Taking it Forward

Progress on the HIV Continuum of Care Among Blacks
by Hazel D. Dean, MPH, ScD, Deputy Director, NCHA

Today, the Centers for Disease Control and Prevention (CDC) released a new study, “Progress Along the Continuum of HIV Care Among Blacks with Diagnosed HIV— United States, 2010,” in the Morbidity and Mortality Weekly Report (MMWR). The study looked at outcomes for adult and adolescent blacks, both male and female, who have HIV for the five stages of the HIV continuum of care, including HIV diagnosis, linkage to care, staying in care, getting antiretroviral therapy (ART), and achieving a low amount of HIV virus in the body, referred to as viral suppression. These are the steps of the continuum of care and critical steps in our HIV prevention efforts.

 

The National HIV/AIDS Strategy (NHAS) outlines goals for the continuum of care, which includes achieving 85% linkage to care, 80% retention in care, and a 20% increase by 2015 in the number of persons with an undetectable viral load.

 

The new CDC analysis shows that among blacks of all age groups and both sexes who are HIV positive, 75% were linked to care, 48% were retained in care, 46% were prescribed anti-retroviral therapies (ART), and 35% had achieved viral suppression.

 

The study released today also shows

• That by age group young persons aged 13-24 years had the highest number of diagnoses and the lowest linkage to care (69%);
• That young persons, aged 18 to 24 years, were the least likely to have a suppressed viral load (18%);
• That by transmission category, male-to-male transmission had the lowest linkage to care at 71.6 percent;
• That more women (40%) than men (33%) have a suppressed viral load;
• That women with HIV attributed to injection drug use or heterosexual contact had the highest rate of linkage to care at 82% and 81%, respectively, and
• That lack of health insurance, poverty, and stigma are still leading reasons as to why blacks with HIV might not seek care, receive care, or adhere to care or achieve viral suppression.

Our first step has been and still is to get people tested for HIV. Once diagnosed, we must focus on strengthening our efforts to link and keep people with HIV in care, and promote adherence to medication to achieve optimal health outcomes.  

The Affordable Care Act strengthens continuum of care efforts by increasing coverage for HIV testing and ensuring that insurance companies can no longer deny coverage based on pre-existing conditions, including HIV—a big step forward for our efforts.

 

For this National Black HIV/AIDS Awareness Day (Feb. 7) and every day, our work is dependent on all of us. As this year’s theme states, we are our brothers’/sisters’ keepers. We need to use the most effective tools and programs, and do all of this in a collaborative manner; so we can meet the goals of NHAS and continue our movement toward an AIDS-free generation.