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HIV/AIDS in Women and Racial/Ethnic Minorities in the U.S.

  • HIV/AIDS (RD MacArthur, Section Editor)
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Abstract

The clinical issues affecting women with HIV/AIDS differ little from those affecting men. However, current research shows that treatment and outcome disparities affect many women with HIV, hypothesized to result from a complex interplay of socioeconomic and gender role influences. These disparities are also a reflection of racial/ethnic differences in treatment and outcome, since 80% of women with HIV/AIDS are black or Hispanic. Women have unique needs for HIV prevention — both prevention of sexual transmission to or from sexual partners and prevention of perinatal transmission. Racial/ethnic minorities continue to be disproportionately affected by the HIV/AIDS epidemic in the U.S. Minorities are less likely to be in care and on HAART than others with HIV/AIDS. These disparities result in poorer outcomes for minorities, especially blacks, with HIV/AIDS. New strategies for optimizing engagement and retention in care, and for prevention hold great promise for women and minorities with HIV in the U.S.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance, •• Of major importance

  1. Centers for Disease Control and Prevention. HIV surveillance report, 2009; vol 21, pp. 1–79. http://www.cdc.gov/hiv/topics/surveillance/resources/reports/. Published February 2011. Accessed July 15, 2011.

  2. UNAIDS. Global report: UNAIDS report on the global AIDS epidemic 2010. Available at: http://www.unaids.org/globalreport/Global_report.htm. Accessed on July 23, 2011.

  3. Center for Disease Control and Prevention. HIV slide set: HIV surveillance in women (through 2009). Available at: http://www.cdc.gov/hiv/topics/surveillance/resources/slides/women/index.htm. Accessed on July 23, 2011.

  4. Massachusetts Department of Public Health, Bureau of Infectious Disease, Office of HIV/AIDS. Intersecting risks: HIV infection among heterosexual women and men in Massachusetts. December 1, 2010. Available at: http://www.mass.gov/Eeohhs2/docs/dph/aids/intersecting_risks.pdf. Accessed July 18, 2011.

  5. Center for Disease Control and Prevention. HIV slide set: HIV mortality (through 2007). Available at: http://www.cdc.gov/hiv/topics/surveillance/resources/slides/mortality/index.htm. Accessed on July 23, 2011.

  6. Whitmore SK, Zhang X, Taylor A, Blair J. Estimated number of infants born to HIV-infected women in the United States and five dependent areas, 2006. J Acquir Immune Defic Syndr. 2011;57(3):218–22.

    Article  PubMed  Google Scholar 

  7. Center for Disease Control and Prevention. Slide set: pediatric HIV/AIDS surveillance (through 2009). Available at: http://www.cdc.gov/hiv/topics/surveillance/resources/slides/pediatric/index.htm. Accessed on July 23, 2011.

  8. •• Panel on Treatment of HIV-infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for the use of antiretroviral drugs in pregnant HIV-1-infected women for maternal health and interventions to reduce perinatal transmission in the United States. Department of Health and Human Services. May 24, 2010; pp. 1–117. Available at: http://www.aidsinfo.nih.gov/ContentFiles/PerinatalGL.pdf. Accessed on July 1, 2011. Updated guidelines for treating pregnant women with HIV. These guidelines provide a comprehensive review of relevant efficacy and toxicity data.

  9. • Moodley D, Esterhuizen T, Pather T, et al. High HIV incidence during pregnancy: compelling reason for repeat HIV testing. AIDS. 2009;23(10):1255–9. Large cohort study showing a high rate of acquisition of HIV during pregnancy which is the basis for both early and late HIV testing during pregnancy.

    Article  PubMed  Google Scholar 

  10. Heffron R, Donnell D, Rees H, et al. Hormonal contraceptive use and risk of HIV-1 transmission: a prospective cohort analysis. 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention, Rome. July 20, 2011. Abstract # WEAX0206.

  11. Center for Disease Control and Prevention. HIV surveillance by race/ethnicity (through 2009). Available at: http://www.cdc.gov/hiv/topics/surveillance/resources/slides/race-ethnicity/index.htm. Accessed on July 23, 2011.

  12. •• Cargill V, Fenton KA. The epidemiology, prevention, and control of HIV/AIDS among African Americans. In: Stone VE, Ojikutu B, Rawlings MK, Smith KY, editors. HIV/AIDS in US communities of color. New York: Springer; 2009. p. 1–22. This is Chapter 1 in the first comprehensive text book on HIV/AIDS among U.S. racial/ethnic minorities.

