HIV, Race, and Injection Drug Use

"In the United States, 10% of HIV infections diagnosed in 2018 were attributed to unsafe injection drug use or male-tomale sexual contact among persons who inject drugs (PWID) (1). In 2017, among PWID or men who have sex with men and who inject drugs (MSM-ID), 76% of those who received a diagnosis of HIV infection lived in urban areas* (2). To monitor the prevalence of HIV infection and associated behaviors among persons who reported injecting drugs in the past 12 months, including MSM-ID, CDC’s National HIV Behavioral Surveillance (NHBS) conducts interviews and HIV testing among populations of persons at high risk for HIV infection (MSM, PWID, and heterosexually active adults at increased risk for HIV infection) in selected metropolitan statistical areas (MSAs) (3). The estimated HIV infection prevalence among PWID in 23 MSAs surveyed in 2018 was 7%. Among HIV-negative PWID, an estimated 26% receptively shared syringes and 68% had condomless vaginal sex during the preceding 12 months. During the same period, 57% had been tested for HIV infection, and 55% received syringes from a syringe services program (SSP). While overall SSP use did not significantly change since 2015, a substantial decrease in SSP use occurred among Black PWID, and HIV prevalence among Black PWID was higher than that among Hispanic and White PWID. These findings underscore the importance of continuing and expanding HIV prevention programs and community-based strategies for PWID, such as those provided by SSPs, especially following service disruptions created by the COVID-19 pandemic (4). Efforts are needed to ensure that PWID have low-barrier access to comprehensive and integrated needs-based SSPs (where legally permissible) that include provision of sterile syringes and safe syringe disposal, HIV and hepatitis C virus (HCV) testing and referrals to HIV and HCV treatment, HIV pre-exposure prophylaxis, and treatment for substance use and mental health disorders."

"From 2015 to 2018, HIV prevalence among PWID [People Who Inject Drugs] in selected MSAs [Metropolitan Statistical Areas] was unchanged at 7%. This analysis found a higher HIV prevalence among Black PWID than among Hispanic or White PWID, despite fewer reported risk behaviors associated with HIV infection among Black PWID. In 2018, when compared with Hispanic or White PWID, fewer Black PWID shared syringes or injection equipment and had condomless anal sex. Overall, SSP use did not significantly increase since 2015 (from 52% to 55%), but a substantial decrease in SSP use among Black PWID (from 51% to 40%), and significantly lower use of SSPs in 2018 among Black PWID compared with Hispanic and White PWID was observed. Lower SSP use among Black PWID in the context of disproportionally higher rates of HIV diagnoses in Black communities (1) might lead to increased risk for HIV transmission among Black PWID. It is critical to explore and address the causes for these disparities in SSP use and HIV infection rates.

"In 2020, the COVID-19 pandemic impeded delivery of prevention services for PWID nationally, resulting in a substantial reduction in SSP operations and provision of medication for opioid use disorder (4). This analysis highlights the ongoing need for risk reduction and improved access to HIV prevention services among PWID than existed before the COVID-19 pandemic, especially because access to these services was reduced as a result of the pandemic. Findings from this analysis and continuous monitoring of characteristics and risk behaviors associated with HIV infection of PWID will facilitate estimation of how the pandemic disrupted behaviors as well as access to essential prevention services among PWID."

"In 2021, compared with 2017, the annual number and rate of persons living with diagnosed HIV infection increased in the United States and 6 dependent areas, (Table 15b). At year-end 2021, 1,088,769 persons were living with diagnosed HIV infection (persons aged ≥ 13 years: 1,087,503) (Tables 15b and 17b). The overall rate of persons living with diagnosed HIV infection was 324.5 (persons aged ≥ 13 years: 383.7) (Figure 10, Table 15b)."

"• Gender: From 2014 through 2018 in the United States and 6 dependent areas, the largest percentage increase (24%) in the number of persons living with diagnosed HIV infection was among transgender MTF (Table 14b). At year-end 2018, the largest percentage (75%) of persons living with diagnosed HIV infection were male, followed by females (24%) (Table 14b). Transgender MTF, transgender FTM, and AGI each accounted for less than 1%.

"• Age group: From 2014 through 2018 in the United States and 6 dependent areas, the largest percentage increase (51%) in the rate of persons living with diagnosed HIV infection was among persons aged 65 years and older (from 130.0 in 2014 to 196.6 in 2018) (Table 14b). At year-end 2018, persons aged 50–54 years made up the largest percentage (15%) of persons living with diagnosed HIV (Table 14b). The highest rate (762.6) was among persons aged 50–54 years, followed by those aged 55–59 years (704.3), and those aged 45–49 years (600.0).

"• Race/ethnicity: At year-end 2018 in the United States, the highest rate (1,034.2) and the largest percentage (41%) were those for blacks/African Americans (Table 14a). Among the remaining race/ethnicity groups, the rates were 665.7 for persons of multiple races, 386.4 for Hispanics/Latinos, 154.0 for whites, 150.3 for Native Hawaiians/other Pacific Islanders, 129.6 for American Indians/Alaska Natives, and 80.9 for Asians.

