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African American women, falling out of care

Rod McCullom | 4/29/2013, 6:47 p.m. | Updated on 4/29/2013, 6:47 p.m.

Black AIDS Institute

Reports of an almost 20-month-old Mississippi infant who was cured of HIV dominated news coverage during early March. But much of the coverage around the case lacked context.

“This mother did not receive any prenatal care and learned that she was HIV-positive during delivery,” said Vanessa Mills, executive director of Empower “U,” one of the first Black HIV/AIDS community-based organizations in Miami. “The mother and infant received regular care and treatment for 18 months – but then they dropped out of care and treatment for 10 months.”

Making, keeping the connection

Connecting people living with HIV/AIDS to appropriate medical care and treatment as soon as possible – a concept known as “treatment as prevention” – has become a key strategy in ending the epidemic. The Mississippi case has become a cautionary tale about access to care and treatment for Black women – especially in the South, which has seen the largest increase in new infections in the United States.

Blacks represent only 13 percent of the nation’s population but account for about 44 percent of all new seroconversions, the Centers for Disease Control and Prevention reports. Almost 40 percent of Mississippians are Black, as are more than three-fourths of the state’s new HIV infections.

“So it’s very likely the mother and newborn were Black,” notes Bambi W. Gaddist, Dr.P.H., founder and executive director of the South Carolina HIV/AIDS Council.

But connecting the newly diagnosed to care is just one step. As the Mississippi case demonstrates, keeping them in care can often become a difficult challenge.

A new model known as the “HIV treatment cascade” illustrates how many people in one community, country or group are actually receiving the full benefits of the medical care and treatment they need and are thus suppressing not only their viral load but also the overall community viral load.

Only 25 percent of the more than 1 million individuals in the U.S. who are living with HIV/AIDS are making it all the way through the HIV treatment cascade and achieving viral suppression, according to the CDC reports. African Americans and younger people are the least likely to be in ongoing care and have their virus under control.

Testing during pregnancy is vital

“This case is the intersection of sexual and reproductive health – as well as race, gender, health and economic disparities,” says Kimberly A. Parker, Ph.D., assistant professor of health studies at Texas Woman’s University.

Infection rates among Black women are nearly 20 times higher than those among White women; however, new HIV infections among Black women decreased by 21 percent between 2008 and 2010.

Because mothers are generally HIV tested and treated during their pregnancies, mother-to-child transmission is extremely rare in the United States – there were only 162 cases in 2010. But of those cases, more than 60 percent occurred among Black women.

These data underscore “the importance of testing during pregnancy, especially for Black women,” Mills said. “It also demonstrates the critical role of prenatal care to Black women. Low birth weight and increased infant mortality rates are very prevalent in our communities.”