Free Essay

Family Assessent

In: Other Topics

Submitted By gmrehab1
Words 5456
Pages 22
Racial Disparity in U.S. Diagnoses of Acquired
Immune Deficiency Syndrome, 2000 –2009
Qian An, MS, Joseph Prejean, PhD, H. Irene Hall, PhD
This activity is available for CME credit. See page A3 for information.

Background: Increased attention has been focused on health disparities among racial/ethnic groups in the U.S.

Purpose: To assess the extent of progress toward meeting the targets of Healthy People 2010 objectives and eliminating disparities.
Methods: All diagnoses of AIDS during 2000 –2009 among people aged Ն13 years in the 50 states and District of Columbia, reported to national HIV surveillance through June 2010, together with census population data were used in this analysis (conducted in March 2011). This study assesses the trend in racial/ethnic disparities in rates of AIDS diagnoses both between particular groups using rate difference (RD) and rate ratio (RR) and across the entire range of racial/ethnic subgroups using three summary measures of disparity: between-group variance (BGV); Theil index (TI); and mean log deviation (MLD).

Results: The overall racial/ethnic disparity, black–white disparity, and Hispanic–white disparity in rates of AIDS diagnoses decreased for those aged 25– 64 years from 2000 to 2009. The black–white and Hispanic–white disparity in rates of AIDS diagnoses also decreased among men aged Ն65 years; however, the black–white disparity increased among young men aged 13–24 years (BGV: pϽ0.001, black–white RD: pϽ0.01) from 2000 to 2009.
Conclusions: Findings indicate overall decreases in racial/ethnic disparities in AIDS diagnoses except in young men, particularly young black men aged 13–24 years where the burden of AIDS is increasing. HIV testing, prevention, treatment and policy-making should be a priority for this group.
(Am J Prev Med 2012;43(5):461–466) Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine


uman immunodefıciency virus disproportionately affects communities of color, particularly blacks/African Americans (blacks) and Hispanics/
Latinos (Hispanics). In 2009, blacks and Hispanics comprised about 12% and 16% of the U.S. population, but comprised about 44% and 20% of estimated new infections.1 A goal of Healthy People 2010 is to eliminate health disparities among subgroups of the U.S. population.2
Reducing racial and ethnic disparities in HIV infections has been an overarching national goal of the CDC’s HIV prevention strategic plan since 2001.3,4 The 2001 CDC plan provided a valuable guide for HIV prevention, care, and treatment efforts in both the private and public sectors for the last decade. Using AIDS diagnosis rates, it is possible to assess the racial/ethnic disparity change in a decade in the
From the Division of HIV/AIDS Prevention, National Center for HIV/
AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia
Address correspondence to: Qian An, MS, CDC, 1600 Clifton Rd NE,
Mailstop E-47, Atlanta GA 30333. E-mail:

U.S. The present study assesses the trend in racial/ethnic disparities in rates of new diagnoses of AIDS for 50 states and the District of Columbia from 2000 to 2009 by comparing rates for blacks versus whites, and Hispanics versus whites, and across the range of race/ethnicity subgroups.
Previous studies of racial disparities in HIV diagnoses only focused on disparities between two particular groups or two particular time points using pair-wise measures such as rate ratio or rate difference.5–7 To monitor disparities in rates of AIDS diagnosis in the U.S., the current study adopts and extends the framework proposed by Harper and Lynch,8 who systematically reviewed a variety of measures of health disparity and provided recommendations for choosing measures that can be used to monitor health disparities in cancer-related health outcomes.9 –11 Given the increased attention of prevention and treatment efforts to reduce HIV disparities among racial/ethnic groups in the U.S., it is hypothesized that the racial disparity in rates of AIDS diagnoses has decreased in the past decade, particularly the black– white disparity and the Hispanic–white disparity.

Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine

Am J Prev Med 2012;43(5):461– 466 461

An et al / Am J Prev Med 2012;43(5):461– 466


In 1982, the CDC implemented surveillance for what would later be identifıed as AIDS, although it was not clearly defıned at the time and went through several case defınitions in the early years.
All diagnoses of AIDS (defıned as cases with a CD4ϩ T-lymphocyte count per microliter of Ͻ200 or CD4ϩ T-lymphocyte percentage of total lymphocytes of Ͻ14, or the presence of an opportunistic illness) during 2000 through 2009 among individuals aged
Ն13 years residing in the 50 states and District of Columbia reported to national HIV surveillance through June 2010 were included in this analysis (conducted in March 2011) and were adjusted for reporting delay (time lag between the date of a case diagnosis and the date a case was reported to the national surveillance system).12 Population denominators for the calculation of rates were based on intercensal estimates for 2000 –2009 obtained from the U.S. Census Bureau.13 Rates of AIDS diagnoses were calculated for seven race/ethnicity groups: American Indian/
Alaska Native; Asian; black/African American; Hispanic/Latino
(which includes individuals of any race); Native Hawaiian/other
Pacifıc Islander; white; and multiple race (individuals who report more than one race).

