Background:
The largest disparities in HIV diagnoses in the United States are between Black and White persons. Federal initiatives for HIV prevention have evolved over the years, with the 2025 National HIV/AIDS Strategy including a focus on health equity. We examined trends in Black-White HIV diagnosis disparities to evaluate progress towards achieving equity in HIV diagnosis in the United States.
Methods:
Data from CDC’s National HIV Surveillance System were used to assess temporal trends in absolute and relative disparities in HIV diagnosis between Black and White persons during 2017–2021. Predicted values based on four years (2017–2019 and 2021) of data were used. Data for the year 2020 were excluded due to the impact of COVID-19 on HIV diagnoses. Estimated annual percentage change (EAPC) and 95% confidence intervals (CIs) were calculated to assess trends by selected characteristics.
Results:
During 2017 to 2021, absolute disparities in Black-White HIV diagnosis decreased among males from 65.7 per 100,000 population to 57.6 per 100,000 population (absolute: EAPC = -3.2 [CI: -3.6, -2.7]) and from 22.5 per 100,000 population to 17.7 per 100,000 population (absolute: EAPC = -5.8 [CI: -6.5, -5.0]) among females. Relative disparities decreased from 15.1 per 100,000 population to 10.8 per 100,000 population among females (EAPC = -7.2 [CI: -8.4, -5.9]) and remained the same for males. Among male subpopulations, disparities increased among those with HIV attributable to male-to-male sexual contact (Absolute: EAPC = 1.2 [CI: 0.8, 1.5]; Relative: EAPC = 1.5 [CI: 1.0, 1.9]). Relative disparities increased among males aged 13─24 years (EAPC = 7.4 [CI: 7.0, 7.7] and males in the West (EAPC = 2.0% [CI: 1.1, 2.9]. Among female subpopulations, no increases in disparities were found.
Conclusions:
Overall, Black-White HIV diagnosis disparities mostly decreased in the United States, indicating progress toward eliminating disparities; however, increases or no changes were observed for some subpopulations, suggesting little to no progress in improvements for health equity. Efforts to address both absolute and relative disparities must be accelerated to eliminate Black-White disparities in HIV diagnosis.