From 2001 to 2007, in the 33 U.S. states we studied, an estimated 100,013 cases of HIV infection were eligible for analysis, based on the availability of country-of-birth information. Of these, 88.3% (88,293) were native-born and 11.7% (11,720) were foreign-born. There were significant declines (from 15,429 in 2001 to 13,189 in 2007) in annual HIV diagnoses among native-born black people (EAPC: −5.5%; 95% CI −5.9, −5.0); however, changes were small among foreign-born black people, with a 1.3% annual decrease (from 1,736 in 2001 to 1,595 in 2007; 95% CI −2.6, −0.1).
In , we present demographic characteristics and transmission categories by place of birth. Among females, a higher percentage of foreign-born black people were diagnosed with HIV infection than native-born black individuals (49.0% vs. 35.8%; p<0.001). The distribution of HIV diagnoses among black adults and adolescents was similar by place of birth and age. However, among people aged 13–19 and 20–29 years, native-born black individuals accounted for a higher percentage compared with foreign-born black people (4.9% vs. 2.0% and 23.6% vs. 19.8%, respectively; p<0.001); though among people aged 30–39 years, there was a higher percentage of HIV diagnoses in foreign-born black people than in native-born black individuals (34.4% vs. 28.5%; p<0.001).
Estimates of HIV diagnoses among black adults and adolescents, by place of birth, selected demographic characteristics, and transmission category, 33 U.S. states, 2001–2007a
The distribution of transmission categories differed by place of birth. From 2001 to 2007, the percentage of HIV diagnoses attributable to high-risk heterosexual contact was higher among foreign-born black people compared with native-born black people (74.7% vs. 43.0%). Among males, a higher percentage of foreign-born black people had an HIV diagnosis attributable to high-risk heterosexual contact than did native-born black individuals (57.2% vs. 22.6%; p<0.001) (). Compared with foreign-born black males, a higher percentage of native-born black males had an HIV diagnosis attributed to male-to-male sexual contact (54.6% vs. 33.2%; p<0.001), as well as combined male-to-male sexual contact and IDU (5.0% vs. 1.8%; p<0.001). HIV diagnoses attributable to high-risk heterosexual contact accounted for the highest percentages of HIV diagnoses for both native-born and foreign-born black females; however, the percentages were significantly higher among foreign-born black females (92.9% vs. 79.5%; p<0.001). HIV exposure through IDU was lower among foreign-born than native-born black individuals for both males (7.3% vs. 17.3%; p<0.001) and females (5.7% vs. 19.8%; p<0.001).
Comparing rates of HIV diagnosis in 2007 for adults aged ≥18 years, by place of birth, we found that foreign-born black people had a slightly higher HIV diagnosis rate (81.4 per 100,000) than native-born black people (78.9 per 100,000); however, differences were seen in rates by gender and U.S. or world region of birth. Native-born black males had the highest HIV diagnosis rate (115.0 per 100,000); however, the diagnosis rate for foreign-born black females (78.8 per 100,000) was nearly equal to that for foreign-born black males (84.2 per 100,000) and considerably higher than the rate for native-born black females (48.0 per 100,000).
From 2001 to 2007, most of the study group in the 33 states resided in the South (65.1% of native-born and 52.5% of foreign-born individuals) (). Higher percentages of foreign-born black people diagnosed with HIV infection resided in the Northeast, Midwest, and West compared with native-born black people, who were mostly concentrated in the South.
Comparing 2007 rates of HIV diagnosis for black adults aged ≥18 years by place of birth and region, we found the highest rates for native-born black people in the Northeast (114.6 per 100,000) and South (84.3 per 100,000) compared with foreign-born black people, for whom the highest rates were in the West (162.4 per 100,000) and Midwest (113.1 per 100,000). The highest diagnosis rates among native-born black people were in the Northeast (males: 169.3 per 100,000; females: 69.7 per 100,000) and South (males: 120.8 per 100,000; females: 53.2 per 100,000). We found differences among foreign-born black people, by region and gender. HIV diagnosis rates among foreign-born black females were highest in the West (209.6 per 100,000) and Midwest (153.1 per 100,000); however, rates among foreign-born black males were highest in the West (121.1 per 100,000) and South (105.0 per 100,000). HIV diagnosis rates among black females were higher for foreign-born compared with native-born individuals, regardless of region, except in the Northeast (69.7 per 100,000 vs. 49.5 per 100,000).