Measures of Health Disparity
Three summary measures of health disparity (Theil index, mean log deviation and between-group variance) suitable for nominal groups were chosen to assess the trend of disparity across the entire range of racial/ethnic subgroups.8,9 Because blacks and Hispanics have been affected disproportionately by HIV compared to whites, pair-wise measures of health disparity (rate ratio and rate difference) were included to quantify trends in black–white and Hispanic– white disparities. Pair-wise comparison was not conducted for other racial/ethnic groups because the rates of AIDS diagnoses in those groups were unstable and results might be unreliable.
The three summary measures quantify disparities across seven racial/ethnic subgroups and factor in both the AIDS diagnosis rate and the population size of each racial/ethnic subgroup, both of which change over time and affect the overall disparity. Therefore, these summary measures are more sensitive in monitoring disparities over time than pair-wise measures.8,11 Moreover, both absolute measures and relative measures were included simultaneously to assess changes in absolute and relative disease burden because using only one type of measure could generate misleading results.
The Theil index (TI) and mean log deviation (MLD) are summary measures of relative disparity. They summarize the disproportional impact of a disease, using the rate ratio relative to the population average, weighted by population size. Given yj as the rate of health in group j and ␮ as the total population rate of health, then rj ϭ yj ␮ is the ratio of the rate of health in group j relative to that of the total population. For grouped data, TI can be calculated as TI ϭ ͚pjrj lnrj and MLD ϭ ͚pj ͓Ϫ j͔, where pj is the lnr proportion of the population in group j.8, 9 Both are positive numbers, where higher values represent more disparity.
Between-group variance (BGV) is a summary measure of absolute disparity. It summarizes the squared differences in group rates from the population average and is also weighted by population size.8 Using notations defıned previously, BGV is calculated as
BGV ϭ ͚pj ͑yj Ϫ ␮͒2 . The BGV is a positive number, with higher values representing more disparity.


Rate ratio (RR) is a relative measure of disparity between two groups. Using white as the reference group, RR is calculated as
RR ϭ yj yw , where yj is the rate for group of interest and yw is the rate for the white population. Rate difference (RD) is an absolute measure of the simple arithmetic difference between two groups and is calculated as RD ϭ yj Ϫ yw.


Data Analysis
For each year from 2000 to 2009, the race/ethnicity-specifıc estimated numbers of AIDS diagnoses and population estimates among people aged Ն13 years were calculated. The race/ethnicityspecifıc rates of AIDS diagnoses were calculated per 100,000 people overall and for gender groups and age groups (13–24 years,
25– 44 years, 45– 64 years, and Ն65 years). The TIs, MLDs, BGVs, black–white RRs, black–white RDs, Hispanic–white RRs, and
Hispanic–white RDs were calculated. All measures were logtransformed to satisfy the assumptions for linear regression.
Linear regressions were conducted (GLM procedure, SAS 9.2) with each log-transformed measure of health disparity as the dependent variable, year of diagnosis as the independent variable to test the signifıcance of the trend and to estimate the annual percentage change. The signifıcance of a trend was assessed at the 0.05 level. The estimated annual percentage change (EAPC) was calculated by taking the exponentiation of the parameter estimate for year of diagnosis. The 95% CI for EAPC was estimated based on a t-distribution with 8 degrees of freedom.

For 2000 to 2009, there were 354,300 diagnosed AIDS cases reported to the CDC from 50 states and the District of Columbia. After adjusting for reporting delay, the total number of estimated AIDS diagnoses from 2000 to 2009 was 377,198.
Overall, all summary measures of health disparity suggest a signifıcant decreasing trend in racial disparity in the rates of AIDS diagnoses from 2000 to 2009 (pϽ0.01). The
EAPC was Ϫ1.3 (95% CIϭϪ1.9, Ϫ0.7) for TI and MLD and was Ϫ7.5 (95% CIϭϪ8.9, Ϫ6.1) for BGV (Table 1).
The black–white disparity and Hispanic–white disparity in the rates of AIDS diagnoses also decreased signifıcantly
(pϽ0.01). The EAPC was Ϫ1.0 (95% CIϭϪ1.8, Ϫ0.2) for black–white RR; Ϫ3.9 (95% CIϭϪ4.7, Ϫ3.1) for black– white RD; 1.7 (95% CIϭϪ2.5, Ϫ0.9) for Hispanic–white RR; and Ϫ5.1 (95% CIϭϪ5.9, Ϫ4.4) for Hispanic–white RD.
Among men/boys, the overall racial/ethnic disparity, black–white disparity and Hispanic–white disparity in the rates of AIDS diagnoses decreased from 2000 to 2009
(pՅ0.01; Appendix A, available online at www.ajpmonline. org). The EAPC was Ϫ1.6 (95% CIϭϪ2.4, Ϫ0.8) for TI;
Ϫ1.5 (95% CIϭϪ2.3, Ϫ0.7) for MLD; Ϫ8.0 (95% CIϭ
Ϫ9.5, Ϫ6.5) for BGV; Ϫ1.2 (95% CIϭϪ2.0, Ϫ0.3) for black–white RR; Ϫ4.2 (95% CIϭϪ5.0, Ϫ3.3) for black– white RD; Ϫ1.4 (95% CIϭϪ2.1, Ϫ0.8) for Hispanic–white
RR; and Ϫ5.0 (95% CIϭϪ5.7, Ϫ4.4) for Hispanic–white
RD (Table 2). Among women/girls, there was a

An et al / Am J Prev Med 2012;43(5):461– 466


Table 1. Measures of racial/ethnic disparity in estimated AIDS diagnosis rates and estimated annual percentage change, U.S., 2000Ϫ2009
Rates of AIDS diagnoses 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

