HIV Infection in Minority Populations
Minority populations in the United States, primarily African Americans and Hispanics, constitute 57 percent of the more than 700,000 cases of AIDS reported to the U.S. Centers for Disease Control and Prevention (CDC) since the epidemic began in 1981. African Americans make up almost 38 percent of all AIDS cases reported in the United States, yet according to the U.S. Census Bureau, they comprise only 12 percent of the U.S. population. Hispanics represent 19 percent of all AIDS cases. Including residents of Puerto Rico, they represent 13 percent of the population in this country. According to CDC:
- As of June 2001, African Americans and Hispanics represented 51 percent of AIDS cases reported among males and 77 percent of those in females.
- As of June 2001, 58 percent of all women reported with AIDS are African American and 20 percent are Hispanic.
- African American children represent 58 percent of all pediatric AIDS cases.
- Of the 194 pediatric AIDS cases reported between July 2000 and June 2001, 163 (84 percent) were in African Americans and Hispanics.
- In 1999, AIDS accounted for an estimated 50 percent of deaths among African Americans and 18 percent among Hispanics. It is the leading cause of death among African-American men ages 25-44.
- Injection drug use is a major factor in the spread of HIV in minority communities. Through June 2001, injection drug users accounted for 20 percent of all AIDS cases among both African Americans and Hispanics.
NIAID Research on HIV Infection and AIDS
The National Institute of Allergy and Infectious Diseases (NIAID), the lead component for AIDS research at the National Institutes of Health (NIH), is at the forefront of the war against this continuing health crisis, which disproportionately affects minority populations.
NIAID supports scientific research at universities, medical schools, hospitals and research institutions, both in the United States and abroad, aimed at preventing, diagnosing, and treating HIV infection and AIDS and other infectious diseases as well as allergic and other immune system disorders.
NIAID's AIDS research agenda includes conducting clinical trials that address the specific needs and concerns of minority populations, ensuring that minority patients have access to all clinical trials and sharing the latest information on AIDS treatment and prevention. In addition, NIAID's Office of Special Populations Research and Training encourages research aimed at improving the health of minority populations. The office also works to increase the effectiveness of outreach and education programs.
Through its Office of Communications and Public Liaison and the Dale and Betty Bumpers Vaccine Research Center, NIAID works with community-based organizations to disseminate information about HIV infection and AIDS and NIAID research activities to minority communities.
NIAID programs and/or networks evaluate promising therapies to fight HIV infection and its associated complications, as well as approaches to reconstitute HIV-damaged immune systems. These include the Adult AIDS Clinical Trials Group (AACTG),the Pediatric AIDS Clinical Trials Group(PACTG), the Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA), the HIV Prevention Trials Network (HPTN), the Acute Infection and Early Disease Research Program (AIEDRP), and the Division of Intramural Research Clinical Program.
Together, these programs represent the largest AIDS treatment and prevention initiative in the United States. Recruiting minorities into clinical trials is a priority for NIAID to ensure that research results will apply to all populations affected by HIV. With the epidemic moving swiftly into minority communities, inclusion of these patients is particularly urgent.
The AACTG investigates therapeutic interventions for HIV infection, AIDS, and complications of HIV-associated immune deficiency in adults. AACTG sites receive additional funding from the National Institute on Drug Abuse (NIDA) to increase participation of injection drug users, who are also hard hit by the AIDS epidemic.
The PACTG evaluates clinical interventions for treating HIV infection and HIV-associated illnesses in neonates, infants, children, adolescents. Both the PACTG and the HPTN are researching approaches to interrupt mother-to-infant transmission in pregnant women. In 2001, 6,186 and 6,426 participants were enrolled in AACTG and PACTG studies respectively. In the AACTG, 26 percent were African American, 19 percent were Hispanic, and 3 percent were Asian/Pacific Islander or Native American. In the PACTG, 47 percent were African American, 25 percent were Hispanic, and 1 percent Asian/Pacific Islander or Native American.
The HPTN is a global multicenter network dedicated to non-vaccine prevention research with a focus on HIV endpoints. They have directed their educational outreach efforts to minority communities working to increase trial volunteerism.
