By Margarita Martín-Hidalgo Birnbaum
It’s going to take a while before we know the effects of a recent court ruling that may limit HIV preventive care. But some clinicians are concerned that if it stands, infection rates may increase. The decision from a Texas judge comes as public health experts learn more about how COVID-19 pandemic restrictions on health care have influenced incidence trends among American race and ethnic groups.
In this reporting tip sheet, we’re sharing ideas on story themes and resources to develop stories about race and ethnicity disparities in HIV testing and PrEP trends, two critical measures of the epidemic of the virus that causes AIDS. We’re pointing you to reports, studies, and other materials that may help you explain why CDC data shows that Black and Hispanic Americans collectively represent the majority of new infections.
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Go beyond looking at national HIV trends by race and ethnicity. According to the CDC, more than 50% of new infections are among people living in Alabama, Mississippi, Louisiana, North Carolina, and other states in the South, where more than half of Black Americans live. It’s one of the reasons the CDC’s Ending the HIV Epidemic in the U.S. initiative is targeting half of the 16 states in that region (the agency’s statistical geographic divisions are based on the U.S. Census Bureau’s regional ones).
Some research offers clues about why Americans living in the South are more likely to have HIV. In this 2019 study, the authors said the analysis “revealed that providers inaccurately identified patient barriers to testing and were not knowledgeable of the CDC’s change in recommendation for universal HIV testing. Specifically, providers ranked cost and not knowing where to receive specialty care as the least important barriers to HIV testing, whereas patients identified these as the most important barriers.”
And we suggest you look at what’s happening in rural and urban areas. The CDC has said that the 2016 and 2017 data they used to target prevention efforts have suggested that more than 10% of infections in several southern and western states were in rural areas. This 2020 report from the Health Resources and Services Administration’s Ryan White HIV/AIDS Program offers insights into why people living with the infection may be at risk of transmitting the virus. This 2021 report from the University of Southern Maine suggests people living in less populated areas of the country experience some of the same challenges in access to preventive care to a greater degree than their urban peers.
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Look at state budgets for HIV prevention and find out what they are doing with the funding they’ve received from the CDC for those efforts. In 2020, the agency announced it was giving state health departments $109 million to prevent HIV under a five-year funding plan. How much of the money is going to HIV awareness efforts that target people of color? How much of the money is going to urban and rural areas? How are they keeping track of prevention measures?
The Kaiser Family Foundation is among nonprofits that keep track of state and federal funding for HIV prevention and treatment. The Ryan White HIV/AIDS Program is among federal initiatives that help fund medical care services for Americans at risk of acquiring the virus and people who live with it. Information on the website says that more than 50% of Americans living with HIV receive services paid from its grant budget.
Some public funding may go to nonprofits, so consider reaching out to local organizations that receive that money. They may also offer insights on state and local campaigns to drum up HIV awareness and promote testing and PrEP use, which appear to be lagging among Americans of color.
You may consider comparing what this country spends on HIV testing and PrEP with what other similar industrialized countries have set aside in their budgets for those prevention measures. The CDC’s Ending the HIV Epidemic campaign is among efforts around the world to significantly lower the global HIV infection rate by 2030, a goal set by the Joint United Nations HIV/AIDS Programme known as UNAIDS. Some funding for prevention efforts may come from international agencies; several municipalities in the U.S. are part of the international Fast-Track Cities initiative.
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Consider looking at HIV disparities by sex identity at birth and sexual orientation. Although CDC data shows that the majority of infections are among people reporting male-to-male contact, trends among women offer clues about their risk for acquiring the infection. In a 2020 overview of HIV rates among women, the authors said the troubling trends among women are “concentrated in the Northeast and South, with a significantly higher proportion of HIV infections occurring in areas with high poverty rates.” They pointed to research showing that “individual risk behaviors” alone could not explain the race and ethnicity disparities in rates of HIV rates and sexually transmitted diseases.
Cory Bradley, Ph.D., a researcher who studies implementation science and HIV, says it’s crucial that journalists address disparities in gender identity and sexual orientation in part because the trends hint at shortcomings in prevention and medical care that may be overlooked. “What we are experiencing is a challenge in getting women to think about using PrEP and how to make PrEP appropriate for them because, in the original research of this product, they didn’t include those populations,” said Bradley, who is doing his postdoctoral work at Washington University School of Medicine.
