1. end+disparities Learning Exchange Part II: Subpopulations

2. Quick Review
This presentation is the second in a series of presentations intended to familiarize you with disparities calculation
Part I: Disparity, a National Priority
Part II: YOU ARE HERE!
Part III: Calculating Disparity
Part IV: Calculation Assumptions
Part V: Selecting QI Projects

3. “We all should know that diversity makes for a rich tapestry, and we must understand that all the threads of the tapestry are equal in value no matter what their color.” - Maya Angelou

4. Learning Objectives
What sub-populations does the end+disparities Learning Exchange focus on through its engagement activities?
Understand the fundamental differences in identified populations along the HIV Care Continuum

5. Disparity HIV Subpopulations To Consider
MSM of Color
African American and Latina Women
Youth (under 24)
Transgender People

6. Disparities among MSM of Color
“When new infections among young black gay men increase by nearly 50% in 3 years, we need to do more to show them that their lives matter.”
- President Barack Obama

7. Disparities among MSM 63% of new HIV infections are among MSM
2% of the U.S. population identify as MSM
Blacks represent 14% of the U.S. population but account for almost half (46%) of all people living with HIV in the U.S
U.S. Population
New HIV Infections

8. MSM of Color
Hall HI, Holtgrave DR, Tang T, Rhodes P. HIV transmission in the United States: considerations of viral load, risk behavior, and health disparities. AIDS Behav. 2013;17(5):

9. MSM of Color Risk behavior = HIV infection
Sexual behavior past 6 months
% Black (n=814)
% Latino (n=1042)
% White (n=1259)
Casual male sex partner
49.3
57.6
59.7*
IDU male sex partner
5.9
7.5
10.6*
HIV+ male sex partner
4.8
6.0
6.1*
Unprotected anal intercourse 48 NA
59*
*P< .05
Harawa NT, Associations of race/ethnicity with HIV prevalence and HIV-related behaviors among young men who have sex with men in 7 urban centers in the United States. Journal of Acquired Immune Deficiency Syndromes. 2004;35(5):526–536.

10. MSM of Color
1 in 11 White MSM will be diagnosed with HIV in his lifetime
1 in 4 Hispanic MSM will be diagnosed with HIV in his lifetime
1 in 2 Black MSM will be diagnosed with HIV in his lifetime
MMWR, CDC Health Disparities and Inequalities Report — United States; Nov 22, 2013 / 62(3);

11. MSM of Color
The estimated rate of HIV infection among MSM over 18 years is a 46-fold difference compared with all other men
In 2010, young MSM (aged 13 to 24 years) accounted for 72% of new HIV infections among all youth, and 30% of new infections among all MSM
Between 2001 and 2006, the number of HIV infections among MSM rose for all races, but particularly for young Black MSM (a 93% increase)
CDC,
CDC,
MMWR, CDC Health Disparities and Inequalities Report — United States; Nov 22, 2013 / 62(3);

12. HIV Care Continuum (Black MSM vs. White MSM)
75%
84%
24%
43%
20%
39%
16%
34%
Black MSM are 47% less likely than White MSM to achieve viral suppression (16% vs 34%).
Hall HI, Holtgrave DR, Tang T, Rhodes P. HIV transmission in the United States: considerations of viral load, risk behavior, and health disparities. AIDS Behav. 2013;17(5):

13. Disparities among African American and Latina Women
“Racial disparity and HIV rates in the United States is a major civil rights issue, and it is, in fact, a major human rights issue.“
- Dr. Adaora Adimora, University of North Carolina

14. Disparities among Women vs Men
Heterosexual women are twice as likely to be diagnosed with HIV as heterosexual men. Women who inject drugs are also at a higher risk than men who inject drugs.

15. Disparities among Women vs Men
CDC. Monitoring the national HIV indicators through surveillance of HIV infection in the United States and 6 U.S. dependent areas—2010. HIV Surveillance Supplemental Report 2012;17(No. 3).

16. Disparities among African American and Latina Women
64% of new HIV infections among women occur within Black women
13% of the U.S. female population are Black women
Blacks represent 14% of the U.S. population but account for almost half (46%) of all people living with HIV in the U.S
U.S. Female Population
New HIV Infections

17. Disparities among African American and Latina Women
Of the total number of estimated new HIV infections among women, 6,100 were in Blacks, 18% (1,700) were in Whites, and 15% (1,400) were in Latinas.

