The HIV rate among black women living in some U.S. cities is the same rate as that of some African countries, according to a new multicenter study presented Thursday at the 19th Conference of Retroviruses and Opportunistic Infections.
The jarring findings acknowledge that HIV is not an infection that has been eradicated, but one that has been somewhat forgotten, researchers said.
The new data come from the ISIS study (The Women's HIV Seroincidence Study), and reflect an analysis of at-risk women in six urban areas of the United States that have some of the highest rates of HIV/AIDS: Baltimore, Atlanta, Raleigh-Durham, N.C., Washington, D.C., Newark and New York City.
"This disease is alive and well in this country," said Dr. Carlos Del Rio, principal investigator for the Atlanta area of the study and professor of medicine and infectious disease at Emory University School of Medicine in Atlanta. "But this epidemic is the face of the forgotten people."
There are "hot spots" where the disease thrives in this country, Del Rio said, and most of those areas are some of the most impoverished parts of the United States.
"That's bad, but it's good because we know where to pour our intervention efforts," Del Rio said.
The research included 2099 women ages 18 to 44 who had never had a positive HIV test. Eighty-eight percent of the study participants were black, 12 percent Latina. At the time of enrollment, researchers found that 32 women were infected with HIV but were unaware of their status.
Within one year of joining the study, 0.24 percent of the women tested positive for the disease. That rate is five times higher than the CDC's previous estimate of HIV rates in black American women.
The numbers are comparable to the HIV rates found in the general population in many sub-Saharan African countries, including the Democratic Republic of Congo (0.28 percent) and Kenya (0.53 percent).
"Along with the results, a lot of other statistics came out of this study," said Dr. Sally Hodder, lead author of the study and professor of medicine at New Jersey Medical School in Newark. "Slightly more than 40 percent of the women did not know the HIV status of their last sexual partner. And more than 40 percent of our participants had an annual household income of $10,000 or less."
And out of all the women enrolled, after a one-year follow-up, 10 had died of reasons unrelated to HIV.
"This just goes to show that women don't just have HIV risk to worry about in these areas of the country," Del Rio said. "I've had women look at me and say, 'OK, I'm at high risk for HIV, but I'm also at high risk of getting shot.'"
Poverty, food insecurity and substance abuse all act as confounding factors of HIV risk, Del Rio said.
"So we can't just say, 'Here's some information on AIDS and here are some condoms," he said. "We're talking about structural interventions that are needed. We need better access to medical care and screenings, substance abuse treatment, education and job availability for these areas of the country.
"This is going to need some bold leadership and out-of-the-box thinking," Del Rio added. "I do think it really can be stopped, though. It's not beyond hope and I honestly don't think it wouldn't even take that long to eradicate the disease, it just needs a lot of imagination."