HIV Treatment As HIV Protection, Ctd


A reader writes:

I read your piece on providing antiretrovirals to at-risk groups and was struck by the exclusion of a significantly large group who literally share your pain: African Americans, especially African-American women. There’s a legitimate argument that sexually active African-American women should be prescribed antiretros by their physicians too. New infection estimates for 2010 by the CDC put that group in about the same position as Hispanic men who engage in sex with other men [see above]. The infection rate for black women is 20 times that of white women. African-Americans are 14% of the US population and make up 44% of all current people living with HIV and 44% of all new infections (pdf). As with other social, medical, and economic ills, African-Americans are being hit the hardest.

My reader is right. I didn’t mean to exclude African-American women, for whom this could be a godsend. Another looks abroad:

The study demonstrating prophylactic effects of HIV medications is unquestionable good news, but your response was a bit off-putting. It’s very true that “AIDS and HIV are no longer terrifying for young gay men”, and that’s fantastic, but about 68% of all HIV cases are in Sub-Saharan Africa (pdf). Prevalence in adults is as high as 30% in places like Swaziland and Botswana – is everyone a gay man there? I thought relegating HIV as a “gay” disease was a thing of the past.

I was discussing the US and, as the graph above shows, gay men are still the likeliest group to get infected. But yes, prophylaxis in those countries could be part of a multi-pronged HIV prevention campaign. Just because you address one sub-group doesn’t mean you are actively excluding any other.