1242 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
1242 Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Public Health Rep. 2020 Sep/Oct;135(5):685-690. doi: 10.1177/0033354920943526. Epub 2020 Aug 7.
Racial/ethnic disparities in HIV diagnosis rates remain despite the availability of effective treatment and prevention tools in the United States. In 2019, President Trump announced the "Ending the HIV Epidemic: A Plan for America" (EHE) initiative to reduce new HIV infections in the United States at least 75% by 2025 and at least 90% by 2030. The objective of this study was to show the potential effect of the EHE initiative on racial/ethnic disparities in HIV diagnosis rates at the national level.
We used 2017 HIV diagnoses data from the Centers for Disease Control and Prevention National HIV Surveillance System. We developed a counterfactual scenario to determine changes in racial/ethnic disparities if the 2017 HIV diagnosis rates were reduced by 75% in the geographic regions targeted by the EHE initiative. We used 4 measures to calculate results: rate ratio, population-attributable proportion (PAP), Gini coefficient, and Index of Disparity.
The relative measures of racial/ethnic disparity decreased by 9%-21% in the EHE scenario compared with the 2017 HIV diagnoses data. The largest decrease was in the Hispanic/Latino:white rate ratio (-20.6%) and in the black:white rate ratio (-18.2%). The PAP measure decreased by 11.5%. The absolute versions of the Index of Disparity (unweighted and weighted) were approximately 50% lower in the EHE scenario than in the 2017 HIV diagnoses data.
EHE efforts could reduce but will not eliminate racial/ethnic disparities in HIV diagnosis rates. Efforts to address racial/ethnic disparities should continue, and innovative approaches, specifically those that focus on social and structural factors, should be developed and implemented for populations that are disproportionately affected by HIV in the United States.
尽管美国拥有有效的治疗和预防工具，但在艾滋病毒诊断率方面仍存在种族/民族差异。2019 年，特朗普总统宣布了“终结美国艾滋病疫情：美国计划”（EHE）倡议，旨在到 2025 年将美国新感染艾滋病毒的人数减少至少 75%，到 2030 年减少至少 90%。本研究的目的是展示 EHE 倡议对全国范围内艾滋病毒诊断率的种族/民族差异的潜在影响。
我们使用了疾病控制与预防中心国家艾滋病毒监测系统 2017 年艾滋病毒诊断数据。我们制定了一个反事实方案，以确定如果 EHE 倡议所针对的地理区域 2017 年艾滋病毒诊断率降低 75%，种族/民族差异会发生怎样的变化。我们使用了 4 项措施来计算结果：比率比、人群归因比例（PAP）、基尼系数和差异指数。
与 2017 年艾滋病毒诊断数据相比，EHE 方案中的种族/民族差异的相对衡量标准降低了 9%-21%。最大的降幅出现在西班牙裔/拉丁裔与白人的比率比（-20.6%）和黑人与白人的比率比（-18.2%）。PAP 衡量标准下降了 11.5%。EHE 方案中的差异指数（未加权和加权）的绝对值比 2017 年艾滋病毒诊断数据低约 50%。
EHE 的努力可以减少但不能消除艾滋病毒诊断率方面的种族/民族差异。应该继续努力解决种族/民族差异问题，并为在美国受艾滋病毒影响不成比例的人群开发和实施创新方法，特别是那些专注于社会和结构性因素的方法。
