New England AIDS Education and Training Center: ContentPages

In Brief: August 27, 2020

Inside This Issue: Health Disparities and COVID-19, highlights of 2020 Ryan White Conference, new online dashboard to track progress toward ending the HIV epidemic, recent HIV surveillance reports from CDC, and more.

Health Disparities & COVID-19

COVID-19 Death Rates Are Much Higher Among Persons of Color Than Whites

U.S. death rates from COVID-19 are substantially higher among Persons of Color than among Whites, according to the latest data compiled as part of the ongoing Color of Coronavirus project of the APM Research Lab (ARL). The project’s most recent update analyzes mortality data by race/ethnicity for the nearly 171,000 reported COVID-19 deaths through August 18. ARL notes that race and ethnicity are known for 95% of U.S. persons who have died of COVID-19.

“Our latest update reveals continued wide disparities by race, most dramatically for Black and Indigenous Americans” – with mortality rates about 2.2 times and 1.8 times as high, respectively, compared to Whites, according to ARL. The mortality rates from COVID-19 aggregated for all U.S. states and the District of Columbia were as follows through August 18:

88.4 deaths per 100,000 Black Americans (or 1 in 1,125 persons);
72.2 deaths per 100,000 Indigenous Americans (or 1 in 1,375 persons);
63.9 deaths per 100,000 Pacific Islander Americans (or 1 in 1,575 persons);
54.4 deaths per 100,000 Latino Americans (or 1 in 1,850 persons);
40.4 deaths per 100,000 White Americans (or 1 in 2,450 persons); and
36.4 deaths per 100,000 Asian Americans (or 1 in 2,750 persons)

“If they had died of COVID-19 at the same actual rate as White Americans, about 19,500 Black, 8,400 Latino, 600 Indigenous, and 70 Pacific Islander Americans would still be alive,” according to ARL.

Adjusting the data for age differences in racial and ethnic groups further widens the gap in the overall mortality rates between all other groups and Whites, who have the lowest age-adjusted rate. Compared to Whites, the latest U.S. age-adjusted COVID-19 mortality rates for were 3.6 times as high for Blacks; 3.4 times as high for Indigenous people; 3.2 times as high for Latinos; 3.0 times as high for Pacific Islanders, and 1.3 times as high for Asians.

“What does this mean? It indicates that many younger Americans who are Black, Latino, Indigenous, or Pacific Islanders are dying of COVID-19 – driving their mortality rates far above White Americans’ [rates],” ARL notes. “Despite their relative youthfulness (a protective factor against COVID), their death rates are elevated. As Brookings Institution has reported, ‘In every age category, Black people are dying from COVID at roughly the same rate as White people more than a decade older.’”

NASTAD Recommends Steps to Address Health Disparities Worsened by COVID-19

Responding to the COVID-19 disparities data reported by ARL’s Color of Coronavirus project and other sources, NASTAD [National Alliance of State and Territorial AIDS Directors] recently published an issue brief calling for institutional accountability in public health “to effectively address the health inequities exacerbated by COVID-19 and other pandemics . . . To achieve health equity and to better prepare for future outbreaks, we must address long-standing systemic issues, including medical racism, institutional stigma and trauma, discriminatory hiring practices, medical mistrust, and the inequitable distribution of public health resources.” The issue brief recommends several steps to address these issues:

Improve data collection and reporting, including information about race, ethnicity, and other demographic data;
Expand access to testing and treatment, particularly to the most impacted communities;
Engage in culturally responsive marketing and outreach for Communities of Color;
Collaborate with diverse partners, including faith-based organizations and other trustworthy institutions;
Invest in health workforce expansion and staff support to serve marginalized communities; and
Undertake institutional change to dismantle systemic racism.

Ryan White HIV/AIDS Program

Highlights of the Virtual 2020 National Ryan White Conference

More than 8,000 Ryan White HIV/AIDS Program (RWHAP) recipients, subrecipients, national, state and local stakeholders, planning bodies, people with HIV, and front-line providers participated in the 2020 National Ryan White Conference on HIV Care & Treatment, which was held virtually on August 11 through 14. The theme of this year’s conference was “30 years of innovating care, optimizing public health, and ending the HIV epidemic.” The HIV.gov blog has posted several detailed summaries of this year’s conference: Day 1 Recap; Day 2 Recap; Day 3 Recap; Day 4 Recap; as well as clinical conference highlights, with particular emphasis on the potential of long-acting, injectable HIV medications to maintain viral suppression in persons with HIV and to prevent infection in those at risk.

