HIV Infection in Minority Populations

Overview

According to CDC

• As of December 2002, African Americans and Hispanics represented 57 percent of males living with AIDS and 78 percent of those in females.
• As of December 2002, 59 percent of all women reported with AIDS are African American and 19 percent are Hispanic.
• African-American children represent almost 59 percent of all pediatric AIDS cases.
• Of the 92 pediatric AIDS cases reported in 2002, 82 (89 percent) were in African Americans and Hispanics.
• AIDS is the leading cause of death among African-American men ages 25-44.

NIAID Research on HIV Infection and AIDS

NIAID supports scientific research at universities, medical schools, hospitals, and research institutions, both in the United States and abroad, aimed at preventing, diagnosing, and treating

HIV infection, AIDS, and other infectious diseases as well as allergic and other immune system disorders.

NIAID's AIDS research agenda includes conducting clinical trials that address the specific needs and concerns of minority populations, ensuring that minority patients have access to all clinical trials and to the latest information on AIDS treatment and prevention. In addition, NIAID's Office of Special Populations Research and Training encourages research aimed at improving the health of minority populations and also works to increase the effectiveness of outreach and education programs.

Through its Office of Communications and Public Liaison and the Dale and Betty Bumpers Vaccine Research Center, NIAID works with community-based organizations to disseminate information about HIV infection, AIDS, and NIAID research activities, especially HIV vaccine development, to minority communities.

Clinical Research

• Adult AIDS Clinical Trials Group (AACTG)

• Pediatric AIDS Clinical Trials Group (PACTG)

• Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA)

• HIV Prevention Trials Network (HPTN)

• HIV Vaccine Trials Network (HVTN)

• Acute Infection and Early Disease Research Program (AIEDRP)

• Division of Intramural Research Clinical Program

• Research Centers in Minority Institutions

• AIDS Clinical Trials Infrastructures in Minority Institutions

Together, these programs represent the largest AIDS treatment and prevention initiative in the world. Recruiting minorities into clinical trials is a priority for NIAID to ensure that research results will apply to all populations affected by HIV. With the epidemic disproportionately affecting minority communities, inclusion of these populations is particularly urgent. The AACTG investigates therapeutic interventions for HIV infection, AIDS, and complications of HIV-associated immune deficiency in adults. ACTG sites receive additional funding from the National Institute on Drug Abuse (NIDA) to increase participation of injection drug users, who are also hard-hit by the AIDS epidemic.

The PACTG evaluates clinical interventions for treating HIV infection and HIV-associated illnesses in neonates, infants, children, and adolescents. Both the PACTG and the HPTN are researching approaches to interrupt mother-to-infant transmission in pregnant women. In 2003, 7,699 and 2,984 participants were enrolled in AACTG and PACTG studies, respectively. In the AACTG, 29 percent were African American, 18 percent Hispanic, 2 percent Asian/Pacific Islander, and less than one percent Native American. In the PACTG, 57 percent were African American, 28 percent Hispanic, and less than 1 percent Asian/Pacific Islander or Native American.

The CPCRA is a network of community-based health centers and clinics that support clinical research in community settings. The network conducts large comparative studies that examine how to use available therapies more effectively as well as the long term consequences of different treatments. Currently, CPCRA trials are under way in 17 cities at 18 units. In 2003, 3,513 people participated in CPCRA studies. Of those, 46 percent were African American, 16 percent Hispanic, and less than 1 percent Native American or Asian/Pacific Islander.

NIAID also supports clinical research on vaccine and non-vaccine strategies to prevent HIV infection. Vaccine studies are carried out through the HVTN, and non-vaccine prevention studies are conducted by the HPTN. The HVTN is a global network of clinical sites that evaluate preventive HIV vaccine in all phases of clinical trials. They allow for studies that examine differences in HIV diversity and genetic background, all of which may prove crucial to developing an effective vaccine for use around the world. Through close collaborations and education outreach programs with communities where vaccines will be tested, the HVTN hopes to enroll a diversified population in its clinical trials. This will ensure access and representation of populations most affected by and vulnerable to HIV spread.

The HPTN is a global multicenter network dedicated to non-vaccine biomedical and behavioral interventions. The primary areas of research of the HPTN include mircrobicides, sexually transmitted infection prevention and treatment, behavioral and barrier interventions, antiretroviral drugs, interventions related to drug abuse, and modalities to decrease mother-to-infant transmission. They have directed their educational outreach efforts to minority communities working to increase trial volunteerism.

The HVTN and HPTN opened in 2000 and have since enrolled thousands of study participants. In FY 2003, 962 and 15,389 people participated in the HVTN and HPTN, respectively. Of those in the HVTN, 15 percent were African American, 32 percent Hispanic, 1.2 percent Asian/Pacific Islander and less than one percent Native American. In the HPTN, 57 percent of participants were African American, 6 percent Hispanic, 11 percent Asian/Pacific Islander and less than one percent Native American.

In addition, the Research Centers in Minority Institutions and the AIDS Clinical Trials Infrastructures in Minority Institutions are major programs to enhance basic and clinical HIV research performed at minority institutions.

Epidemiologic Research

Similar populations of women are the focus of the WIHS, which NIAID established. The Institute awarded funds to six U.S. sites in 1993 to investigate primarily the impact of HIV infection on women. Several other NIH institutes also collaborate on WIHS and provide funds for various components. They include NIDA, National Cancer Institute, National Institute of Child Health and Human Development, and National Institute of Dental and Craniofacial Research.

Active community involvement through WIHS sites and the WIHS National Community Advisory Board helps encourage minority women to participate in the studies. More than 80 percent of the women currently enrolled in WIHS are from minority populations.

In the United States, the Multicenter AIDS Cohort Study (MACS) and WIHS are the two largest observational studies of HIV/AIDS in homosexual or bisexual men and in women, respectively. These studies have made major contributions to understanding how HIV is spread, how the disease progresses, and how it can best be treated. Over the past year, these studies expanded their enrollment to increase the size of the study groups by 60 percent and increase the number of minority participants. The enlarged groups will focus on contemporary questions regarding HIV infection and treatment.

More Information

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NIAID is a component of the National Institutes of Health (NIH), which is an agency of the Department of Health and Human Services. NIAID supports basic and applied research to prevent, diagnose, and treat infectious and immune-mediated illnesses, including HIV/AIDS and other sexually transmitted diseases, illness from potential agents of bioterrorism, tuberculosis, malaria, autoimmune disorders, asthma and allergies.

News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov.

Prepared by:
Office of Communications and Public Liaison
National Institute of Allergy and Infectious Diseases
National Institutes of Health
Bethesda, MD 20892

Department of Health and Human Services

National Institutes of Health (NIH) Bethesda, Maryland 20892

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