Background:
African-born individuals make up just 0.35% of the U.S. population, but may account for a disproportionate share of U.S. HIV/AIDS cases. Little information is available on HIV patterns among foreign-born populations in the U.S..


Objective:
To define the percentage of newly diagnosed cases of HIV among African-born persons in areas of the U.S. with large numbers of African immigrants.

Method:
We requested data on African-born persons with HIV from states containing the 16 U.S. metropolitan areas where African-born residents comprise greater than 0.5% of the population. Four states provided data for the following areas: California, Minnesota, King County, Washington (KC), and Virginia's portion of the Washington, DC metropolitan area (VA-DC).

Result:
Minnesota, KC, VA-DC and California reported 583, 763, 636, and 8,674 newly diagnosed HIV cases, respectively, in 2003-2004. In Minnesota, African-born cases represented 20% of all new HIV cases, 41% of cases among women, 15% of heterosexual cases, and 56% of cases with no identified risk (NIR). KC African-born cases accounted for 9% of new cases, 42% of female cases, 29% of heterosexual cases, and 46% of cases with NIR. In VA-DC, African-born cases accounted for 13% of new cases, 29% of cases among women, 31% of heterosexual cases, and 20% of NIR cases. African-born cases represented only 1% of new cases in California, including 5% of female cases, 4% of heterosexual cases, and 4% cases with NIR.

Conclusion:
In some areas of the U.S., African-born individuals account for a substantial percentage of newly diagnosed HIV cases, especially among heterosexuals and women. This epidemiologic pattern may be obscured if country of origin is not collected and used in routine analyses of surveillance data.

Implications:
Country or region of birth should be consistently included in local and national analyses of HIV surveillance data, particularly in conjunction with exposure category, sex, and race.