagnosed HIV in Rural, Urban, and Metropolitan Statistical Areas - 42 U.S. Jurisdictions, 2018.
MMWR. Morbidity and Mortality Weekly Report. 2021. Lyons SJ, Dailey AF, Yu C, Johnson AS.
The Journal of the American Medical Association. 2023. Gandhi RT, Bedimo R, Hoy JF, et al.
The Lancet. HIV. 2021. Quan AML, Mah C, Krebs E, et al.
The American Journal of Managed Care. 2025. Daoud O, Gladstein JE, Brixner D, O'Brochta S, Naik S.
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