SAN FRANCISCO -- HIV prevalence is so great among African Americans that even those who avoid risky behaviors are at high risk, according to findings reported at the Conference on Retroviruses and Opportunistic Infections.
Dr. Kimberly Smith, of Rush University Medical Center in Chicago, warned that focusing on drug use, homosexual behavior and multiple partners actually undermines efforts to counteract the dramatic disparities faced by blacks in regards to HIV prevalence and mortality.
This is particularly true for heterosexuals, she told attendees of the conference.
"The prevalence has come to a point now where…there's basically no room for error," she said at a press conference. This requires a shift in perspective for policy and prevention efforts, Smith said.
"If we start to focus on this as a community challenge rather than focusing on individual risks, then that may move us in the right direction," she said at a press conference.
Black people account for only 12 percent of the U.S. population, but make up half of HIV cases in the country.
Whereas the overall rate of HIV prevalence in America is under 1 percent, Smith called attention to a New England Journal of Medicine article published earlier this week that documented the rate in several U.S. cities with large black populations as comparable to and sometimes worse than the rate reported in sub-Saharan Africa.
For example, the HIV rate is 3 percent in the largely black Washington D.C. population (over 6 percent among black men there) and reaches nearly 14 percent in men who have sex with men in New York City compared with a general-population prevalence of 7.8 percent in Kenya and 16.9 percent in South Africa.
Stigmatizing groups with risky behaviors leaves the majority unaware of their risk, Smith noted.
"Part of our challenge is that a lot of the black community has not perceived itself to be at risk based upon the evolution of how we understood risk of HIV in the United States," she said at the press conference.
The narrow initial perception as a "gay, white disease" persisted into the mid-90s, she said.
By the time high-profile black HIV cases like that of Earvin "Magic" Johnson stirred awareness about risk, Smith said at the plenary session, "the horse was out of the barn, the cat was out of the bag, and HIV was running rampant in black community."
HIV mortality for African Americans shows the same dramatic gap as HIV rates compared with other race and ethnic groups in the U.S., with an eight-fold excess mortality risk for black men and 20-fold increased risk for black women.
Many factors contribute to this, including late diagnosis, the fact that up to 20 percent of black HIV-infected persons never see an HIV provider for at least five years after diagnosis, poorer access to care and poorer response and adherence to treatment once initiated, Smith noted.
Dr. Kevin Fenton agreed that social contexts drive these disparities. Fenton spoke about barriers to HIV prevention at a separate session at the conference.
Only 16 percent of people living with HIV have private insurance and 62 percent are unemployed explained Fenton, who is director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis prevention at the U.S. Centers for Disease Control in Atlanta.
"While we've made great strides in developing prevention interventions and targeting individual risk behavior, the bottom line is that behavioral change programs are not enough to get ahead of the curve," Fenton said at a press conference.
Without confronting the root causes, little will change, he cautioned.