HRSA’s RWHAP TargetHIV resource has also posted YouTube videos of the plenary sessions for each day of the conference. For your convenience, we are providing plenary session themes and links below:

Day 1 Plenary: Ending the Epidemic (55 minutes)

Day 2 Plenary: Optimizing Public Health (85 minutes)

Day 3 Plenary: Innovating Care (89 minutes)

Day 4 Plenary: 30 Years of HIV Care and Treatment (77 minutes)

HRSA Marks 30^th Anniversary of the Ryan White CARE Act

On August 18, 1990, the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act was signed into law. This legislation created the largest U.S. federal program – the Ryan White HIV/AIDS Program (RWHAP) – which focuses exclusively on providing care and treatment to people with HIV. Administered by HHS’s Health Resources and Services Administration (HRSA), the RWHAP provides funding to support a comprehensive system of HIV primary medical care, medication, and essential services to more than 530,000 people with HIV – about half of all people diagnosed with HIV in the U.S.

“The RWHAP has been a cornerstone of the public health response to HIV in the United States for the last three decades,” HHS Secretary Alex Azar noted on the 30^th anniversary of the CARE Act. “What was once a deadly disease is now a manageable chronic condition, and we see that in the success of the RWHAP, with the vast majority of its clients reaching viral suppression.” In 2018, about 87% of RWHAP clients who received HIV medical care were virally suppressed, up from about 70% in 2010.

“The RWHAP is a key part of the Administration's Ending the HIV Epidemic: A Plan for America,” said HRSA Administrator Tom Engels. “During the COVID-19 pandemic, the program remains committed to providing lifesaving services to the nation's most vulnerable populations, including people with HIV.”

Ending the U.S. HIV Epidemic

HHS Launches AHEAD to Track Progress on EHE Initiative Goals

This month, the U.S. Department of Health and Human Services launched America’s HIV Epidemic Analysis Dashboard (AHEAD), which allows users to track the nation’s progress toward the key goals of the U.S. Ending the HIV Epidemic (EHE) initiative: to reduce new HIV infections 75% by 2025 and 90% by 2030.

AHEAD displays data on the six EHE indicators that the federal government uses to track progress towards the EHE Initiative goals:

HIV incidence – the estimated number of new HIV infections in a given year;
Knowledge of HIV status – the estimated percentage of people with HIV who have received an HIV diagnosis;
HIV diagnoses – the number of people with HIV diagnosed in a given year confirmed by laboratory or clinical evidence;
Linkage to HIV medical care – the percentage of people with HIV diagnosed in a given year who have received HIV medical care within one month of diagnosis;
Viral suppression – the percentage of people living with diagnosed HIV infection in a given year with a viral load less than 200 copies per milliliter of blood; and
Pre-exposure prophylaxis (PrEP) coverage – the estimated percentage of individuals with indications for PrEP who have been prescribed PrEP.

“This tool is an asset that provides the most up-to-date information available about EHE, including data, progress, and updates highlighting innovative approaches,” noted Harold Phillips, senior HIV advisor and chief operating office for the EHE initiative. “The launch of the dashboard to track EHE progress aims to bolster communities by providing decision-support capabilities to get ahead of the epidemic at the local level. It will inform jurisdictional and national leaders on EHE efforts and promote transparency in data sharing and progress towards our collective goal of ending the HIV epidemic by 2030.”

Educational Resources

New HIV Surveillance Reports and Infographics from CDC

In recent weeks, the U.S. Centers for Disease Control and Prevention (CDC) published several reports focusing on new HIV diagnoses, testing, HIV trends in particular U.S. regions and age groups, as well as core indicators for monitoring progress in ending the HIV epidemic. These include four new documents in its HIV Surveillance Data Tables series:

Diagnoses of HIV Infection Among Adolescents and Young Adults, United States and 6 Dependent Areas 2014-2018 – This report focuses on HIV diagnoses, prevalence, and deaths among adolescents aged 13 to 19 and young adults aged 20 to 24. Breakdowns are provided by year of diagnosis, gender, race/ethnicity, transmission category, and region of residence. In addition to the two main age groups mentioned above, breakdowns are also provided for the following two- and three-year age ranges: 13-14, 15-17, 18-19, 20-22, and 23-24.