"At the end of 2018, 1,040,352 adults and adolescents were living with diagnosed HIV infection in the United States and 6 dependent areas (Figure 10). Among 795,198 males living with diagnosed HIV infection, 35% were black/African American, 33% were white, 25% were Hispanic/Latino, 5% were males of multiple races, and 2% were Asian. Less than 1% each were American Indian/Alaska Native and Native Hawaiian/other Pacific Islander. Among 245,154 females living with diagnosed HIV infection, 58% were black/African American, 20% were Hispanic/Latino, 16% were white, 5% were females of multiple races, and 1% were Asian. Less than 1% each were American Indian/Alaska Native and Native Hawaiian/other Pacific Islander."

"Region and race/ethnicity: In 2018 in the United States and 6 dependent areas, 2,492 diagnosed HIV infections were among PWID. Of these, the largest number of HIV infection diagnoses were in the South (976), followed by the Northeast (595) (Figure 19). In all regions, the largest percentage of diagnosed HIV infections among PWID was among whites. In the South, whites accounted for 436 diagnosed HIV infections among PWID (45%), blacks/African Americans accounted for 359 (37%), and Hispanics/Latinos accounted for 143 (15%) (Table 6b). In the Northeast, whites accounted for 212 diagnosed HIV infections among PWID (36%), blacks/African Americans accounted for 206 (35%), and Hispanics/Latinos accounted for 152 (26%). Please use caution when interpreting data for American Indian/Alaska Native, Asian, and Native Hawaiian/other Pacific Islander PWID, and persons of multiple races who inject drugs: the numbers are small."

"The first cases of Pneumocystis carinii(jirovecii) pneumonia among young men, which were subsequently linked to HIV infection, were reported in the MMWR on June 5, 1981 (1). At year-end 2019, an estimated 1.2 million persons in the United States were living with HIV infection (2)."

"From 2014 through 2018 in the United States and 6 dependent areas, the percentage of diagnoses of HIV infection attributed to injection drug use increased. In 2018, among 1,434 male adult and adolescent PWID with diagnosed HIV infection, approximately 41% were white, 30% were black/African American, and 24% were Hispanic/Latino (Figure 18). Among 1,058 female adult and adolescent PWID with diagnosed HIV infection, 50% were white, 30% black/African American, and 15% Hispanic/Latino. Please use caution when interpreting data for American Indian/Alaska Native, Asian, and Native Hawaiian/other Pacific Islander PWID, and persons of multiple races who inject drugs: the numbers are small."

According to the CDC, Human Immunodeficiency Virus (HIV) disease was the eighth leading cause of death among Black people in the US aged 20-24, the sixth leading cause among Black people aged 35-44, and the eighth among Black people aged 45-54.

HIV disease was the sixth leading cause of death among Black males in the US aged 20-24, the sixth leading cause among Black males aged 25-34, the eighth leading cause among Black males aged 35-44, and the eighth leading cause among Black males aged 45-54.

HIV disease was the ninth leading cause of death among Black females in the US aged 25-34, the seventh leading cause among Black females aged 35-44, and the tenth leading cause among Black females aged 45-54.

"In 2018 in the United States and 6 dependent areas, 2,492 diagnosed HIV infections were among PWID. Of these, the largest number of HIV infection diagnoses were in the South (976), followed by the Northeast (595) (Figure 19). In all regions, the largest percentage of diagnosed HIV infections among PWID was among whites. In the South, whites accounted for 436 diagnosed HIV infections among PWID (45%), blacks/African Americans accounted for 359 (37%), and Hispanics/Latinos accounted for 143 (15%) (Table 6b). In the Northeast, whites accounted for 212 diagnosed HIV infections among PWID (36%), blacks/African Americans accounted for 206 (35%), and Hispanics/Latinos accounted for 152 (26%). Please use caution when interpreting data for American Indian/Alaska Native, Asian, and Native Hawaiian/other Pacific Islander PWID, and persons of multiple races who inject drugs: the numbers are small."

"AIDS-related deaths among all state and federal prison inmates declined an average 16% per year between 2001 and 2010, from 24 deaths per 100,000 inmates in 2001 to 5 per 100,000 in 2010.

"Among state and federal inmates with HIV/AIDS, the rate of AIDS-related deaths dropped significantly, from 134 deaths per 10,000 inmates with HIV/AIDS in 2001 to 38 per 10,000 in 2010.

"When grouped by 2010 yearend custody populations, the declining rate of HIV/AIDS in small, medium, and large state prisons had the same 3% average annual decline in the national rate between 2001 and 2010.

"Between 2001 and 2010, the average annual decline of 16% in the national AIDS mortality rate was similar to the decline in small (down 12%), medium (down 17%), and large (down 19%) state prison populations.

"Rate of HIV/AIDS cases and AIDS-related deaths declined across all sizes of prison populations.

"In 2009, the AIDS mortality rate among state prison inmates (6 per 100,000) fell below the rate for the U.S. general population (7 per 100,000).

"AIDS-related deaths in state prisons declined from 89 in 2009 to 69 in 2010 among males, from 70 to 43 among black non-Hispanics, and from 87 to 60 among all state inmates age 35 or older."

Click here for complete datatable of Number of AIDS-Related Deaths Among State Prison Inmates 2008-2010

From 2000 through 2014, a total of 569 people died from AIDS-related illnesses while serving time in a local jail in the US. Of those, 98 were white non-Latinx, 395 were black non-Latinx, 73 were Latinx, and 3 were "other."
In 2015, a total of 10 people serving time in local jails in the US died from AIDS-related illnesses.

"Among jail inmates in 2002 who had ever been tested for HIV, Hispanics (2.9%) were more than 3 times as likely as whites (0.8%) and twice as likely as blacks (1.2%) to report being HIV positive."