EAPC (95% CI)


Summary indicators
Theil index (ϫ100)










49.9 Ϫ1.3 (Ϫ1.9, Ϫ0.7) Ͻ0.01

Mean log deviation










44.0 Ϫ1.3 (Ϫ1.9, Ϫ0.7) Ͻ0.01

Between-group variance 487.9 460.6 442.7 452.8 402.6 340.1 297.5 285.9 275.3 260.6 Ϫ7.5 (Ϫ8.9, Ϫ6.1) Ͻ0.01

Pair-wise comparison
rate ratio

10.0 Ϫ1.0 (Ϫ1.8, Ϫ0.2)











HispanicϪwhite rate ratio










3.4 Ϫ1.7 (Ϫ2.5, Ϫ0.9) Ͻ0.01

BlackϪwhite rate difference










49.7 Ϫ3.9 (Ϫ4.7, Ϫ3.1) Ͻ0.01

HispanicϪwhite rate difference










13.3 Ϫ5.1 (Ϫ5.9, Ϫ4.4) Ͻ0.01

Note: Race/ethnicity groups are mutually exclusive; Hispanics can be of any race. Estimates of AIDS diagnoses are adjusted for reporting delay, but not complete reporting. Rate is per 100,000 people.
EAPC, estimated annual percentage change

ing trend in overall racial/ethnic disparity (pՅ0.02), and in Hispanic–white disparity (pϽ0.01); in black–white disparity, the absolute black–white RD decreased signifıcantly (pϽ0.01) but not the black–white RR (pϭ0.13).
The EAPC was Ϫ0.7 (95% CIϭϪ1.2, Ϫ0.2) for TI; Ϫ0.9
(95% CIϭϪ1.6, Ϫ0.2) for MLD; and Ϫ6.8 (95%
CIϭϪ8.8, Ϫ4.7) for BGV; Ϫ0.8 (95% CIϭϪ1.9, 0.3) for black–white RR; Ϫ3.5 (95% CIϭϪ4.6, Ϫ2.5) for black–white RD; Ϫ2.6 (95% CIϭϪ4.3, Ϫ0.9) for
Hispanic–white RR; and Ϫ5.8 (95% CIϭϪ7.3, Ϫ4.2) for
Hispanic–white RD (Table 2).

Among those aged 13Ϫ24 years, the relative summary measures suggest no change in the overall racial/ethnic disparity in the rates of AIDS diagnoses (TI: pϭ0.90, and
MLD: pϭ0.97); however, the absolute summary measure,
BGV, suggests a signifıcant increasing trend in racial disparity from 2000 to 2009 (BGV: pϽ0.01), with an
EAPC of 7.8 (95% CIϭ5.4, 10.3; Appendix B, available online at Among all pair-wise measures, the black–white RD showed an increasing trend from 2000 to 2009 (pϽ0.01) with an EAPC of 3.7
(95% CIϭ2.5, 4.9), whereas the black–white RR

Table 2. Estimated annual percentage change for measures of racial/ethnic disparity in estimated AIDS diagnosis rates, U.S., 2000Ϫ2009


Aged 13Ϫ24 years

Aged 25Ϫ44 years

Aged 45Ϫ64 years

Aged Ն65 years

Measure of relative disparity
Ϫ1.6 (Ϫ2.4, Ϫ0.8) Ϫ0.7 (Ϫ1.2, Ϫ0.2)

0.1 (Ϫ0.8, 0.9)

Ϫ1.9 (Ϫ2.7, Ϫ1.0)

Ϫ2.1 (Ϫ2.5, Ϫ1.8) Ϫ2.5 (Ϫ3.7, Ϫ1.3)

Mean log deviation (ϫ100) Ϫ1.5 (Ϫ2.3, Ϫ0.7) Ϫ0.9 (Ϫ1.6, Ϫ0.2)

0 (Ϫ1.0, 1.0)

Ϫ1.9 (Ϫ2.8, Ϫ1.0)

Ϫ2.1 (Ϫ2.5, Ϫ1.8) Ϫ2.6 (Ϫ4.2, Ϫ0.9)

Theil index (ϫ100)

BlackϪwhite rate ratio

Ϫ1.2 (Ϫ2.0, Ϫ0.3) Ϫ0.8 (Ϫ1.9, 0.3)

0.6 (Ϫ0.9, 2,2)

Ϫ1.2 (Ϫ2.2, Ϫ0.2)

Ϫ2.4 (Ϫ3.0, Ϫ1.8) Ϫ3.1 (Ϫ5.0, Ϫ1.1)

HispanicϪwhite rate ratio

Ϫ1.4 (Ϫ2.1, Ϫ0.8) Ϫ2.6 (Ϫ4.3, Ϫ0.9)

Ϫ1.3 (Ϫ3.7, 1.2)

Ϫ1.5 (Ϫ2.6, Ϫ0.3)

Ϫ4.2 (Ϫ5.3, Ϫ3.2) Ϫ4.9 (Ϫ9.0, Ϫ0.7)

Ϫ8.0 (Ϫ9.5, Ϫ6.5) Ϫ6.8 (Ϫ8.8, Ϫ4.7)

7.8 (5.4, 10.3)