CPCRA is a network of community-based health centers and clinics which support clinical research in community settings by conducting large comparative studies that examine how to use available therapies more effectively as well as the long-term consequences of different treatments. Currently, CPCRA trials are under way in 17 cities at 18 units. In 2001, 4,244 people participated in CPCRA studies. Of those, 49 percent were African American, 13 percent were Hispanic, and 1 percent were Native American or Asian/Pacific Islander.
NIAID also supports clinical research on vaccine and non-vaccine strategies to prevent HIV infection. Vaccine studies are carried out through the HIV Vaccine Trials Network (HVTN) and non-vaccine prevention studies are conducted by the HPTN. The HVTN is a global network of clinical sites which evaluate preventive HIV vaccine in all phases of clinical trials. They allow for studies that examine differences in HIV diversity and genetic background , all of which may prove crucial to developing an effective vaccine for use around the world. Through close collaborations and education outreach programs with communities where vaccines will be tested, the HVTN hopes to enroll a diversified population in its clinical trials, ensuring access and representation of populations most affected by and vulnerable to HIV spread.
The HVTN and HPTN opened in 2000 and have enrolled thousands of study participants. In 2001, 383 and 9,517 people participated in the HVTN and HPTN, respectively. Of those in the HVTN, 21 percent were African American, 3 percent were Hispanic, and 1 percent Native American or Asian/Pacific Islander. In the HPTN, 57 percent of participants were African American, 7 percent Hispanic, and about 3 percent Native American or Asian/Pacific Islander.
In addition, NIAID supports two major programs to enhance basic and clinical HIV research performed at minority institutions: Research Centers in Minority Institutions and AIDS Clinical Trials Infrastructures in Minority Institutions.
NIAID conducts and supports research on HIV infection in a variety of population groups, including minority populations. These studies are conducted through the Women and Infants Transmission Study (WITS/WITS II), the Women's Interagency HIV Study (WIHS), and the Multicenter AIDS Cohort Study (MACS). Inner-city women, children, and injection drug users are the focus of WITS/WITS II. Eighty-four percent of the women in this study are from minority populations.
Similar populations of women are the focus of the WIHS, which NIAID established and awarded funds to six U.S. sites in 1993 to investigate primarily the impact of HIV infection on women. Several other NIH institutes also collaborate on WIHS and provide funds for various components. They include NIDA, the National Cancer Institute, National Institute of Child Health and Human Development, and National Institute of Dental and Craniofacial Research.
Active community involvement through the WIHS sites and the WIHS National Community Advisory Board helps encourage minority women to participate in the studies. More than 80 percent of the women currently enrolled in WIHS are from minority populations.
In the United States, the Multicenter AIDS Cohort Study (MACS) and WIHS are the two largest observational studies of HIV/AIDS in homosexual or bisexual men and in women, respectively. These studies have made major contributions to understanding how HIV is spread, how the disease progresses, and how it can best be treated. Over the past year, these studies expanded their enrollment to increase the size of the study groups by 60 percent and increase the number of minority participants. The enlarged groups will focus on contemporary questions regarding HIV infection and treatment.
For information about Food and Drug Administration-approved HIV-related clinical trials being conducted throughout the United States, contact the AIDS Clinical Trials Information Service.
1-888-480-3739 (TTY/Deaf Access)
For federally approved treatment guidelines on HIV/AIDS, contact the HIV/AIDS Treatment Information Service:
1-888-480-3739 (TTY/Deaf Access)
Both services operate from 12 p.m. to 5 p.m. Eastern Time, Monday through Friday. Spanish-speaking specialists are available.
To receive materials or to talk with a Health Communication Specialist, contact the CDC National HIV and STD Hotline. This service is available 24 hours a day.
1-800-243-7889 (TTY/Deaf Access)
To get information specifically about clinical trials conducted by the NIAID Intramural AIDS Research Program, call 1-800-243-7644 (http://clinicaltrials.gov).
NIAID is a component of the National Institutes of Health (NIH). NIAID supports basic and applied research to prevent, diagnose, and treat infectious and immune-mediated illnesses, including HIV/AIDS and other sexually transmitted diseases, illness from potential agents of bioterrorism, tuberculosis, malaria, autoimmune disorders, asthma and allergies.
Press releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov.
Office of Communications and Public Liaison
National Institute of Allergy and Infectious Diseases
National Institutes of Health
Bethesda, MD 20892
U.S. Department of Health and Human Services