HIV in Black and White Women, 2010–2016: 93% of Black Women's Infections Tied to the Gap

New HIV infections among U.S. women and adolescent girls fell during 2010–2016, with the largest decrease — 21% — among Black women. Yet in 2016, Black women were 13% of the U.S. female population and accounted for 60% of new HIV infections among women.

Measuring the gap

CDC used the population attributable proportion (PAP) disparity measure: the share by which new infections among Black and White women combined would fall if the group with the higher rate (Black women) had the lower rate (White women's).

• Data: HIV incidence and prevalence estimates for women and girls aged 13 and older, from an HIV Supplemental Surveillance Report.
• Excess infections = estimated infections among Black women minus the number expected at the White women's rate.
• PAP = excess infections ÷ all new infections among Black and White women.
• The change from 2010 to 2016 was tested with 10,000 simulations.

Findings

Counts rounded to the nearest hundred.

• The rate among Black women and girls fell from 32.5 to 24.4 per 100,000; among White women and girls it was 1.6 in both 2010 and 2016 (range 1.4–1.7).
• Had Black women's rate matched White women's, new infections among Black and White women together would have been 75% lower in 2010 and 70% lower in 2016 — a 7% decrease in the PAP (p = 0.15).
• In 2016, an estimated 3,900 of 4,200 (93%) new infections among Black women would not have occurred at White women's rate.

What it means

The decline among Black women signals some progress, matching earlier research that found shrinking racial and ethnic gaps in HIV diagnoses among women in 2010–2014. But the disparity persists, and reducing it is essential to controlling HIV overall.

• Social and structural determinants drive it: unequal access to health care, HIV stigma, and higher background rates of some sexually transmitted infections.
• Most infections among Black women come through heterosexual transmission, so prevention must also reach heterosexual and bisexual men.
• Compared with White people, Black women and men face longer delays in diagnosis and are less likely to be virally suppressed (under 200 copies of viral RNA per mL of blood).
• Viral suppression, preexposure prophylaxis (PrEP), condoms and prompt, adequate treatment after diagnosis will all help close the gap — as the U.S. Department of Health and Human Services works toward ending the HIV epidemic by 2030.

Limitations

1. HIV incidence estimates depend on model assumptions and data completeness.
2. Only one measure of disparity was used; others could give different results.
3. The p-value may be overstated: it assumed estimation errors for the same group were unrelated across years.
4. The PAP counts excess infections but says nothing about which structural or policy changes would end the disparity.
5. Only two racial groups were compared; disparities may exist for others.

Sources

Based on Bradley ELP, Williams AM, Green S, Lima AC, Geter A, Chesson HW, McCree DH, "Disparities in Incidence of Human Immunodeficiency Virus Infection Among Black and White Women — United States, 2010–2016," MMWR Morbidity and Mortality Weekly Report, volume 68, Centers for Disease Control and Prevention; a work of the United States government in the public domain.