Racial/Ethnic Disparities Among Children with Diagnoses of Perinatal HIV Infection --- 34 States, 2004--2007

Racial/Ethnic Disparities Among Children with Diagnoses of Perinatal HIV Infection --- 34 States, 2004--2007
Weekly
February 5, 2010 / 59(04);97-101

Early in the epidemic of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in the United States, racial/ethnic disparities were observed in the diagnoses of AIDS among adults and children (1). Since the early 1990s, the annual number of diagnoses of perinatally acquired AIDS and HIV infection has declined by approximately 90% in the United States as a result of routine HIV screening of pregnant women and the availability of effective interventions to prevent transmission (2,3). To characterize the most recent trends in diagnoses of perinatal HIV infection by race/ethnicity, CDC analyzed national HIV surveillance data for the period 2004--2007 from 34 states. This report summarizes the results of those analyses, which indicated that, during 2004--2007, 85% of diagnoses of perinatal HIV infection were in blacks or African Americans (69%) or Hispanics or Latinos (16%). The average annual rate of diagnoses of perinatal HIV infection during 2004--2007 was 12.3 per 100,000 among blacks, 2.1 per 100,000 among Hispanics, and 0.5 per 100,000 among whites. However, from 2004 to 2007, the racial/ethnic disparity narrowed, as the annual rate of diagnoses of perinatal HIV infection for black children decreased from 14.8 to 10.2 per 100,000, and the rate for Hispanic children decreased from 2.9 to 1.7 per 100,000. To further reduce perinatal HIV transmission and racial/ethnic disparities, HIV-infected pregnant women, and particularly black and Hispanic women, should receive timely prenatal care, early antiretroviral treatment, and other recommended interventions.

HIV infection and AIDS are notifiable in all 50 states, the District of Columbia, and five U.S. territories. States have implemented HIV infection reporting over time, and national HIV surveillance with uniform reporting was not implemented fully until 2008.* CDC regards data from states with confidential, name-based HIV surveillance systems to be adequate for monitoring trends only if they have been reported for at least 4 years (2). For this analysis, HIV and AIDS diagnosis data for the period 2004--2007 (the latest data available) were obtained from the 34 states† that have had name-based reporting since at least December 2003. A diagnosis of perinatal HIV infection (definitive or presumptive) was defined in a child who 1) was born to a woman with HIV infection, 2) was aged <13 years, and 3) had met CDC's 2008 revised surveillance case definition for HIV infection in children (4). The number and percentage of diagnoses of perinatal HIV infection during 2004--2007 were calculated by year of diagnosis and stratified by race/ethnicity. To calculate rates of HIV diagnoses per 100,000 infants aged ≤1 year in each racial/ethnic group, yearly population estimates were obtained for the 34 states from the U.S. Census Bureau. Population data for infants were used as a proxy for live births because race/ethnicity data were not available for live births in the 34 states in the same manner that race and ethnicity are reported in HIV surveillance. Trends in the annual rates of diagnosis of perinatal HIV infection were analyzed by the two-sided Cochran-Armitage test, with statistical significance at p<0.05. Rate ratios were calculated to compare rates for blacks, Hispanics, and children of other or multiple races with rates for whites.

During 2004--2007, the average annual overall rate of diagnoses of perinatal HIV infection was 2.7 per 100,000 infants aged ≤1 year in the 34 states (Table). The highest rates were among children who were black (12.3 per 100,000), followed by children who were Hispanic (2.0), of other or multiple races (1.6), and white (0.5). Using the rate among white children as the referent, the rate ratios for black and Hispanic children and children of other or multiple races were 23.1, 3.8, and 3.1, respectively. From 2004 to 2007, the annual rate of diagnoses of perinatal HIV infection for black children decreased from 14.8 to 10.2 per 100,000 (p = 0.003), and the rate for Hispanic children decreased from 2.9 to 1.7 per 100,000 (p = 0.04). The rates for white children and for children of other or multiple races did not change significantly (Figure 1).

During 2004--2007, among all children with diagnoses of perinatal HIV infection in the 34 states, 69% were black, 16% were Hispanic, 11% were white, and 4% were of other or multiple races. In contrast, 15% of infants in the 34 states aged ≤1 year were black, 22% were Hispanic, 56% were white, and 7% were of other or multiple races. The percentages of black and Hispanic females aged ≥13 years with HIV infection were similar to those for children with diagnoses of perinatal HIV infection; 67% were black, and 14% were Hispanic (Figure 2).

Reported by
MA Lampe, MPH, S Nesheim, MD, RL Shouse, MD, CB Borkowf, PhD, V Minasandram, K Little, PH Kilmarx, MD, S Whitmore, DrPh, A Taylor, MD, L Valleroy, PhD, Div of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC.

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Racial/Ethnic Disparities Among Children with Diagnoses of Perinatal HIV Infection --- 34 States, 2004--2007