One Size Fits (n)One: The Influence of Sex, Age, and Sexual Human Immunodeficiency Virus (HIV) Acquisition Risk on Racial/Ethnic Disparities in the HIV Care Continuum in the United States
- 31 August 2018
- journal article
- research article
- Published by Oxford University Press (OUP) in Clinical Infectious Diseases
- Vol. 68 (5), 795-802
- https://doi.org/10.1093/cid/ciy556
Abstract
The United States National HIV/AIDS Strategy established goals to reduce disparities in retention in human immunodeficiency virus (HIV) care, antiretroviral therapy (ART) use, and viral suppression. The impact of sex, age, and sexual HIV acquisition risk (ie, heterosexual vs same-sex contact) on the magnitude of HIV-related racial/ethnic disparities is not well understood. We estimated age-stratified racial/ethnic differences in the 5-year restricted mean percentage of person-time spent in care, on ART, and virally suppressed among 19 521 women (21.4%), men who have sex with men (MSM; 59.0%), and men who have sex with women (MSW; 19.6%) entering HIV care in the North American AIDS Cohort Collaboration on Research and Design between 2004 and 2014. Among women aged 18–29 years, whites spent 12.0% (95% confidence interval [CI], 1.1%–20.2%), 9.2% (95% CI, .4%–20.4%), and 13.5% (95% CI, 2.7%–22.5%) less person-time in care, on ART, and virally suppressed, respectively, than Hispanics. Black MSM aged ≥50 years spent 6.3% (95% CI, 1.3%–11.7%), 11.0% (95% CI, 4.6%–18.1%), and 9.7% (95% CI, 3.6%–16.8%) less person-time in these stages, respectively, than white MSM ≥50 years of age. Among MSM aged 40–49 years, blacks spent 9.8% (95% CI, 2.4%–16.5%) and 11.9% (95% CI, 3.8%–19.3%) less person-time on ART and virally suppressed, respectively, than whites. Racial/ethnic differences in HIV care persist in specific populations defined by sex, age, and sexual HIV acquisition risk. Clinical and public health interventions that jointly target these demographic factors are needed.Funding Information
- National Institutes of Health (U01-AI069918, F31-AI124794, F31-DA037788, G12-MD007583, K01-AI093197, K23-EY013707, K24-AI065298, K24-AI118591, K24-DA000432, KL2-TR000421, M01-RR000052, N01-CP01004, N02-CP055504, N02-CP91027, P30-AI027757, P30-AI027763, P30-AI027767, P30-AI036219, P30-AI050410, P30-AI094189, P30-AI110527, P30-MH62246, R01-AA016893, R01-CA165937, R01-DA011602, R01-DA012568, R01-AG053100, R24-AI067039, U01-AA013566, U01-AA020790, U01-AI031834, U01-AI034989, U01-AI034993, U01-AI034994, U01-AI035004, U01-AI035039, U01-AI035040, U01-AI035041, U01-AI035042, U01-AI037613, U01-AI037984, U01-AI038855, U01-AI038858, U01-AI042590, U01-AI068634, U01-AI068636, U01-AI069432, U01-AI069434, U01-AI103390, U01-AI103397, U01-AI103401, U01-AI103408, U01-DA03629, U01-DA036935, U01-HD032632, U10-EY008057, U10-EY008052, U10-EY008067, U24-AA020794, U54-MD007587, UL1-RR024131, UL1-TR000004, UL1-TR000083, UL1-TR000454, UM1-AI035043, Z01-CP010214, Z01-CP010176)
- Centers for Disease Control and Prevention (CDC-200-2006-18797, CDC-200-2015-63931)
- Agency for Healthcare Research and Quality (90047713)
- Health Resources and Services Administration (90051652)
- Canadian Institutes of Health Research (CBR-86906, CBR-94036, HCP-97105,, TGF-96118)
- Ontario Ministry of Health and Long Term Care
- Government of Alberta
This publication has 28 references indexed in Scilit:
- Substance Use Predictors of Poor Medication Adherence: The Role of Substance Use Coping Among HIV-Infected Patients in Opioid Dependence TreatmentAIDS and Behavior, 2012
- Splines for Trend Analysis and Continuous Confounder ControlEpidemiology, 2011
- Late Entry to HIV Care Among Latinos Compared With Non-Latinos in a Southeastern US CohortClinical Infectious Diseases, 2011
- Prevention of HIV-1 Infection with Early Antiretroviral TherapyThe New England Journal of Medicine, 2011
- A Systematic Review of HIV/AIDS Survival and Delayed Diagnosis Among Hispanics in the United StatesJournal of Immigrant and Minority Health, 2011
- The Spectrum of Engagement in HIV Care and its Relevance to Test-and-Treat Strategies for Prevention of HIV InfectionClinical Infectious Diseases, 2011
- Cohort Profile: The North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD)International Journal of Epidemiology, 2007
- Effect of dysthymia on receipt of HAART by minority HIV-infected womenJournal of General Internal Medicine, 2006
- Greater Risk for HIV Infection of Black Men Who Have Sex With Men: A Critical Literature ReviewAmerican Journal of Public Health, 2006
- Female‐to‐Female Transmission of Human Immunodeficiency VirusClinical Infectious Diseases, 2003