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African Americans face the most severe burden of HIV of all racial/ethnic groups in the United States (US). Despite representing only 14% of the US population in 2009, African Americans accounted for 44% of all new HIV infections in that year. Compared with members of other races and ethnicities, African Americans account for a higher proportion of HIV infections at all stages of disease—from new infections to deaths.

The Numbers

New HIV Infections

• In 2009, black men accounted for 70% of the estimated new HIV infections among all blacks. The estimated rate of new HIV infection for black men was more than six and a half times as high as that of white men, and two and a half times as high as that of Latino men or black women.
• In 2009, black men who have sex with men (MSM)¹ represented an estimated 73% of new infections among all black men, and 37% among all MSM. More new HIV infections occurred among young black MSM (aged 13–29) than any other age and racial group of MSM. In addition, new HIV infections among young black MSM increased by 48% from 2006–2009.
• In 2009, black women accounted for 30% of the estimated new HIV infections among all blacks. Most (85%) black women with HIV acquired HIV through heterosexual sex. The estimated rate of new HIV infections for black women was more than 15 times as high as the rate for white women, and more than three times as high as that of Latina women.

Estimates of New HIV Infections in the United States, 2009, for the Most-Affected Subpopulations

Subpopulations representing 2% or less of the overall US epidemic are not reflected in this chart.

HIV and AIDS Diagnoses² and Deaths

• From 2006–2009, the estimated number and rate of HIV diagnoses among blacks remained stable in the 40 states with long-term confidential name-based HIV reporting.
• At some point in their lifetimes, an estimated 1 in 16 black men and 1 in 32 black women will be diagnosed with HIV infection.
• In 2009, an estimated 16,741 blacks were diagnosed with AIDS in the US, a number that has slowly decreased since 2006.
• By the end of 2008, an estimated 240,627 blacks with an AIDS diagnosis had died in the US. In 2007, HIV was the ninth leading cause of death for all blacks and the third leading cause of death for black women and black men aged 35–44.

Prevention Challenges

African Americans face a number of challenges that contribute to the higher rates of HIV infection.

The greater number of people living with HIV (prevalence) in African American communities and the fact that African Americans tend to have sex with partners of the same race/ethnicity means that they face a greater risk of HIV infection with each new sexual encounter.

African American communities continue to experience higher rates of other sexually transmitted infections (STIs) compared with other racial/ethnic communities in the US. The presence of certain STIs can significantly increase the chance of contracting HIV. Additionally, a person who has both HIV and certain STIs has a greater chance of infecting others with HIV.

The socioeconomic issues associated with poverty, including limited access to high-quality health care, housing, and HIV prevention education, directly and indirectly increase the risk for HIV infection and affect the health of people living with and at risk for HIV infection.

Lack of awareness of HIV status can affect HIV rates in communities. Approximately 1 in 5 adults and adolescents in the US living with HIV are unaware of their HIV status. This translates to approximately 116,750 persons in the African American community. Late diagnosis of HIV infection is common, which creates missed opportunities to obtain early medical care and prevent transmission to others. The sooner an individual is diagnosed and linked to appropriate care, the better the outcome.

Stigma, fear, discrimination, homophobia, and negative perceptions about HIV testing can also place too many African Americans at higher risk. Many at risk for infection fear stigma more than infection and may choose instead to hide their high-risk behavior rather than seek counseling and testing.

What CDC Is Doing

CDC and its partners are pursuing a high-impact prevention approach to advance the goals of the National HIV/AIDS Strategy and maximize the effectiveness of current HIV prevention methods. This approach focuses on implementing programs that have shown the greatest potential to reduce new HIV infections in populations and geographic areas at highest risk and on a scale large enough to yield the greatest possible impact on the HIV epidemic. Examples of activities addressing African American communities include:

• The Act Against AIDS campaign delivers culturally appropriate messages about HIV infection. “Take Charge. Take the Test.” encourages African American women to get tested for HIV. “Testing Makes Us Stronger,” is aimed at increasing HIV testing among black MSM. For more information, visit www.actagainstaids.org.
• An active part of the Act Against AIDS campaign, the Act Against AIDS Leadership Initiative (AAALI), is a $16 million, six-year partnership between CDC and the country’s leading organizations that represent the populations hardest hit by HIV. AAALI was initially formed to provide critical funding and to intensify HIV prevention efforts in black communities, but has since expanded to include organizations that focus on black MSM and the Latino community.
• Expanded Testing Initiative (ETI). In 2010, CDC announced a second three-year expanded HIV testing program that builds on an initiative started in 2007 to increase HIV testing among African Americans. In the first three years of the project, more than 2.8 million tests were conducted and 18,432 people were newly diagnosed with HIV. Most of the people who were tested (57.4%) and diagnosed with HIV (66.0%) were African American. ETI includes 30 health jurisdictions and focuses on increasing HIV testing among African Americans and Latinos, as well as MSM and injection drug users of all races and ethnicities. Funding for the program was increased from $36 million per year to more than $50 million per year.
• In September 2011, CDC awarded $55 million for HIV Prevention Projects for Young Men of Color Who Have Sex with Men (YMCSM) and Young Transgender (YTG) Persons of Color, to provide effective HIV prevention services over five years to YMCSM and YTG persons of color and their partners regardless of age, gender, and race/ethnicity.
• CDC provides support and technical assistance to health departments and community-based organizations to deliver effective prevention interventions for African Americans. Efforts include
  • WILLOW, which emphasizes gender pride among HIV-positive African American women, informs them how to identify and maintain supportive social networks and healthy relationships, and learn coping strategies and safe sex communication skills;
  • Sister to Sister and SIHLE provide culturally sensitive health information to empower and educate African American women and adolescent females;
  • Nia educates African American heterosexual men about HIV/AIDS and its effect on their communities and motivates risk-reduction behaviors by effective condom use;
  • d-up: Defend Yourself!! and Many Men, Many Voices address social, cultural, and religious norms, promote condom use, and assist black MSM in recognizing and handling HIV risk-related racial and sexual bias. For information, visit www.effectiveinterventions.org.

CDC also supports research to reduce HIV risk among African Americans.