HIV in persons born outside the United States, 2007-2010

Abstract

Context: Persons born outside the United States comprise about 13% of the US population, and the challenges these persons face in accessing health care may lead to poorer human immunodeficiency virus (HIV) disease outcomes.

Objective: To describe the epidemiology of HIV among persons born outside the United States and among US-born persons diagnosed in the United States.

Design, setting, and participants: Analysis of the estimated number of US-born persons and persons born outside the United States diagnosed with HIV from 2007 through 2010 in 46 states and 5 US territories, the demographic characteristics, and the HIV transmission risk factors reported to the National HIV Surveillance System. Foreign-born persons were defined as persons born outside the United States and its territories, inclusive of naturalized citizens.

Main outcome measure: Diagnosis of HIV infection.

Results: From 2007 through 2010, HIV was diagnosed in 191,697 persons in the US population; of these, 16.2% (95% CI, 16.0%-16.3%) (n = 30,995) were born outside the United States. Of the 25,255 persons with a specified country or region of birth outside the United States, 14.5% (n = 3656) were from Africa, 41.0% (n = 10,343) were from Central America (including Mexico), and 21.5% (n = 5418) were from the Caribbean. The 4 states (California, Florida, New York, and Texas) reporting the highest numbers of persons born outside the United States and diagnosed with HIV were also the top 4 reporters of HIV cases overall. Among persons born outside the United States with HIV, 73.5% (n = 22,773) were male. Among whites, 1841 of 55,574 (3.3%) of HIV diagnoses were in persons born outside the United States; in blacks, 8614 of 86,547 diagnoses (10.0%); in Hispanics, 17,913 of 42,431 diagnoses (42.2%); and in Asians, 1987 of 3088 diagnoses (64.3%). The percentage infected through heterosexual contact was 39.4% among persons born outside the United States vs 27.2% for US-born persons.

Conclusions: Among persons in 46 US states and 5 US territories who received a diagnosis of HIV from 2007 through 2010, 16.2% were born outside the United States. Compared with US-born persons diagnosed with HIV, persons born outside the United States had different epidemiologic characteristics.