"Ending the Epidemic" Will Not Happen Without Addressing Racial/Ethnic Disparities in the United States Human Immunodeficiency Virus Epidemic

Abstract

We estimated human immunodeficiency virus incidence and incidence rate ratios (IRRs) for black and Hispanic vs white populations in 6 cities in the United States (2020-2030). Large reductions in incidence are possible, but without elimination of disparities in healthcare access, we found that wide disparities persisted for black compared with white populations in particular (lowest IRR, 1.69 [95% credible interval, 1.19-2.30]).

Keywords: HIV/AIDS; United States; racial/ethnic inequities; simulation modeling.

Figure 1.

Projected change in the racial/ethnic human immunodeficiency virus (HIV) incidence rate and incidence rate ratio under status quo (black) and city-specific optimal combination implementation strategies delivered at ideal levels (gray) for 6 United States cities, 2020–2030. All figures are model-based projections; “status quo” entails holding HIV service access constant at 2015 (preexposure prophylaxis: 2017) levels; “ideal implementation” entails implementing city-specific combinations of between 9 and 13 evidence-based interventions at ideal levels (ie, reaching 90% of each intervention’s target population). Abbreviations: B, black/African American; CA, California; FL, Florida; GA, Georgia; H, Hispanic/Latinx; IR, incidence rate (per 100 000 individuals); MD, Maryland; NY, New York; W, white/other; WA, Washington.