    Chapter  Google Scholar 

  13. •• Stone VE. Overcoming challenges to successful treatment outcomes in minority patients with HIV/AIDS. In: Stone VE, Ojikutu B, Rawlings MK, Smith KY, editors. HIV/AIDS in US communities of color. New York: Springer; 2009. p. 53–67. This is Chapter 2 in the first comprehensive text book on HIV/AIDS among U.S. racial/ethnic minorities.

    Chapter  Google Scholar 

  14. The White House Office of National AIDS Policy. National HIV/AIDS strategy for the United States. July 2010. http://www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf. Accessed May 23, 2011.

  15. El-Sadr WM, Mayer KH, Adimora AA. The HIV epidemic in the United States: a time for action. J Acquir Immune Defic Syndr. 2010;55(S2):S63.

    PubMed  Google Scholar 

  16. • El Sadr WM, Mayer KH, Hodder SL. AIDS in America: forgotten but not gone. N Engl J Med. 2010;362(11):967–70. Compelling review of the current status of the U.S. HIV/AIDS epidemic and why there is a need for new strategies to address this epidemic.

    Article  PubMed  Google Scholar 

  17. Center for Disease Control and Prevention. HIV surveillance in injections drug users (through 2009). Available at: http://www.cdc.gov/hiv/idu/resources/slides/index.htm. Accessed on July 23, 2001.

  18. Center for Disease Control and Prevention. HIV surveillance in men who have sex with men. Available at: http://www.cdc.gov/hiv/topics/surveillance/resources/slides/msm/index.htm. Accessed on July 23, 2011.

  19. •• Lemly DC, Shepherd BE, Hulgan T, et al. Race and sex differences in antiretroviral therapy use and mortality among HIV-infected persons in care. J Infect Dis. 2009;199:991–8. Large study showing that minorities and women in care spend less time on HAART and this is associated with poorer longer outcomes.

    Article  PubMed  Google Scholar 

  20. •• Lillie-Blanton M, Stone VE, Jones AS, et al. Association of race, substance abuse, and health insurance coverage with use of highly active antiretroviral therapy among HIV-infected women, 2005. Am J Public Health. 2010;100:1493–9. This study analyzed a large cohort of women and their care experiences and found that minority, uninsured and/or alcohol using women were more likely to not be receiving HAART.

    Article  PubMed  Google Scholar 

  21. •• Losina E, Schackman BR, Sadownik SN, et al. Racial and sex disparities in life expectancy losses among HIV-infected persons in the U.S.: impact of risk behavior, late initiation, and early discontinuation of antiretroviral therapy. Clin Infect Dis. 2009;49:1570–8. Very important study using state transition modeling techniques, which found that women and minorities have lower life expectancy following an HIV diagnosis.

    Article  PubMed  Google Scholar 

  22. Smith KY. Paying the price for late starts and early stops: racial and sex disparities in HIV-related mortality. Clin Infect Dis. 2009;49:1579–81.

    Article  PubMed  Google Scholar 

  23. Mugavero MJ, Lin HY, Willig JH, et al. Missed visits and mortality among patients establishing initial outpatient HIV treatment. Clin Infect Dis. 2009;48:248–56.

    Article  PubMed  Google Scholar 

  24. Fagan JL, Bertolli J, McNaghten AD. Understanding people who have never received HIV medical care: a population based approach. Public Health Reports. 2010;125:520–7.

    PubMed  Google Scholar 

  25. Metsch LR, Bell C, Pereyra M, et al. Hospitalized HIV-infected patients in the era of highly active antiretroviral therapy. Am J Public Health. 2009;99:1045–9.

    Article  PubMed  Google Scholar 

  26. Bell C, Metsch LR, Vogenthaler N, et al. Never in care: characteristics of HIV-infected crack cocaine users in 2 U.S. cities who have never been to HIV care. J Acquir Immune Defic Syndr. 2010;54:376–80.

    PubMed  Google Scholar 

  27. Meditz AL, MaWhinney S, Allshouse A, et al. Sex, race and geographic region influence clinical outcomes following primary HIV-1 infection. J Infect Dis. 2011;203:442–51.

