Why Are Black Men Falling Behind When it Comes To ART?

It’s time for us to get real. We are not doing enough to help black men who have sex with men and are living with HIV. If you don’t believe me, just look at the data.

Last February, the Centers for Disease Control and Prevention released a report predicting that one out of every two gay, bisexual, or same-gender loving black men will become HIV-positive in their lifetime­ — unless we do something about it. 

Even worse, those black men who do become HIV-positive aren’t getting into care and onto antiretroviral medication, and thus are more likely to experience negative health outcomes.

“Blacks continue to be less likely to be prescribed [antiretroviral] treatment,” according to a new study published in the Journal of Infectious Diseases.

Brooke E. Hoots from the University of North Carolina, Chapel Hill, and her colleagues at CDC’s National HIV Behavioral Surveillance Study Group, wrote that the difference in ART use, “persisted even after controlling for other predictors of lower access, namely, less education, lower income, and lack of health insurance.”

The researchers found that the proportion of newly diagnosed HIV-positive men in the U.S. who were able to start ART because of proper access to care increased between 2008 and 2014. However, those rates were 9 percent lower among black gay and bi men compared to their white counterparts. Why the disparity?

“The issues involved are often as much societal as medical,” the authors concluded, pointing to a lack of access “to housing and education, employment and adequate income, substance use and mental health services, and other social determinants of health.”

Discrimination, poverty, stigma, and a lack of access to healthcare affect the overwhelming number of the African-Americans who accounted for 45 percent of all HIV diagnoses in 2015, according to the CDC.

“How health systems can be improved and linked to communities of need without addressing these overarching issues remains a massive challenge for investigators and implementers alike,” the researchers said.

As reported by Michael Carter on NAM’s AIDSMap, the proportion of people linked to care within three months of diagnosis increased from 79 percent in 2008 to 87 percent in 2014. However, linkage to care was more likely among people with higher levels of education and health insurance.

Higher rates of ART use were observed among white people, older age groups, better educated gay and bi men, and those with health insurance. There were also regional disparities, with people in Southern states having the lowest level of ART use.

In 2014, the scientists found 90 percent of those with insurance were on ART. However, men living in the South were less likely to be insured because fewer Southern states have expanded Medicaid coverage under the Affordable Care Act. (This doesn’t bode well for other areas now that the ACA is under attack by Republicans.)

After reviewing the data, researchers argued that understanding the racial differences in ART access and use should be the next research priority. Furthermore, they concluded that innovative programs and community outreach were needed to bridge the gap.