Black women in city infected with HIV at higher rate than national average

African-American women in Baltimore and five other U.S. cities are becoming infected with HIV at a rate five times the national average for black women, and closer to the rates of some African countries, according to a new study.

Researchers at the Johns Hopkins University and around the country who made the findings suspected the rates were higher in these "hot spots" that have battled the epidemic for decades, but the numbers still came as a surprise in a field that tends to focus more on black and gay men.

"This is why it's important to remind people that this is going on right here in our hometown," said Dr. Charles Flexner, the principal investigator for the Baltimore part of the study and a clinical pharmacologist and infectious disease expert at Johns Hopkins.

"Given what is going on in Baltimore, it's hard to be too aggressive with this," he said. "It's a huge public health problem and the earlier we get it under control, the better off we're going to be."

The study was conducted with funding from the National Institutes of Health by researchers who are part of a national consortium called the HIV Prevention Trials Network, which looks for solutions for the epidemic. The data were presented Thursday at the 19th annual Conference on Retroviruses and Opportunistic Infections in Seattle.

Specifically, the researchers found in Baltimore; Atlanta; Newark, N.J.; New York City; Raleigh-Durham, N.C.; and Washington that the annual rate of infection was 24 per 10,000 black women. Nationally, the U.S. Centers for Disease Control and Prevention reports that black women become infected at a rate of 5 per 10,000.

The rate in the Congo is 28 per 10,000.

Baltimore declared HIV a public health emergency in 2002, but the numbers of infected people continue to rise, particularly among at-risk groups, including IV drug users and gay and bisexual men.

Dr. Patrick Chaulk became assistant commissioner for HIV and STD services in the Health Department about two months ago, after a city task force laid out a plan to cut new cases of HIV infection by 25 percent by 2015. Chaulk said the plan includes programs that target all at-risk groups.

Chaulk was charged with helping coordinate public dollars that amount to about $6 million to $7 million for outreach and education and $20 million for treatment annually.

He said much of the resources go to men because they make up two-thirds of new cases of HIV in the city. Nationally it's about three-quarters, according to the CDC. Just Thursday, the federal and city health organizations launched a new program called Testing Makes Us Strong that uses advertising to encourage gay and bisexual men to learn their HIV status.

But the city and partners at the state and in academic and nonprofit circles still haven't forgotten the women, Chaulk said. He pointed to programs aimed at drug users and sex workers, among others.

Other groups also are targeting women: The National Association for the Advancement of Colored People plans to hold a forum Saturday in Baltimore to mark the seventh annual National Women and Girls HIV/AIDS Awareness Day, a nationwide initiative coordinated by the U.S. Department of Health and Human Services' Office on Women's Health and aimed at raising awareness of the impact on women.

Every week, one city project sends a van with health workers to the Block, the city's red light district. The workers have built trust among the population there and not only test for HIV and other sexually transmitted diseases but offer reproductive health services, needle exchanges and assistance in securing health insurance and housing.

Through the program, the city reported testing 4,660 women last year for HIV, including 3,362 African-American women. About seven were found to be positive for infection and referred for treatment.

By the end of 2009, the city reported just over 13,000 city residents living with HIV/AIDS. That year, there were 505 new cases of HIV and 221 AIDS diagnoses, and 180 AIDS deaths.

"We have a lot of activities going on," Chaulk said. "We hope in the next couple of years to begin to see a decline in new cases."

The new study from Hopkins and other researchers underscores the urgency in addressing the problem, said Dr. William A. Blattner, chair of the City's Commission on HIV/AIDS Prevention and Treatment, which developed the citywide plan to reduce infections.

Blattner, also associate director of the Institute of Human Virology at the University of Maryland School of Medicine, said the city now has a four-pillar strategy: reducing new infections; increasing access to care and improving health outcomes; reducing HIV-related disparities and health inequalities; and achieving a more coordinated city response.

About the black women in particular, he said, "HIV continues to impact our most vulnerable and marginalized, in particular economically disadvantaged women whose risk is compounded by gender inequality and potential barriers to substance abuse interventions."

Reaching those women won't be easy, said Patrice Henry, a patient advocate at Johns Hopkins who was diagnosed with HIV in 1995.

Many women put off being tested because of the stigma still associated with HIV/AIDS, even if they know they've engaged in risky behavior, Henry said. They fear telling family and partners. Many don't have insurance, she said.

"Women also tend not to put their medical concerns first," she said. "They either think this won't happen to them or they still find it a sensitive issue to discuss. Some even know their status and procrastinate on treatment. I've spoken with women who were tested a year or two ago and never got into treatment."

Henry, a single 59-year-old living in Baltimore, tells her own story to women newly diagnosed with HIV who come to Hopkins for treatment. She shows them they don't have to be scared of dying, or living with the virus.

She tells them how she was a professional who never used drugs and was particular about men she dated. It was nearly impossible for her to believe her diagnosis.

By the time she learned, she already had developed AIDS and lost much of her body weight. She was given just a few months to live. Her mother was sitting in the city clinic's waiting room and her first thought was how she would tell her.

But Henry had the doctors explain her treatment to her and her mother. She stuck with the drug regimen, adopted a healthy diet and has been healthy for 17 years.

Now, she said, she hopes this new study will show how big the problem has become, and maybe persuade more women to get tested and treated.

"We as women need to look after ourselves," Henry said. "We need to take a step and get tested, and if we're involved in a relationship, we need to ask that person if he's been tested. If not, we need to say if you're in a relationship with me you need to get tested. Both of us need to know."

meredith.cohn@baltsun.com



HIV infection statistics



•About 25 percent of HIV infections around the nation occur in women

•67 percent of those are in black women

•Nationally, the annual rate of HIV infection is 5 per 10,000 black women

•In Baltimore and five other "hot spots," the rate of infection is 24 per 10,000 black women



Source: CDC, HIV Prevention Trials Network study