African Immigrants and the End of the HIV Epidemic in the United States: Actionable Recommendations to Enhance Equity

Abstract

African immigrants in the United States are disproportionately affected by HIV yet remain overlooked in public health strategies such as the Ending the HIV Epidemic (EHE) initiative. Many reside in EHE-prioritized counties, but their categorization under the broad "Black/African American" label obscures their distinct pathways to HIV acquisition and barriers to care. We explore how African immigrants can be more effectively prioritized in the EHE framework. We examine key challenges, including stigma, cultural and linguistic barriers, and structural inequities, that limit access to prevention and treatment services. Additionally, sociocultural factors, such as traditional health beliefs and immigration-related stressors, exacerbate these barriers. We propose actionable strategies to address these gaps, including disaggregated data collection, culturally tailored interventions, and partnerships with African immigrant communities. By aligning EHE efforts with the unique needs of this population, public health strategies can better address disparities and advance equity in the fight to end the HIV epidemic. (Am J Public Health. 2025;115(9):1490-1499. https://doi.org/10.2105/AJPH.2025.308160).

Figure 1:. NIH Support for HIV Research Projects^a on Latino, Asian and African Immigrant Populations^b by Year of Funding (1987 – 2024)

Source: NIH RePORTER (https://reporter.nih.gov/) ^a Projects: Unique projects only. Multi-year projects collapsed into a single unit, with costs totaled across years of funding. ^b Search Criteria: Asian Immigrants: (“Asian immigrant” OR “Asian-born” OR “Asian immigrants” OR “Asian-origin” OR “Asian-American” OR “Asian American” OR “Southeast Asian population” OR “Southeast Asian immigrant?”) AND HIV Latino Immigrants: (“Latino immigrant” OR “Latino immigrants” OR “Hispanic immigrant” OR “Hispanic immigrants” OR Latino OR Hispanics OR Latinos NOT African NOT Black) AND HIV African Immigrants: (“African immigrant” OR “African-born” OR “African immigrants”) AND HIV