Measure of absolute disparity
Between-group variance

BlackϪwhite rate difference Ϫ4.2 (Ϫ5.0, Ϫ3.3) Ϫ3.5 (Ϫ4.6, Ϫ2.5)
HispanicϪwhite rate difference Ϫ5.0 (Ϫ5.7, Ϫ4.4) Ϫ5.8 (Ϫ7.3, Ϫ4.2)

Ϫ10.5 (Ϫ12.3, Ϫ8.7) Ϫ4.7 (Ϫ5.9, Ϫ3.5) Ϫ2.8 (Ϫ5.7, 0.2)

3.7 (2.5, 4.9)

Ϫ5.4 (Ϫ6.4, Ϫ4.4)

Ϫ2.6 (Ϫ3.3, Ϫ1.9) Ϫ1.5 (Ϫ3.0, 0.0)

1.4 (Ϫ1.0, 3.8)

Ϫ6.3 (Ϫ7.1, Ϫ5.5)

Ϫ5.5 (Ϫ6.5, Ϫ4.4) Ϫ3.9 (Ϫ7.9, 0.2)

Note: Race/ethnicity groups are mutually exclusive; Hispanics can be of any race. Estimates of AIDS diagnoses are adjusted for reporting delay, but not complete reporting. Rate is per 100,000 people.

November 2012


An et al / Am J Prev Med 2012;43(5):461– 466

(pϭ0.39); Hispanic–white RR (pϭ0.27); and Hispanic– white RD (pϭ0.20) showed no changes.
Among those aged 25Ϫ44 years, all summary measures and pair-wise measures suggest a decreasing trend in overall racial/ethnic disparity, black–white disparity and Hispanic–white disparity from 2000 to 2009
(pՅ0.02). The EAPC was Ϫ1.9 (95% CIϭϪ2.7, Ϫ1.0) for
TI; Ϫ1.9 (95% CIϭϪ2.8, Ϫ1.0) for MLD; Ϫ10.5 (95%
CIϭϪ12.3, Ϫ8.7) for BGV; Ϫ1.2 (95% CIϭϪ2.2, Ϫ0.2) for black–white RR; Ϫ5.4 (95% CIϭϪ6.4, Ϫ4.4) for black–white RD; Ϫ1.5 (95% CIϭϪ2.6, Ϫ0.3) for Hispanic– white RR; and Ϫ6.3 (95% CIϭϪ7.1, Ϫ5.5) for
Hispanic–white RD.
Among those aged 45Ϫ64 years, all summary measures and pair-wise measures also suggest a decreasing trend in the racial/ethnic disparity in the rates of AIDS diagnoses from 2000 to 2009 (pϽ0.01). The EAPC was
Ϫ2.1 (95% CIϭϪ2.5, Ϫ1.8) for TI and MLD; Ϫ4.7 (95%
CIϭϪ5.9, Ϫ3.5) for BGV; Ϫ2.4 (95% CIϭϪ3.0, Ϫ1.8) for black–white RR; Ϫ2.6 (95% CIϭϪ3.3, Ϫ1.9) for black–white RD; Ϫ4.2 (95% CIϭϪ5.3, Ϫ3.2) for Hispanic– white RR; and Ϫ5.5 (95% CIϭϪ6.5, Ϫ4.4) for
Hispanic–white RD. In the oldest age group, all relative measures suggest a decreasing trend in racial disparity in rates of AIDS diagnoses (pՅ0.03), while all absolute measures suggest no change (pϭ0.06) from 2000 to 2009.
The EAPC was Ϫ2.5 (95% CIϭϪ3.7, Ϫ1.3) for TI; Ϫ2.6
(95% CIϭϪ4.2, Ϫ0.9) for MLD; Ϫ3.1 (95% CIϭϪ5.0, Ϫ1.1) for black–white RR; and Ϫ4.9 (95% CIϭϪ9.0, Ϫ0.7) for
Hispanic–white RR.
To examine whether the racial disparity trend in the rates of AIDS diagnoses from 2000 to 2009 varied by region, the analyses were conducted by region also
(Northeast, Midwest, South, and West). Results showed a general decreasing trend in the overall racial/ethnic disparity, black–white disparity, and Hispanic–white disparity in all regions of the U.S. and an increasing trend in black–white disparity among those aged 13–24 years in all regions but west (data not shown).
To understand the disagreement in relative and absolute measures of racial disparity in rates of AIDS diagnoses during 2000 –2009 for those aged 13–24 years and those aged Ն65 years, a comparison was made of the race/ethnicity-specifıc rates of AIDS diagnoses for each age and gender group in 2000 and 2009. From 2000 to
2009, the rates of AIDS diagnoses increased by 38% in the group aged 13–24 years, decreased by 32% and 8% for those aged 25– 44 years and those aged 45– 64 years, respectively, and remained unchanged in the group aged
Ն65 years (Table 3). The increase in the rates of AIDS diagnoses among young people aged 13–24 years was attributable to the 90% increase among men/boys, from
4.1 per 100,000 in 2000 to 7.8 per 100,000 in 2009.

