What the EPI will not tell you: HIV in Communities of Colour

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This session by Marsha Martin, of the Black AIDS Institute, introduced attendees to alternative methods for understanding local epidemic dynamics.

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What the EPI will not tell you: HIV in Communities of Colour

  1. 1. Marsha A. Martin, DSW Urban Coalition for HIV/AIDS Prevention Services AIDS 2014 Melbourne, Australia July 22, 2014
  2. 2. Human Immunodeficiency Virus It is a virus It is the virus.
  3. 3.  AA are less than 15% of the U.S. population  AA represents nearly half of all new HIV infections  AA women are 15 times more likely to be living with HIV than white women.  New infections among young AA gay and bisexual men rose 48% from 2006 to 2010.  AA transgender women have the highest percentage of new HIV-positive test results  Three in five African Americans know someone living with or who has died from HIV/AIDS
  4. 4.  NYC 2007-2011  191 new HIV diagnoses among trans people  99% were among transgender women.  90% transgender women were blacks/African Americans or Latinos.  Over half (52%) of newly diagnosed transgender women were in their twenties  Majority of studies report black transgender women more likely to become infected with HIV than non-black transgender women.
  5. 5. “ The United States will become a place where new infections are rare and when they occur, every person, regardless of age, gender identity or socio-economic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination.”
  6. 6. “..What is sometimes less recognized is the extent to which the HIV epidemic among African Americas remains concentrated among Black Gay Men, who comprise the single largest group of African Americans living with HIV.."
  7. 7. “Efforts to reduce HIV among Blacks must confront the epidemic among Black gay and bisexual men as forcefully as existing efforts to confront the epidemic among other groups. These overlapping communities both need intensive efforts to stem HIV infection”
  8. 8.  HTPN 061 - Six Cities 1500+ AA men  Multiple partners  51% URAI w/male partner  75% UIAI w/male partner  44% sex w/ female partner  Status unknown partners  ND - strong gay identity  ND – unprotective sex  ND – no female partners  ND – no trans partners  Status unknown partners
  9. 9. National messages for the community:  Greater than AIDS  Get Educated about HIV  Get Tested For HIV  Get Treated if living with HIV  Treatment is Prevention  It is One Pill A Day  Let’s Stop HIV Together  Let’s Raise the Bars  Start Talking. Stop HIV
  10. 10.  The largest number of new HIV infections in the US occurs among gay, bisexual, other men who have sex with men, and transgender women. This is followed by African American heterosexual women.  By race/ethnicity overall, African Americans are the most heavily affected, followed by Latinos.
  11. 11.  African Americans face the most severe burden of HIV and AIDS in the US. 12-15% of US population, 44% of all new infections and of people living with HIV.  Latinos represent 16% of the population, 20% of all new infections and 19% of people living with HIV.  Whites represent 65% of the US population, 29% of all new HIV infections.
  12. 12.  In part due to a number of social determinants and economic challenges, such as lack of access to care, discrimination, stigma, racism, homophobia, transphobia and poverty, people of color have higher rates of HIV infection than whites.  These findings underscore the urgent need to prioritize and target HIV prevention efforts in disproportionately affected communities, both on structural and individual levels.
  13. 13. Proven HIV Prevention Methodologies:  HIV testing and linkage to care  HIV medications and pre-exposure prophylaxis  Access to condoms and behavioral health  Prevention programs for people with HIV and their partners  Prevention programs for people at high risk for HIV infection  Substance abuse treatment and access to syringe exchange programs and  STI/STD screening and treatment
  14. 14. US CDC says we will: Intensify HIV prevention in communities most heavily impacted; Utilize combination of effective evidence based HIV prevention interventions; and Educate about HIV and how to prevent it.
  15. 15.  Too few AA and trans people with HIV are aware they are infected.  Many are not in regular HIV care and treatment.  It is estimated that just under 30% of those in HIV care are virally suppressed. 70 % are not.  The diversity of people living with HIV requires specialty HIV prevention services tailored to meet myriad needs.  Yet HIV prevention resources are limited.
  16. 16.  “part of the party”  “just a matter of time”  “making me afraid to go out”  “easier to get it over with”
  17. 17.  Barriers to care and services: limited skills in negotiating the system; lack of information, unaware of HIV status, internalized racism, homophobia and transphobia  Facilitators to care and services: expansion of culturally appropriate services and messages, ACA LGBT outreach and engagement, permission and modeling of resiliency  CDC's high-impact prevention strategy – does not address the reality that HIV is part of the party
  18. 18.  Increase socio-cultural sexual health services for all at risk  Increase screening for STDs/STIs  Increase HIV positive persons in care  Increase linkage of HIV negative persons to prevention services including PrEP  Increase on-going supportive services  Increase health services aimed at socio- cultural well-being  Decrease Isolation and discrimination
  19. 19. It is the virus
  20. 20. Thank you to the folks at the African Diaspora Networking Zone Thank you to Tim, Kali and Jeremiah for continuing to push all of us Thank you to everyone at CDC Thank you to the government and community representatives and delegation members of the Urban Coalition of HIV/AIDS Prevention Services from: LA, SF, Chicago, Houston, Ft.Lauderdale, Baltimore, Philadelphia ,NYC, DC, Atlanta. Marsha A. Martin, DSW

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