Diagnoses of HIV Infection Among Adults Aged 50 Years and Older – United States and 6 Dependent Areas, 2014-2018 – This report focuses on HIV diagnoses, prevalence, and deaths among older adults, with breakdowns by year of diagnosis, gender, race/ethnicity, transmission category, and region of residence. Breakdowns are also provided for different age ranges among older adults: 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, and 85 or older.

Diagnoses of HIV Infection Among Adults and Adolescents in Metropolitan Statistical Areas – United States and Puerto Rico, 2018 – This report focuses on HIV diagnoses, prevalence, and deaths in metropolitan statistical areas (MSAs) – cities and surrounding areas with a population of 500,000 or more. Data are provided for specific MSAs, with breakdowns by gender, age, race/ethnicity, and transmission category.

Core Indicators for Monitoring the Ending the HIV Epidemic Initiative, Preliminary 2019 Data – This report presents 2019 preliminary data for the following three of the six core indicators used to monitor U.S. progress toward the goals of the Ending the HIV Epidemic (EHE) initiative: diagnoses of HIV infection, linkage to HIV medical care within one month after diagnosis, and PrEP coverage – the percentage of people with indications for PrEP who are prescribed PrEP. Breakdowns are provided by gender, age, race/ethnicity, and region of residence.

CDC also published its annual testing report for 2018: HIV Testing at CDC-Funded Sites: United States, Puerto Rico, and the U.S. Virgin Islands, 2018 – This report provides detailed information on the approximately 2.76 million CDC-funded HIV tests performed in 2018, with breakdowns by test setting (health care and non-health care settings, including subcategories); age, gender, race/ethnicity, and transmission category; and linkage to care. Data on HIV-positive test results and linkage to care rates are also provided for U.S. states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands.

CDC also published two fact sheets and infographics in recent weeks focusing on HIV diagnoses and the continuum of care:

AIDSVu Updates Its HIV Resources to Reflect Latest Data

Emory University has recently updated its AIDSVu interactive online mapping tool to incorporate the latest available HIV data, which focuses on the year 2018. AIDSVu includes extensive national, state, county, and city-level data, with demographic breakdowns for HIV prevalence, new HIV diagnoses, late HIV diagnoses, and HIV mortality. Information is also provided on the use of PrEP, racial/ethnic disparities in HIV prevalence, HIV testing, the continuum of care, social determinants of health, and sexually transmitted diseases. AIDSVu has also released updated ZIP code-level maps for nearly 50 cities across the U.S. and added HIV care continuum data for more than 35 of those cities. According to AIDSVu, this detailed local-level data allows users to see more clearly how the HIV epidemic impacts cities and neighborhoods at a fine geographic level, and may thereby aid in the development of targeted and effective policy and programmatic interventions.

Recent COVID-19 Reports

MMWR’s Continuing Coverage of COVID-19

CDC’s Morbidity and Mortality Weekly Report (MMWR) continues to provide extensive, ongoing coverage of COVID-19-related research – typically publishing several new reports each week and then archiving them on a page devoted to studies on COVID-19 and SARS-CoV-2 – the virus responsible for COVID-19. Reports published in recent weeks include the following:

**In the Next Issue of In Brief . . .**

Healthy People 2030 and YRBS Results

As this issue of In Brief went to press, the U.S. Department of Health and Human Services (HHS) and CDC announced the release of the following:

Healthy People 2030, which establishes 355 data-driven national objectives to improve health and well-being in the U.S. during the next decade. The objectives include several focusing specifically on HIV, viral hepatitis, and sexually transmitted diseases.
Results and Data from the 2019 Youth Risk Behavior Survey (YRBS), which monitors health behaviors that contribute markedly to the leading causes of death, disability, and social problems among youth and adults in the U.S. These include sexual behaviors that place people at risk for HIV and sexually transmitted diseases, as well as alcohol and other substance use.

We plan to summarize these new resources in greater depth in the early September issue of In Brief.