Of foreign-born black people diagnosed with HIV from 2001 to 2007, most were born in the Caribbean (54.1%) and Africa (41.5%) (). People born in South America accounted for 2.4% of those diagnosed, while people born in Europe, Asia, Central America, North America, and Oceania accounted for less than 1% each. By gender, males accounted for the majority (56.6%) of HIV diagnoses among black people born in the Caribbean; however, females accounted for most (57.4%) diagnoses among those born in Africa ().
Estimates of HIV diagnoses among black adults and adolescents born in the Caribbean and Africa, by selected demographic characteristics and transmission category, 33 U.S. states, 2001–2007a
HIV diagnoses occurred at a younger age among black people born in Africa compared with those born in the Caribbean. The majority of black people born in Africa were aged 30–39 years at HIV diagnosis; most of those born in the Caribbean were aged 40–49 years at diagnosis (41.4% and 30.8%, respectively) (). HIV transmission among both populations was mostly attributable to high-risk heterosexual contact, regardless of gender. Most of those who were born in the Caribbean were from Haiti (66.9%). Of the remaining Caribbean black people, 18.2% were from Jamaica, 6.3% from Trinidad and Tobago, 3.3% from the Bahamas, 1.4% from Barbados, and 3.8% from other areas of the Caribbean. HIV diagnoses were more equally distributed by country of birth among black people born in Africa (12.2%, Ethiopia; 10.5%, Kenya; 9.5%, Nigeria; 7.1%, Zimbabwe; 6.8%, Liberia; 6.8%, Zambia; 6.2%, South Africa; 6.1%, Ghana; 5.2%, Cameroon; and 29.7%, other areas of Africa) ().
Late diagnosis of HIV infection
Early diagnosis of HIV infection is important both for initiation of treatment, so that the infection will not progress to AIDS, and prevention of the spread of HIV to sexual or drug-use partners. From 2001 to 2006, the percentage of foreign-born black people diagnosed with AIDS within 12 months of HIV diagnosis, regardless of gender, was significantly higher than that of native-born black people (44.5% vs. 37.2%; p<0.001) (). Foreign-born black people aged 20–59 years were significantly more likely than their native-born counterparts to be diagnosed with AIDS within 12 months of HIV diagnosis. Adults aged 60 years and older had the greatest percentage of people with late HIV diagnoses, regardless of place of birth, and nearly equal percentages of native-born and foreign-born black people in this group had late diagnoses. Percentages of late HIV diagnoses were also significantly higher among foreign-born black people, regardless of transmission category, except among female injection drug users. Male injection drug users accounted for the greatest percentage of late diagnoses, regardless of place of birth ().
Estimates of black adults and adolescents with an AIDS diagnosis within 12 months of HIV diagnosis, by place of birth and selected characteristics, 33 U.S. states, 2001–2006a
Survival after an AIDS diagnosis
For the 50 states and the District of Columbia, we estimated that foreign-born black people were more likely than native-born black people to survive one year after an AIDS diagnosis (87.2% vs. 84.9%). When gender and age were considered, higher proportions of foreign-born black people who were female, aged 20–29 years, or aged ≥40 years were likely to survive one year after an AIDS diagnosis, compared with native-born black people. Higher proportions of foreign-born than native-born black people were likely to survive three years after an AIDS diagnosis, regardless of gender, age, and year of diagnosis (except for adolescents aged 13–19 years, for whom there was no difference). Of foreign-born black people diagnosed with AIDS from 1996 to 2003 in the 50 states and the District of Columbia, 81.7% survived three years after diagnosis, compared with 74.9% of native-born black people. All differences were statistically significant.