HIV (human immunodeficiency virus) does not affect all groups equally. In the United States, Black and Latinx people, men who have sex with men (MSM), trans women/transfeminine people, and the trans community at large are disproportionately impacted. Women are twice as likely to get HIV and three times more likely to die from the disease than their male partners.
There are many reasons for this, but poverty, unequal access to healthcare and employment, stigma, racism, sexism, and unequal access to education all play key roles. Injecting drug use also contributes, particularly among MSM, trans women, and Latinx people.
Today, Black people in the U.S. are eight times more likely to be diagnosed with HIV than White people, while MSM are five times more likely to be HIV-positive compared to all other groups. Research suggests Black MSM have a 50% chance of testing positive for HIV in their lifetime due to compounding structural inequity. Moreover, nearly two-thirds of Black trans women and over one-third of Latinx trans women are living with HIV in the U.S. today.
The same social and economic barriers that fuel HIV infection rates are evident in lower rates of testing and higher rates of treatment failure in disproportionately impacted groups. Among Black people living with HIV, only 59% have received care. Of those who have received care, only 43% are able to fully suppress the virus with treatment. By comparison, 67% of White people with HIV are linked to care, while 57% have been able to achieve complete viral suppression.
In addition, language barriers and the current public debate about immigration are other reasons why Black and Latinx migrants are more likely to delay HIV testing and treatment until the condition advances.
There are no easy answers to any of these concerns, but, by focusing on treatment, prevention, and disproportionate areas, the federal government hopes to slash the number of new HIV cases by at least 90% by 2030 under its Ending the HIV Epidemic in the U.S. (EHE) initiative.
In an effort to support these goals, the latest destination in Verywell’s Health Divide series aims to provide:
-- James Myhre, HIV educator, & Dennis Sifris, MD, HIV specialist
Anju Goel, MD, is board-certified in internal medicine. She has over 10 years of experience in the California public health system addressing communicable disease, health policy, and disaster preparedness.
Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2015–2019. HIV Surveillance Suppl Rep. 2021;26(1):1-81.
Pellowski JA, Kalichman SC, Matthews KA, Adler K. A pandemic of the poor: social disadvantage and the U.S. HIV epidemic. Am Psychol. 2013 May-Jun;68(4):197-209. doi:10.1037/a0032694
Centers for Disease Control and Prevention. Estimated percentages and characteristics of men who have sex with men and use injection drugs — United States, 1999–2011. MMWR Morbid Mortality Week Rep. 2013 Sep 20;62(37):757-62.
Centers for Disease Control and Prevention. HIV infection, risk, prevention, and testing behaviors among transgender women–National HIV Behavioral Surveillance–7 U.S. cities, 2019-2020. In: HIV Surveillance Special Report 2021. April 2021.
Benbow ND, Aaby DA, Rosenberg ES, Brown CH. County-level factors affecting Latino HIV disparities in the United States. PLoS ONE. 2020;15(8):e0237269. doi:10.1371/journal.pone.0237269
Kaiser Family Foundation. Black Americans and HIV/AIDS: the basics. Updated February 7, 2020.
Centers for Disease Control and Prevention. HIV among gay and bisexual men. Updated September 21, 2021.
Hess KL, Hu X, Lansky A, Mermin J, Hall HI. Lifetime risk of a diagnosis of HIV infection in the United States. Ann Epidemiol. 2017;27(4):238-243. doi:10.1016/j.annepidem.
Centers for Disease Control and Prevention. HIV continuum of care, U.S., 2014, overall and by age, race/ethnicity, transmission route and sex. July 27, 2017.
HIV.gov. What Is Ending the HIV Epidemic in the U.S.? Updated June 2, 2021.
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