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Heterosexual Black people are twenty times more likely to be diagnosed with HIV than heterosexual White people.

The rates of HIV among individuals who practice homosexual sex are well-studied. However, there are limited studies on the prevalence of HIV among heterosexual individuals, which this study aimed to address. In this study, the prevalence of HIV between races and genders was shown.

Data was gathered from four publicly available national surveys, namely: the National Health and Nutrition Examination Survey (NHANES), the National Survey of Family Growth (NSFG), the General Social Survey (GSS), and the American Community Survey (ACS). Heterosexual activity was defined for males as having had sex with women exclusively for the past 12 months; for women, it was defined as having had sex with men within exclusively or with men or women in the past 12 months. The study focuses on the associations between race, ethnicity, and gender and HIV prevalence rates in heterosexual individuals. Data was analyzed through four logistic regression models.

The results show that among heterosexually active men, HIV diagnosis was highest among Black men (16.16/100,000) and lowest among White men (0.76/100,000). The disparity rate ratio between these two groups was calculated as 21.28, which meant Black men were 20 times more likely to be diagnosed with HIV than their White counterparts. This disparity was noted to be most pronounced in the Midwest region of the United States.

Among heterosexually active women, the HIV diagnosis rates were highest among  Black women (33.49/100,000) and lowest among White women (1.71/100,000), with a disparity rate ratio of 19.55. HIV diagnosis rates were highest for these two groups in the Southern region of the United States.

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Overall, heterosexually active women were found to have HIV diagnosis rates that are twice those of heterosexual men. The proposed explanation for this is that women are more likely to be screened for HIV in the context of receiving reproductive healthcare services. Furthermore, receptive intercourse has been shown to transmit HIV more effectively than penetrative intercourse. Lastly, many infections among heterosexual women may be associated with male partners who also engage in homosexual intercourse and who are connected to these HIV transmission networks.

Based on race, Black ethnicity has 20 times higher HIV diagnosis rates than the White populace of heterosexually active adults. The proposed reason for the disparity in HIV diagnosis rates is that Black people have less durable viral suppression rates (36.1%) than the White populace (50.8%). The reasons for this include less likelihood of minority patients having a healthcare provider of the same race and ethnicity and lower health literacy among the Black populace which negatively impacts adherence to antiretroviral therapy. Additionally, structural racism, discrimination, and mistrust in the health system create barriers to the utilization of HIV services among the Black populace.

The disparities revealed in this study indicate the need for the government to focus at the federal level on educating the general populace about HIV transmission and prevention, as well as making preventive measures readily available to all races and ethnicities. In order to prevent the continuous climb of HIV cases in the United States, racial discrimination should not be a barrier to the procurement of preventive medication such as pre-exposure prophylaxis. 

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Martin, E. G., Ansari, B., Hart-Malloy, R., Smith, D. K., Delaney, K. P., Gift, T. L., . . . Rosenberg, E. S. (2021). Racial and ethnic disparities in HIV diagnoses among heterosexually active persons in the United States nationally and by state, 2018. PloS One, 16(9), e0257583. doi:10.1371/journal.pone.0257583