Closing the Gap: A Comprehensive Review of HIV Prevention, PrEP, and Racial Disparities

In the 1980s, Ervin “Magic” Johnson shocked the world when he announced he tested positive for HIV. At that time, being diagnosed with HIV was seen as a death sentence. But, as we have seen with Magic, it doesn’t have to be. 

The human immunodeficiency virus, or HIV, attacks the immune system. This leads to a weakened ability to fight off infections and diseases. Once HIV advances past a certain point, it becomes AIDS. HIV/AIDS is a global health concern. It has a big impact on people and communities, especially for Black people.

Advances in research on HIV/AIDS have led to increased awareness of how the virus is transmitted. Additionally, advances in HIV treatment options allow for someone to find the regimen that is right for them. There are even options to reduce HIV transmission with pre-exposure prophylaxis (PrEP). 

Spreading awareness about HIV/AIDS opens up the conversation around the importance of prevention. With 13% of the Black US population^1,2 unaware of their status, it’s clear there is still work to do. 

HIV/AIDS Statistics

As of 2021, an estimated 38.4 million people, or roughly 0.5% of the world’s population, were living with HIV globally.³ We have made progress in treatment and prevention. But, HIV rates are still unevenly distributed. Sub-Saharan Africa bears the epidemic’s brunt. Nearly two-thirds of all people with HIV live there. 

In the US, an estimated 1.2 million people were living with HIV in 2020, with over 39,000 new diagnoses that year.² HIV diagnoses have declined overall in recent years. But, certain groups, such as Black Americans, are impacted at much higher rates.

Disproportionate Impact on Black Communities

Black Americans make up only 13% of the US population. But, they account for 40% of new HIV diagnoses and 42% of people living with HIV in the country.² 

For Black women, the statistics are even more alarming. They are 15 times more likely⁴ to progress to AIDS and die from HIV-related infections compared to white women. 

These disparities in HIV numbers stem from several factors, including:

• • Lack of awareness: Limited knowledge about HIV transmission and prevention methods can contribute to the spread of the virus.

• • Limited access to quality healthcare: Historical and ongoing discrimination have created barriers to healthcare access for Black communities, leaving them more vulnerable to HIV infection and complications.

• • Social and economic factors: Poverty, housing instability, and lack of education can contribute to risky behaviors that increase HIV transmission risk.

• • Stigma and discrimination: Stigma surrounding HIV and LGBTQ+ communities can deter testing and treatment, hindering efforts to control the epidemic.

• • Substance Abuse: Drug and alcohol abuse can lead to risky behaviors, such as unprotected sex and sharing needles, increasing the likelihood of HIV transmission.

So, how can someone prevent themselves from becoming a part of these statistics? The answer lies in preventing the transmission of HIV. Understanding how HIV is transmitted can help in choosing the correct prevention method. 

Understanding HIV Transmission

HIV transmission comes down to having direct contact with bodily fluids that contain the HIV. Some ways of catching the virus raise the risk of infection. These include any kind of unprotected sex and sharing needles for IV drug use. Other routes of HIV transmission with a lower instance of infection involve⁵:

• • Mother-to-child transmission during childbirth, breastfeeding, or pregnancy

• • Infected blood transfusions and organ transplants

• • Work exposure through accidental needle sticks

Black gay and bisexual men and black heterosexual women account for a majority of new HIV cases across the US. Routes of transmission in these subgroups mainly stem from unprotected sexual contact.¹ 

Understanding these transmission routes helps develop effective prevention strategies and promotes education and awareness.

HIV Prevention Strategies

Preventing HIV transmission is one of the best ways to help decrease its impact, especially among Black people. It may take a combination of prevention strategies to be effective. Which prevention strategy is best depends on how likely someone is to come in contact with the virus. For instance, IV drug users may benefit from needle exchange programs or use pre-exposure prophylaxis (PrEP). Similarly, education around the use of condoms, safer sex practices, and PrEP may be more effective for those more likely to acquire HIV through sex. 

Introduction to PrEP

Pre-exposure prophylaxis, or PrEP, involves taking medication in the form of a daily pill or every other monthly injection to reduce the risk of HIV infection. PrEP has proven to be highly effective when taken consistently, offering a proactive approach to HIV prevention.⁶

Yet, research shows Black people, specifically Black women, are not using PrEP to prevent HIV transmission as often as other races. Some barriers to using PrEP include⁷:

• • Limited knowledge and awareness of PrEP

• • Perceived low HIV-risk 

• • Adherence and side effects concerns

• • Influence of sexual and romantic partners

• • Stigma from family

• • Lack of PrEP marketing toward Black women

• • Medical mistrust

• • Costs

Getting the word out about PrEP and its benefits for those at risk of contracting HIV should continue to be a top priority. For Black communities, ensuring this information is reaching Black women will take preventing the spread of HIV a step further. Additionally, improving healthcare access and the cost associated with PrEP could help to eliminate many of these barriers. 

The Bottom Line

The journey from the early days of HIV/AIDS to the current prevention strategies and awareness has been transformative. HIV/AIDS was once a death sentence. But now, it’s a manageable condition. And it’s preventable with an effective strategy.

The impact on Black Americans, particularly women, demands urgent attention. Black communities have high HIV rates because of a lack of awareness, limited healthcare access, money, and stigma.

Effective prevention strategies, including PrEP, offer ways to curb the spread of HIV. Still, Black communities underuse PrEP. This is especially true for women. It shows the need for targeted outreach and addressing barriers.

To reduce HIV/AIDS’s impact on Black lives, we need collaboration. We must focus on education, challenge societal stigmas, and advocate for accessible healthcare. It’s not just about stopping a virus. It’s about empowering communities to protect themselves and their loved ones from HIV/AIDS. The time for action is now.

Conversation Starters:

• • How do you think societal factors, such as stigma and limited healthcare access, contribute to the unequal impact on Black Americans?

• • Have you heard about the recent advancements in HIV/AIDS prevention, especially with medications like PrEP?

• • How can individuals take more responsibility in spreading awareness about HIV/AIDS and advocating for preventive measures in their communities?

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Resources:

1. CDC. HIV and Black/African American People in the U.S. | Fact Sheets | Newsroom | NCHHSTP | CDC. www.cdc.gov. Published February 9, 2022. https://www.cdc.gov/nchhstp/newsroom/fact-sheets/hiv/black-african-american-factsheet.html 
2. HIV.gov. HIV & AIDS Trends and U.S. Statistics Overview. HIV.gov. Published October 3, 2023. https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics/
3. KFF. The Global HIV/AIDS Epidemic. KFF. Published July 26, 2023. https://www.kff.org/global-health-policy/fact-sheet/the-global-hiv-aids-epidemic/
4. U.S. Department of Health & Human Services. HIV/AIDS and African Americans | Office of Minority Health. minorityhealth.hhs.gov. https://minorityhealth.hhs.gov/hivaids-and-african-americans
5. CDC. HIV Risk Behaviors. CDC. Published 2019. https://www.cdc.gov/hiv/risk/estimates/riskbehaviors.html
6. Phanuphak, N., & Gulick, R. M. (2020). HIV treatment and prevention 2019: current standards of care. Current opinion in HIV and AIDS, 15(1), 4–12. https://doi.org/10.1097/COH.0000000000000588
7. Smit F, Masvawure TB. Barriers and Facilitators to Acceptability and Uptake of Pre-Exposure Prophylaxis (PrEP) Among Black Women in the United States: a Systematic Review. J Racial Ethn Health Disparities. Published online August 2, 2023. doi:10.1007/s40615-023-01729-9