March 12, 2012
HIV rates for urban black women five times higher than estimated
Data from Baltimore and five other urban ‘hot spots’ cited by researchers
A national team of AIDS experts at Johns Hopkins and elsewhere say that they are surprised and dismayed by results of their new study showing that the yearly number of new cases of HIV infection among black women in Baltimore and other cities is five times higher than previously thought. The data show that infection rates for HIV, the virus that causes AIDS, among this population are much higher than the overall incidence rates in the United States for African-American adolescents and African-American women.
The data come from an ongoing larger series of studies supported by the HIV Prevention Trials Network and reflect testing and analysis of at-risk women in six urban areas in the northeastern and southeastern United States hardest hit by the global AIDS epidemic. The so-called “hot spots” are Baltimore; Atlanta; Raleigh-Durham, N.C.; Washington, D.C.; Newark, N.J.; and New York City. Researchers presented their findings March 8 at the 19th annual Conference on Retroviruses and Opportunistic Infections, held in Seattle.
Specifically, the team found that among 2,099 women ages 18 to 44, 88 percent of whom were black, 1.5 percent (32 women) tested positive at the outset of the study and were not enrolled, while among those who remained, 0.24 percent tested positive for HIV within a year after joining the study. All study participants were HIV-negative, including more than 200 from Baltimore, when they volunteered for the study.
Experts say that this rate of infection, or seroconversion, is five times that of previous estimates from the Centers for Disease Control and Prevention for urban African-American women.
“This study clearly shows that the HIV epidemic is not over, especially in urban areas of the United States, like Baltimore, where HIV and poverty are more common, and sexually active African-American men and women are especially susceptible to infection,” said the principal investigator for the Baltimore portion of the study, Charles Flexner, a clinical pharmacologist and infectious disease expert at Johns Hopkins.
“We, as care providers and policymakers, have our job cut out for us in devising HIV prevention programs targeted to sexually active men and women in Baltimore and other cities,” said Flexner, a professor at the Johns Hopkins University School of Medicine and the university’s Bloomberg School of Public Health. Prevention tactics, he says, should include more counseling about sexually transmitted infections, distribution of condoms and intensive education about safer sex practices.
In Baltimore, the study, which was conducted from May 2009 to July 2010, asked participating women about their safe sex practices and other health issues, then asked them to come to The Johns Hopkins Hospital for HIV testing at no cost. Those who tested positive were offered counseling and treatment.
“While we have always known that African-Americans had a higher risk of HIV infection than other American racial groups, this study confirms it and underscores the severity of the national and local problem, especially in cities,” Flexner said.
In the United States, more than 1 million men and women are already known to have tested positive for HIV, and Flexner says that women of all races account for a quarter of the 50,000 new infections each year. Sixty-six percent of those women each year are black, even though African-American women represent only 14 percent of the U.S. female population. The national age-adjusted death rate for black women in the United States is nearly 15 times higher than that observed for HIV-infected white women.
The new study, formally known as HPTN 064 Women’s Seroincidence Study, was funded by the National Institute of Allergy and Infectious Diseases. The study site leader was co-investigator Anne Rompalo, an infectious disease specialist and professor in the Johns Hopkins School of Medicine.