    Article  PubMed  Google Scholar 

  28. Giordano TP, Bartsch G, Zhang Y, et al. Disparities in outcomes for African American and Latino subjects in the Flexible Initial Retrovirus Suppressive Therapies (FIRST) trial. AIDS Patient Care and STDs. 2010;24:287–95.

    Article  PubMed  Google Scholar 

  29. Currier J, Averitt Bridge D, Hagins D, et al. Sex-based outcomes of darunavir-ritonavir therapy: a single-group trial. Ann Intern Med. 2010;153(6):349–57.

    PubMed  Google Scholar 

  30. Smith KY, Garcia F, Ryan R, et al. GRACE (Gender Race and Clinical Experience): outcomes by race at week 48. 49th Interscience Conference on Antimicrobial Agents and Chemotherapeutics (ICAAC), San Francisco, September 12, 2009, Abstract H-918.

  31. • Ribaudo H, Smith KY, Robbins G, et al. Race difference in the efficacy of initial ART on HIV infection in randomized trials undertaken by ACTG. Presented at: 18th Conference on Retroviruses and Opportunistic Infections (CROI 2011); February 27–March 1; Boston, MA. Paper #50. This meta-analysis looks at virologic outcomes on five ACTG trials and found that minorities ahd 40% lower response rates.

  32. • Smith KY, Tierney C, Daar E, et al. Association of race/ethnicity and sex on outcomes in ACTG Study A5202. 18th Conference on Retroviruses and Opportunistic Infections (CROI 2011). Boston, February 27–March 2, 2011. Abstract 536. This study examined a large recent ACTG study, # 5202, and found that minorities did more poorly on all study arms (regimens).

  33. •• Gardner EM, McLees MP, Steiner JF, et al. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis. 2011;52(6):793–800. Very important article which used modeling techniques to estimate levels of engagement of HIV care and estimates of numbers and percentages of U.S. patients at each level.

    Article  PubMed  Google Scholar 

  34. Lange JM. Test and treat: is it enough? Clin Infect Dis. 2011;52:801–2.

    Article  PubMed  Google Scholar 

  35. Horstman E, Brown J, Islam F, et al. Retaining HIV-infected patients in care: Where are we? Where do we go from here? Clin Infect Dis. 2010;50:752–61.

    Google Scholar 

  36. Christopoulos KA, Das M, Colfax GN. Linkage and retention in HIV care among men who have sex with men in the U.S. Clin Infect Dis. 2011;52(S2):S214–22.

    Article  PubMed  Google Scholar 

  37. Smith KY, Aziz M. Challenges and successes in linking HIV-infected women to care in the U.S. Clin Infect Dis. 2011;52(S2):S231–7.

    PubMed  Google Scholar 

  38. Mugaavero MJ, Norton WE, Saag MS. Health care system and policy factors influencing engagement in HIV medical care: piecing together the fragments of a fractured health care delivery system. Clin Infect Dis. 2011;52(S2):S238–46.

    Article  Google Scholar 

  39. •• Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363:2587–99. The first study to show efficacy of pre-exposure prophylaxis (PrEP) in human subjects, specifically in men who have sex with men.

    Article  PubMed  CAS  Google Scholar 

  40. •• Baeten J, Celum C. Antiretroviral Pre-Exposure Prophylaxis for HIV-1 prevention among heterosexual African men and women: the Partners PrEP Study. 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention, Rome. July 18, 2011. Abstract #MOAX0106. One of the two initial clinical trials which showed efficacy of pre-exposure prophylaxis (PrEP) in serodiscordant heterosexual couples.

  41. •• Thigpen MC, Kebaabetswe PM, Smith DK, et al. Daily oral antiretroviral use for the prevention of HIV infection in heterosexually active young adults in Botswana: results from the TDF2 study. 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention, Rome. July 18, 2011. Abstract #WELBC01. One of the two initial studies which showed efficacy of pre exposure prophylaxis (PrEP) in serodiscordant heterosexual couples.

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Disclosure

V. Stone has received honoraria and consulting fees from Gilead Sciences and Tibotec Therapeutics.

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  1. Divisions of General Medicine and Infectious Disease, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Bulfinch 130, Boston, MA, 02114, USA

    Valerie E. Stone

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Stone, V.E. HIV/AIDS in Women and Racial/Ethnic Minorities in the U.S.. Curr Infect Dis Rep 14, 53–60 (2012). https://doi.org/10.1007/s11908-011-0226-4

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  • DOI: https://doi.org/10.1007/s11908-011-0226-4

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