HIV/AIDS among African Immigrants in the U.S.: The Need for Disaggregating HIV Surveillance Data by Country of Birth.

The goals of the United States' National HIV/AIDS Strategy are reducing HIV infections, increasing linkage to care, and reducing health disparities. To accomplish these, it is imperative to have accurate data about HIV prevalence, especially in high-burden populations, including immigrants, ethnic/racial minorities and other minority populations. However, recent increases in HIV prevalence among Black migrants from sub-Saharan Africa has drawn attention to the need to examine the epidemiological diversity of the Black population, and accurately account for HIV prevalence within it. In most HIV surveillance data, a single category, Black/African American, is used to combine data for U.S.-born and foreign-born Blacks, including migrants from sub-Saharan Africa. Such categorizations result in under-estimation of HIV prevalence in the African immigrant population, making it difficult to allocate resources appropriately for HIV prevention and treatment. This paper highlights and provides recommendations regarding the importance of disaggregating HIV surveillance data on Blacks by country of birth.

Comparison of HIV/AIDS rates between U.S.-born Blacks and African-born Blacks in Utah, 2000 - 2009.

The Utah Department of Health currently groups African-born blacks with U.S.-born blacks when reporting HIV/AIDS surveillance data. Studies suggest that categorizing HIV/AIDS cases in this manner may mask important epidemiological trends, and the distinct differences between these two populations warrant disaggregating data prior to reporting. The purpose of this study was to characterize the HIV/AIDS positive populations in U.S. and African-born blacks in Utah and evaluate the need for disaggregating the two groups. A total of 1,111 cases were identified through the statewide electronic HIV/AIDS Reporting System from 2000 - 2009. Data were analyzed for prevalence of HIV diagnosis for African-born blacks, U.S.-born blacks, and U.S.-born whites. Secondary analysis included HIV diagnosis by age, sex, African region of nativity, transmission risk factors, and differences in late diagnosis of HIV infection. U.S.-born whites accounted for 914 (82.3%) cases, and had the lowest annual prevalence (4/100,000). Conversely, African-born and U.S.- born blacks had the highest prevalence, 162/100,000 and 24/100,000 respectively. African-born blacks made up 0.25% of the total population, but accounted for 7.9% of all HIV/AIDS cases. African-born black males were more likely to report "no reported risk" for HIV transmission than U.S.-born black males. Of African-born blacks, 55.7% reported East-African nativity. These results demonstrate the importance of stratifying the black/African American racial category by African-born and U.S.-born blacks when collecting and reporting HIV/AIDS state surveillance data even in a low-incidence state,which will better inform prevention and linkage-to-care efforts in Utah.