USA: Still a disparity of viral suppression rates between race/ethnic groups
Across the U.S., people of color living with HIV are less likely to be on antiretroviral therapy and virally suppressed than their white counterparts. But new research, with data from the Medical Monitoring Project, indicates that we’re making progress in closing gaps in treatment equity—although disparities in rates of viral suppression still remain.
(The Medical Monitoring Project samples participants receiving care from HIV facilities so does not speak to people out of care. Additional notes on data collection and the Medical Monitoring Project can be found below.)
Antiretroviral therapy data
From 2009 to 2013, the percentage of people who had been prescribed antiretroviral therapy (ART) as a whole increased. By race and ethnicity, rates of ART prescriptions among:
- Black participants increased from 86% to 93%;
- Hispanic participants increased from 89% to 95%; and,
- White participants increased from 92% to 95%.
Between 2009 and 2013, the disparity in ART prescriptions between Black and white participants declined 62%. After adjusting for age and the time since HIV diagnosis, the difference in ART prescription rates between Black and white participants was not significant (93% compared to 95%).
Comparing Hispanic participants to white participants, the disparity in ART prescriptions declined by 100%, with no disparity remaining in 2013. (Both groups of people had 95% with ART prescriptions.)
The take-away: All race/ethnic groups made gains in antiretroviral therapy (as measured by being prescribed medication). Among people in the sample, there were no race/ethnic disparities remaining at the last time period measured (2013).
Viral suppression data
From 2009 to 2013, the percentage of people overall who were virally suppressed increased. However, the gaps in viral suppression between people of color and white people in the sample did not shrink. By race and ethnicity, rates of viral suppression among:
- Black participants increased from 64% to 76%;
- Hispanic participants increased from 75% to 81%; and,
- White participants increased from 79% to 86%.
Between 2009 and 2013, there was a 32% reduction in viral suppression disparity between Black and white participants. Unfortunately, this reduction was not statistically significant, and a disparity remained in viral suppression rates between Black (76%) and white (86%) participants in 2013. The difference in viral suppression rates between Hispanic and white participants remained “virtually unchanged,” the authors noted.
The take away: Between 2009 and 2013, all race/ethnic groups made gains in the percentage of people who were virally suppressed. However, the rates of viral suppression for Blacks and Hispanics still lagged behind those for whites.
Where the data are coming from
The researchers, Linda Beer, PhD and colleagues, analyzed data collected from the Medical Monitoring Project between 2009 and 2013. The Medical Monitoring Project has collected information since 2005 from people across 16 states and 1 U.S. territory (Puerto Rico) who attend HIV care facilities. All participants living with HIV and over 18 years old.
In 2015, the project expanded their sample to include adults living with HIV who are not in HIV care, according to the Centers for Disease Control and Prevention. (The current study does not include these data.)
Read more about the Medical Monitoring Project.
Beer, L. and colleagues. Trends in Racial and Ethnic Disparities in Antiretroviral Therapy Prescription and Viral Suppression in the United States, 2009–2013. JAIDS, December, 2016.