Among young men aged 13–24 years, the rates of AIDS diagnoses increased by 116% from 15.4 per 100,000 to
33.3 per 100,000 in blacks, by 35% from 6.3 per 100,000 to
8.5 per 100,000 in Hispanics, and by 50% from 1.2 per
100,000 to 1.8 per 100,000 in whites from 2000 to 2009.
For the group aged Ն65 years, although the overall rates of AIDS diagnoses remained unchanged, the rates of
AIDS diagnoses decreased in men from 3.8 per 100,000 in
2000 to 3.6 per 100,000 in 2009. Among the oldest men, the rates of AIDS diagnoses decreased from 26.1 to 21.3 per 100,000 (18.4%) in blacks and from 11.9 to 8.5 per
100,000 (28.6%) in Hispanics, but increased from 1.4 to
1.5 per 100,000 (7.1%) in whites from 2000 to 2009. In addition, to investigate the possibility that using standard age cut-points may have affected the results, a sensitivity analysis was conducted that demonstrated similar results when using fıner age strata by 5-year age groups (data not shown). Discussion
The results confırmed the hypotheses that from 2000 to
2009, the overall racial/ethnic disparity, black–white disparity, and Hispanic–white disparity in rates of AIDS diagnoses decreased in the U.S., with more pronounced decreasing trends among people aged 25– 64 years. The black–white and Hispanic–white disparity in rates of
AIDS diagnoses also decreased among men aged
Ն65 years; however, the black–white disparity increased signifıcantly among young men aged 13–24 years. To our knowledge, the current study is the fırst that comprehensively evaluates the racial/ethnic disparity trend in rates of AIDS diagnoses in the U.S. It is the fırst to apply summary measures, together with pair-wise measures of health disparity to comprehensively assess the racial/ethnic disparity trend in rates of AIDS diagnoses in a decade in the U.S.
These measures were chosen from a variety of health disparity measures8,9,14 –17 to assess changes in both absolute and relative measures. Because racial/ethnic groups are nominal, the three summary measures were considered the best for nominal groups.8 –11 Moreover, they are sensitive to both the sizes of population subgroups and the AIDS diagnosis rate of each racial/ethnic subgroup.8 –11 The results from using these measures were reliable and valid.
For the group aged 13–24 years, the increasing absolute disparity measures indicate that the racial disparity in rates of AIDS diagnoses increased during 2000 –2009.
The absolute increase and the percentage increase in rates of AIDS diagnoses were greater in black young men than white young men. Although the percentage increase was smaller in Hispanic young men than white young men, An et al / Am J Prev Med 2012;43(5):461– 466


Table 3. Estimated AIDS diagnosis rates for selected groups, U.S., 2000 and 2009
Age groups (years)

Non-Hispanic whites Hispanics





















































































































Note: Estimates of AIDS diagnoses are adjusted for reporting delay, but not complete reporting. Rate is per 100,000 people. Hispanics can be of any race.

the absolute increase was greater. As a result, the absolute difference between blacks and whites, and Hispanics and whites, increased from 2000 to 2009 among the group aged 13–24 years, and consequently there was an increase in the absolute summary measure of disparity, BGV. The results suggest that the racial disparity in rates of AIDS diagnoses increased signifıcantly in young men aged
13–24 years from 2000 to 2009, highlighting the increasing burden of HIV in young men, particularly black young men aged 13–24 years in the U.S., which is consistent with fındings from other studies.18,19
Among the groups aged 25– 44 years and 45– 64 years, the reason for the decreasing racial/ethnic disparity trend is that the overall rates of AIDS diagnoses decreased, and the rates decreased faster in blacks and Hispanics than in whites. Among the group aged Ն65 years, the decreasing black–white and Hispanic–white rate ratios indicate that the black–white and Hispanic–white racial disparity in rates of AIDS diagnoses decreased during 2000 –2009.
This was caused by the increasing rates in older white men, together with decreasing rates in black and Hispanic men in the same age group during 2000 –2009.
The disagreement between absolute and relative measures of racial disparity for those aged 13–24 years and
November 2012

those aged Ն65 years suggests that it is important to use the absolute and relative measures simultaneously when evaluating changes in racial disparity over time. When disease rates are increasing as in the group of those aged
13–24 years, a decreasing or stable relative disparity measure does not necessarily correspond to a reduction in the absolute disparity measure; therefore, it is not suffıcient to indicate any trend in the disparity between groups.
However, as shown by the declining disease rates in the black and Hispanic groups of those aged Ն65 years, a decrease in relative disparity measures does correspond to a reduction in the absolute disparity measures and is indicative of a decreasing trend in the disparity between groups.20 This analysis is affected by several limitations. First, the data represent people who have been diagnosed with
AIDS and were reported to the national HIV surveillance system. Studies indicate that the reporting of AIDS cases in most areas of the U.S. is more than 85% complete.21–24
If the percentage of undiagnosed or unreported cases were consistent across years, fındings from the present study should still hold. Additionally, race data were collected differently in 2000 –2002 versus post-2003. Race data collected in 2000 –2002 were mapped to the 2003


