Disparities in HIV Prevalence in a Global Population in Urban United States

Background:  The contribution of the foreign-born to the US HIV epidemic has been recognized as substantial, and is predicted to grow as immigration to the US continues from regions with higher prevalence.  Disparities in prevalence have long been a signature of the domestic epidemic, yet the foreign-born are seldom included as a distinct group in such analyses. We seek to determine disparities in HIV prevalence in a global population undergoing HIV testing in Philadelphia.

Methods:  In Philadelphia’s city health centers rapid HIV testing is conducted in the walk-in clinics.  From all individuals undergoing testing between 2007 and 2011 data collected included demographics, risk behaviors and world region of origin.  To determine proportionality of representation by region, the proportion of the population tested was compared with the proportion of the cohort testing positive.  Data analyses were performed with SAS 9.0 (Cary, NC).

Results:  During the study period 14,216 individuals underwent testing.  A majority (76.2%) were US-born and 59% female.  The greatest HIV disparity was among Caribbean men who constituted 3.6% of the population tested and 11.4% of the HIV-positive.  All world regions showed a gender disparity with men overrepresented and women underrepresented among the HIV-positive except sub-Saharan Africans for whom both genders were overrepresented (1.7% of the total, 3.4% of the positive for men; 3% of the total, 4.5% of the positive for women).  For the US-born, there were no racial/ethnic disparities in HIV prevalence.

Conclusions:  Substantial disparities exist by gender and by world region of origin in this global population in Philadelphia.  The elimination of HIV disparities as mandated by the National HIV/AIDS Strategy is contingent upon the recognition of all disparities in our domestic epidemic, which increasingly includes the foreign-born.  Further study is needed to evaluate the social determinants of these disparities and develop successful strategies for their elimination.