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标题：Unequal Declines in Absolute and Relative Disparities in HIV Diagnoses Among Black Women, United States, 2008 to 2016
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作者：Hanna B. Demeke ; Anna S. Johnson ; Baohua Wu 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2018
卷号：108
期号：Suppl 4
页码：S299-S303
DOI：10.2105/AJPH.2018.304641
语种：English
出版社：American Public Health Association
摘要：Objectives. To assess changes in disparities of HIV diagnosis rates among Black women aged 18 years or older living in the United States. Methods. We calculated estimated annual percent changes (EAPCs) in annual diagnosis rates, rate differences (absolute disparity), and rate ratios (relative disparity) for groups (total, US-born, and non–US-born) of Black women (referent was all White women) with diagnosed HIV infection, using data reported to the National HIV Surveillance System. Results. Of 39 333 Black women who received an HIV diagnosis during 2008 to 2016, 21.4% were non–US-born. HIV diagnosis rates declined among all Black women, with the smallest decline among non–US-born groups (EAPC = –3.1; P ≤ .001). Absolute disparities declined for both US-born and non–US-born Black women; however, the relative disparity declined for Black women overall and US-born Black women, whereas it increased for non–US-born (including Caribbean- and Africa-born) Black women. Conclusions. Differences in disparities in HIV diagnoses exist between US-, and non–US-born (specifically Caribbean- and Africa-born) Black women. Accounting for the heterogeneity of the Black women’s population is crucial in measuring and monitoring progress toward eliminating health disparities among Black women. In the United States, remarkable improvements have been made in diagnosing, treating, and preventing HIV infections. During 2003 to 2014, the number of HIV infection diagnoses declined 25% among the US population and 47% among the female US population. 1 The annual rate of HIV diagnosis among US Black females declined from 38.7 per 100 000 population in 2010 to 30.0 per 100 000 population in 2014. 2 Encouraging progress has also been made in reducing annual HIV diagnosis rates 1,3,4 and narrowing absolute and relative disparities in HIV diagnosis rates between Black women and women of other racial groups. 2,5 Progress among Black women has not been uniform across all groups of Black women, with HIV diagnosis rates continuing to be high among non–US-born Black women. 4 Studies have consistently identified higher HIV diagnosis rates among non–US-born Blacks, especially Africa-born women. 4,6,7 Disparity is a difference in the health of a selected population linked with social, economic, or environmental disadvantages. Accounting for the heterogeneity of the US Black women’s population is crucial in measuring and monitoring progress toward eliminating health disparities and helping tailor strategies, interventions, and programs aimed at reducing disparities in HIV diagnoses. Although disparities in HIV diagnoses among Black women have been documented, 2,4–6 many studies have compared Black women with White and Hispanic women regardless of place of birth. 2,5 Few studies have examined differences among groups of Black women by world region of birth (e.g., Africa and the Caribbean). 4,7 Because HIV is not evenly distributed among US- and non–US-born Black women, 4 categorizing all Black women into 1 racial group for tracking progress in reducing disparities in diagnoses can mask the unequal progress in reducing HIV among certain groups of Black women. Cases among non–US-born Black women are often not separated from US-born Black women in surveillance analyses. Consequently, the surveillance data used to inform the development and planning of HIV-prevention policies and programs may not address the needs of non–US-born Black women. We examined changes in absolute and relative disparities among US- and non–US-born Black women to determine differences in HIV diagnosis disparities. We further categorized non–US-born women by world region of birth and assessed disparities among Caribbean- and Africa-born Black women. We used HIV diagnosis rates among groups of Black women (US-, non–US-, Caribbean-, and Africa-born) to determine whether absolute and relative disparity were equally distributed.