CDC Report Reveals Link Between HIV and Poverty (posted 8/2)

The Centers for Disease Control and Prevention (CDC) recently released a first-of-its-kind analysis showing that 2.1 percent of heterosexuals living in high-poverty urban areas in the United States are infected with HIV.  This analysis suggests that many low-income cities across the United States now have generalized HIV epidemics as defined by the United Nations Joint Program on HIV/AIDS (UNAIDS).  UNAIDS defines a generalized epidemic as one that is firmly established in the general population, with an overall HIV prevalence in the general population of more than 1 percent.  While subpopulations with higher risk (such as men who have sex with men and injection drug users) may still contribute disproportionately to the spread of HIV in these areas, heterosexual transmission is also sufficient to sustain an epidemic independent of those groups. For more information click here.

The analysis also shows that poverty is the single most important demographic factor associated with HIV infection among inner-city heterosexuals.  Contrary to severe racial disparities that characterize the overall U.S. epidemic, researchers found no differences in HIV prevalence by race/ethnicity in this population.  "This study reveals a powerful link between poverty and HIV risk, and a widespread HIV epidemic in America's inner cities," said Kevin Fenton, M.D., Ph.D., director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.  "In this country, HIV clearly strikes the economically disadvantaged in a devastating way."

"These findings have significant implications for how we think about HIV prevention.  We can't look at HIV in isolation from the environment in which people live," said Jonathan Mermin, M.D., director of CDC's Division of HIV/AIDS Prevention.  "This analysis points to an urgent need to prioritize HIV prevention efforts in disadvantaged communities.  We are pleased that President Obama's new National HIV/AIDS Strategy reflects this type of approach, in terms of targeting HIV prevention resources to those in greatest need." There were no significant differences in HIV prevalence by race or ethnicity in these low income urban areas: prevalence was 2.1 percent among blacks, 2.1 percent among Hispanics, and 1.7 percent among whites.  By contrast, the U.S. epidemic overall is characterized by severe racial/ethnic disparities: the HIV prevalence rate for blacks is almost 8 times that of whites, and the HIV prevalence rate among Hispanics is nearly 3 times that of whites.  The absence of race-based differences in this analysis is likely due to existing high prevalence of HIV in poor urban areas, which – regardless of race or ethnicity – places individuals living in these areas at greater risk for exposure to HIV with each sexual encounter.  Authors note that other factors associated with poverty also likely contribute to high HIV prevalence in these settings.  Some of these factors include limited health care access, which can reduce utilization of HIV testing and prevention services; substance abuse, which can increase sexual risk behavior; and high rates of incarceration, which can disrupt the stability of relationships.

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