An et al / Am J Prev Med 2012;43(5):461– 466

categories, affecting a small number of cases in the Asian and Native Hawaiian/other Pacifıc Islander categories; however, the impact of these cases should be small.
The current study assessed the racial/ethnic disparity trends in rates of AIDS diagnoses. The time of progression from initial HIV infection to AIDS varies across individuals, depending on factors such as one’s health status, timing of entry into HIV care, antiretroviral use and adherence, and presence of other medical conditions.25 Therefore, the racial/ethnic disparity trend in
AIDS diagnoses is the combination of the racial/ethnic disparity trend in HIV infection, diagnosis, and access to care. Also, decreasing racial/ethnic disparity in rates of
AIDS diagnoses does not imply a low rate. Recent data show that HIV prevalence is still disproportionately high among blacks.26
Results from this analysis show that the racial/ethnic disparity in rates of AIDS diagnoses decreased in the U.S. from 2000 to 2009 except among young men aged
13–24 years, for whom racial/ethnic disparities increased signifıcantly. Among young men aged 13–24 years, rates of AIDS diagnoses more than doubled in blacks compared with smaller increases in whites and Hispanics from 2000 to 2009. Such disparities indicate priorities for
HIV testing, prevention, treatment, and policy-making.
The fındings and conclusions are those of the authors and do not necessarily represent the views of the CDC.
No fınancial disclosures were reported by the authors of this paper. References
1. Joseph P, Song R, Hernandez A, et al. Estimated HIV Incidence in the
U.S., 2006 –2009. PLoS ONE 2011;6(8):e17502. doi:10.1371/journal. pone.0017502. 2. DHHS. Healthy People 2010: understanding and improving health.
2nd ed. Washington DC: U.S. GPO, 2000. www.healthypeople. gov/Document/pdf/uih/2010uih.pdf. 3. CDC. A heightened national response to the HIV/AIDS crisis among
African Americans. Revised June 2007. resources/reports/pdf/heightenedresponse.pdf. 4. CDC. HIV prevention strategic plan through 2005. January 2001. 5. Drewette-Card JR, Landen GM. The disparity change score: a new methodology to examine health disparities in New Mexico. J Public
Health Manag Pract 2005;11(6):484 –92.
6. Hall HI, Byers RH, Ling Q, Espinoza L. Racial/ethnic and age disparities in HIV prevalence and disease progression among men who have sex with men in the U.S. Am J Public Health 2007;97(6):1060 – 6.
7. CDC. Disparities in diagnoses of HIV infection between blacks/African Americans and other racial/ethnic populations—37 states, 2005–
2008. Morb Mortal Wkly Rep 2011;60:94 – 8.

8. Harper S, Lynch J. Methods for measuring cancer disparities: using data relevant to Healthy People 2010 cancer-related objectives. Washington
DC: National Cancer Institute, 2006. disparities/measuring_disparities.pdf. 9. Harper S, Lynch J, Meersman CS, Breen N, Davis WW, Reichman EM.
An overview of methods for monitoring social disparities in cancer with an example using trends in lung cancer incidence by areasocioeconomic position and race-ethnicity, 1992–2004. Am J Epidemiol 2009;167(8):889 –99.
10. Harper S, Lynch J, Meersman CS, et al. Respond to “Measuring Social
Disparities in Health.” Am J Epidemiol 2009;167(8):905–7.
11. Harper S, Lynch J, Meersman CS, Breen N, Davis WW, Reichman CM.
Trends in area-socioeconomic and race-ethnic disparities in breast cancer incidence, stage at diagnosis, screening, mortality, and survival among women ages 50 years and over (1987–2005). Cancer Epidemiol
Biomarkers Prev 2009;18(1):121–31.
12. Green TA. Using surveillance data to monitor trends in the AIDS epidemic. Stat Med 1998;17:143–54.
13. U.S. Census Bureau. Population estimates: entire data set. July 1, 2009. 14. Pearcy NJ, Keppel GK. A summary measure of health disparity. Public
Health Rep 2002;117:273– 80.
15. Keppel KG, Pearcy JN, Klein RJ. Measuring progress in Healthy People
2010. Healthy People 2010. Stat Notes 2004:1–16.
16. Regidor E. Measures of health inequalities: part 1. J Epidemiol Community Health 2004;58:858 – 61.
17. Regidor E. Measures of health inequalities: part 2. J Epidemiol Community Health. 2004;58:900 –3.
18. CDC. Trends in HIV/AIDS diagnoses among men who have sex with men—33 states, 2001–2006. Morb Mortal Wkly Rep 57:681– 6.
19. Johnson SA, Hu X, Sharpe TT, Dean DH. Disparities in HIV/AIDS diagnoses among racial and ethnic minority youth. J Equity Health
2009;2(1):4 –17.
20. Hoover K, Bohm M, Keppel GK. Measuring disparities in the incidence of sexually transmitted diseases. Sex Transm Dis 2009;35(12S):
S40 –S44.
21. Hall HI, Song R, Gerstle JE III, Lee LM, on behalf of the HIV/AIDS
Reporting System Evaluation Group. Assessing the completeness of reporting of human immunodefıciency virus diagnoses in 2002–2003: capture-recapture methods. Am J Epidemiol 2007;164:391–7.
22. Schwarcz SK, Hsu LC, Parisi MK, Katz MH. The impact of the 1993
AIDS case defınition on the completeness and timeliness of AIDS surveillance. AIDS 1999;13:1109 –14.
23. Klevens RM, Fleming PL, Li J. The completeness, validity, and timeliness of AIDS surveillance data. Ann Epidemiol 2001;11:443–9.
24. Campsmith M, Rhodes P, Hall HI. Estimated prevalence of undiagnosed HIV infection in the U.S. at the end of 2006. Abstract #1036.
Presented at the 2009 Conference on Retroviruses and Opportunistic
Infections; Montreal, Canada, February 11, 2009.
25. CiChocki M. How long does it take for HIV to progress to AIDS? 26. CDC. HIV/AIDS Surveillance Report, 2009; Vol. 21. www.cdc. gov/hiv/surveillance/resources/reports/2009report/. Appendix
Supplementary data
Supplementary data associated with this article can be found, in the online version, at