18. Disparities among African American and Latina Women
1 in 880 white women will be diagnosed with HIV in her lifetime

19. Disparities among African American and Latina Women
1 in 48 African-American women will be diagnosed with HIV in her lifetime
Black women are 18 times likelier to be diagnosed with HIV than white women

20. Disparities among African American and Latina Women
1 in 227 Latina women will be diagnosed with HIV in her lifetime
Latina women are 4 times likelier to be diagnosed with HIV than white women

21. Disparities among Youth (under 24)
“Rather than letting my serostatus set my life ablaze, I allowed it to set a fire under me.”
- Adrian, National Youth HIV & AIDS Awareness Day Ambassador

22. Youth 17% of the U.S. population is at the age of 13-24
26% of new HIV infections are among young persons
Young persons aged 15–29 accounted for 39% of all new HIV infections in the U.S. in 2009, while representing only 21% of the U.S. population in [4]
U.S. Population
New HIV Infections
Office of National AIDS Policy, National HIV/AIDS Strategy. July 2015

23. Youth
One in five new HIV diagnoses were among persons aged 13 to 24 years
Young persons aged 15–29 accounted for 39% of all new HIV infections in the U.S. in 2009, while representing only 21% of the U.S. population in [4]
Office of National AIDS Policy, National HIV/AIDS Strategy. July 2015

24. Youth
CDC,

25. Youth
Only 6% of youth are estimated to be virally suppressed, compared to an average rate of 30% across all age groups.
Zanoni BC, Mayer KH. The adolescent and young adult HIV cascade of care in the United States: exaggerated health disparities. AIDS Patient Care STDS. 2014;28(3):

26. Youth
Black youth accounted for 57% of all new HIV infections among youth, followed by Latino (20%) and White (20%) youth
Blacks comprise 69% of HIV-positive youth ages 13 to 19, even though they make up only 17 percent of this population; young Black women made up 71 percent of HIV infections among young women ages 13 to 24
CDC,

27. Disparities among Transgender People
“Whether it’s a lack of access to quality and compassionate health care, or an out-of-date legal system that allows blatant discrimination, equality is too often out of reach for trans people.”
- “Mission, Vision, and Values,” Transgender Law Center

28. Transgender People
Grossman AH. Aspects of psychological resilience among transgender youth. J LGBT Youth. 2010; 8(2):103–115.

29. Transgender People
Haas AP. Suicide attempts among transgender and gender non-conforming adults. New York: American Foundation for Suicide Prevention; 2014

30. Transgender People
CDC,

31. Transgender People
1 in 250 odds of having HIV as an adult of reproductive age
1 in 5 odds of having HIV as a transgender woman
Transgender People are 49 times more likely to acquire HIV then all adults
Baral SD. Worldwide burden of HIV in transgender women: a systematic review and metaanalysis.
Lancet Infect Dis. 2013;113(3):214–222. doi: /S (12)

32. Transgender People
Transgender women are less likely to receive ART treatment than cisgender people.

33. Transgender People
Estimates suggest that the transgender population could be between 0.1% and 1.1% of reproductive age adults
The unemployment rates for transgender people is twice the national unemployment rate and ninety-seven per cent reported mistreatment, harassment and discrimination while working
HIV prevalence for transgender sex workers is nine times higher than for female sex workers and three times higher for male sex workers
Mizuno and colleagues found that transgender women have significantly lower ART dose adherence and durable viral suppression compared to cisgender men, even though they have similar rates in terms of receipt of care, treatment, and supportive services
UNAIDS, The Gap Report, 2014;
Gates GJ. How many people are lesbian, gay, bisexual, and transgender? The Williams Institute, April 2011.
Herbst JH, Jacobs ED, Finlayson TJ, et al. Estimating HIV prevalence and risk behaviors of transgender persons in the United States. AIDS Behav. 2008;12(1):1-17.
Williamson C. Providing care to transgender persons: a clinical approach to primary care, hormones, and HIV management. J Assoc Nurses AIDS Care. 2010;21(3):221-9.

34. Ending disparities will end the HIV epidemic.

35. Next Steps
This presentation is the second in a series of presentations intended to familiarize you with disparities calculation
Part I: Disparity, a National Priority
Part II: YOU ARE HERE!
Part III: Calculating Disparity
Part IV: Calculation Assumptions
Part V: Selecting QI Projects

36. Next Steps Check out the NQC Disparities Calculator and NQC Guide!
Want to check out the NQC Disparities Calculator? Click this link and you’ll be taken there!
Want to learn more about the NQC Guide on this topic? Click this link and you’ll be taken there!

37. NationalQualityCenter.org Michael@NationalQualityCenter.org
NationalQualityCenter.org 37