Similar Documents

Free Essay

Shopping Habits

...her early 20s, he arranged a marriage to an eligible local bachelor. In response, she ran away from home and joined a Roman Catholic convent. “He wanted me to know only one man,” she says. “I wanted to know many people.” Her father didn’t speak to her for eight years. Outgoing and cheerful, Orejola often invokes a prayer – her favorite – to Jesus’s grandmother, subsequently sainted by the Catholic church. “I say, ‘Saint Anna, please bless me with pleasant surprises.' ” Typhoon Yolanda was not one of them. Orejola cut short a trip to Rome to check on the members of her cooperative here, mostly the children and grandchildren of original members, and to pay calls to her extended family. THE LORD TAKETH AWAY She arrives at the evacuation center where many of the cooperative families have taken shelter in what was the old parish hall. The adjacent church lies in ruins, its roof blown away and its wooden pews scattered and splintered. The parish members have dragged some of the battered pews to what remains of a concrete car port. They have salvaged, too, a mud-splattered lectern. A weather-beaten statue of Mary sits on an old footstool atop a makeshift altar hastily constructed of packing crates. “The Lord giveth, and the Lord taketh away,” the priest intones, as parishioners turn to greet Orejola. Children take her hand and gently bow as they raise it to their foreheads in a sign of...

Words: 480 - Pages: 2

Premium Essay

Media Critique

...COMPARATIVE ANALYSIS OF THE REPRESENTATION OF FAMILY IN THE TELEVISION SHOW WEEDS Name Instructor Introduction For some time now, different faculties on human psychology, sociology and cultural studies have been investigating the effect of media artifacts in influencing and dictating ideologies and perceptions in the societies that consume them. Contemporary findings indicate that media artifacts such as television shows, movies, and books, directly influence the behavior of individuals within their different social groups and determine the type of interpersonal relationships one forges with other people, relative to their role in their lives. In addition, media affect the expressions of social class and socio-economic stature through the encouragement of the consumer culture and individualism. This paper analyses the television series Weeds, seeking to highlight how the portrayal of a single-mother family mirrors the literature on single-parent families in terms of perceived structures, financial challenges, academic achievement of children and the emotional and psychological health as well as the challenges specifically affecting single mothers. Weeds is an eight-season television show depicting the character of Nancy, a recently widowed woman who struggles to a means of mitigating the growing financial problem she faces following the death of Judah, her husband. She eventually opts to expand small her marijuana retailing enterprise to make......

Words: 1830 - Pages: 8

Free Essay

Positive Influences of Disney Princess

...make bad choices and think that it’s ok whether it have to deal with sex, alcohol or drugs. By raising girls on the Disney princess movies, it gives girls a role model that is in a sense “perfect”. The princesses have been the same for 30 years and will stay the same for 30 more years. They are a role model that doesn’t change; there is no worry about them getting into abusing drugs or alcohol The Disney princesses teach girls the importance of family, friendship, acceptance and so much more. So why wouldn’t you want them to be a role model for your daughter? You have a guarantee that they won’t mess up like someone else could. A Disney princess shows the importance of family. In Beauty and the Beast we see Belle who trades her freedom to free her father and takes his place as the Beasts’ prisoner. By having Belle trade places with her father it shows that “Disney animated films contain strong messages about the importance of family relationships. Family members were often shown making sacrifices for one another, and putting their families’ well being before their own.” (Tanner 367) Even after Belle falls in love with the Beast, she leaves to go help her sick father. In Sleeping Beauty, Aurora’s mother and father give her up to the 3 fairies in order to protect her from Maleficents’ curse. For 16 years the fairies gave up magic so that they would be able to raise her in secret. In The Little Mermaid King Triton gives up his freedom for Ariel so that she wouldn’t become one......

Words: 1503 - Pages: 7

Premium Essay

Good Wives

...portion of it is hearsay; however, Ulrich did write two other books on tops similar to this one so she has a reputation for being very knowledgeable on this subject. The one and only positive way men (husbands) used women (wives) were as Deputy Husbands. A Deputy Husband would stand in the place of her husband in his absence or if he were unable to perform his duties. “Some wives were servile, some were shrews, others were respected companions who shared the authority of their spouses in the management of family affairs” (p. 38). In performing her husband’s duties, a wife not only gained the respect of her husband, but she also gained his trust as well. As a consort (“a consort tuned her life to her mate’s” (p. 9)), a wife who harmonized with her husband had spirituality and sexuality but one who did not brought unrest and sometimes wound up in the courts due to their actions. Husbands respected their wives’ domain as the center or the heart of the farm and the family, whereas, the wives were expected to respect the husband’s authority and manly duties. Another negative way men used women was for the purposes of procreation. But if...

Words: 756 - Pages: 4

Free Essay


...Single parent families Single parenting has become a more popular style in the last couple decades. Single parenting has become one of the most common nontraditional families. According to George, “Although there are exceptions, this state usually occurs for one the three reasons: the parent was never married, the parent had separated or divorced from the spouse, or the spouse has died” (George, 2009). Single parents usually experience higher level of stress due to financial situations, high and low relationships with their children in addition to parenting styles, and sometimes the lack of rest (George, 2009). Around 43% of children live within a single parent home that is at or below the national poverty level (George, 2009). Due to not being financially stable, some single parents are forced to live in low-income neighborhoods which result into poor schooling systems. More children are likely to drop out of school and to be raised in poverty. Consequently there are more like to be teen pregnancies. Around 60% of are raised by young single parents who are less likely to get married (Feldman, 2011). In addition to teenagers are more likely to raised their child without the help and support of the father, as a result most teenagers abandon their education and have to rely on minimum wage jobs for a source of income (Feldman, 2011). According to Feldman, “ The consequences of living in a single parent families depends on the financial condition of the family and, if......

Words: 630 - Pages: 3

Premium Essay

Me and My Family

...Analysis interpretation of ’Me and my Family’ “Me and my Family” is a short story from 1997. The narrator is a third-person limited narrator and is subjective because it conveys the thoughts, feelings, opinions of the father, Stew. So when the narrator is subjective, we only see the story from one side and therefore we cannot verify if the narrating is true. Beside Stew, we have Masha who is the wife of Stew and mother of Kitty. Kitty plays an important and great role in this short story. Apart from the family, we hear a bit from Norm (an acquaintance of the father) and other irrelevant people. Kitty has been living in South Carolina and is described as quiet, untactful and aggressive (p. 2, l. 25) by the narrator. When Kitty became a teenager, it has just gone downhill. She came out as lesbian when she was 16 (p. 2, l. 37) and that did not exactly help her relationship with her father. With downhill, the narrator describes; “He did not remember precisely when it had happened, but Kitty, his beautiful, happy little girl, turned into a glum, weird teenager that other kids picked on. She got skinny and ugly. ” (p. 2, l. 40). The quote illustrates one of the themes of the story that is the poor relationship between father and daughter and their quarrels, as can be seen on page 3, line 86: “He grabbed her and shook her, but he could not shake the conviction off her face.” However, this is from the father’s perspective. As mentioned before, we never get to hear Kitty’s side......

Words: 804 - Pages: 4

Premium Essay

Materialistic Society

...innovative products have plunged the modern consumer into decisions about products that were unavailable eighty years ago. Polartec jackets, snow boards, programmable VCRs, and antidepressants are among the many new and improved goods made possible by technical progress. Modern stores are filled with products previously unknown or unobtainable. Supermarkets stock kiwis from New Zealand, coffee from Guatemala, four types of tomatoes, endless breakfast cereals, and a vast array of packaged goods. Products offer the promise of personal choice, of tailoring activities to individual desires, and of expressing and creating personal identity. Our purchases are also how we take our place in society. Going to work, establishing a home, engaging in family and neighborhood activities, and enjoying leisure -- all the activities which secure membership in the modern world and its institutions -- require products for which we must pay. In traditional cultures,...

Words: 3335 - Pages: 14

Free Essay


...boy with him. He looked to be about three or four years old. The guy was holding up a sign saying “Food Please!!!! God forgive me for my sin!!” When my grandmother saw this she began to cry! She pulled her car over into the Churches Chicken parking lot. She told me to stay in the car then she opened her door and got out and begun walking over to the man. I couldn’t quite make out what they were saying to each other but I saw my grandmother smile and hand him something then walked back to the car. I asked what she said to him and she said she asked if she had somewhere to stay and he said yes but it wasn’t a very nice place. She gave him 50 dollars and her card and told him that if he called her she would work something out for him and his family to stay in...

Words: 669 - Pages: 3

Premium Essay

Edds Johnson

...kind of Teratogens. Having worked in the medical field, she was well aware of their negative effects and strived to avoid them. She was average height and weight for a woman, and having already given birth to both myself and my sister, Larissa, she was ready for her third. She had no previous mental or physical health problems worthy of note, either. She did, however, continue working until her third trimester during the pregnancy, where she took a leave of absence from working at the hospital to finish her pregnancy. Her job offered no real difficulties because she worked in the health field, so it was hardly an issue and in fact, was a boon to her pregnancy because of the excellent health benefits. She also exercised daily on the family treadmill to keep herself in shape before, during, and after her pregnancy. Daryl Johnson was also heavily involved during the pregnancy...

Words: 1609 - Pages: 7

Free Essay

Song of Solomon

...Throughout Song of Solomon, readers are treated to a vast array of experiences, which reflect Toni Morrison’s themes of bearing witness to the disturbed past of black people, exploring divisions within a family that has lived through that past, and chronicling personal quests to reconstruct splintered identity at the personal, family and community levels. To create the conscious experience that brings so much of Morrison’s work to life, she imbues Song of Solomon not only with vibrant, directly encountered realism, but also magical themes and experiences. Magical Realism—in essence—is a way of telling a story with two sides. One based on a so-called rational view of reality and the other on the acceptance of the supernatural as everyday reality. Song of Solomon features many instances of the image of flight as it plays a major role in the narrative. Flight signifies true life and the living of it, as well as a sense of freedom and release for the main characters in the book. Of all the characters in the novel, one seems the most affected and that persona is Milkman—someone whom embarks on a journey of self-discovery and discovers the true meaning of flight. Milkman experiences flight in many different ways—through song, imagery and literal experiences. The onus is on us, the reader, to distinguish what is “real” and what is pure mysticism. The first instance of Morrison's use of the image of flight is at the very beginning of the book. "At 3:00 p.m. on Wednesday the......

Words: 1599 - Pages: 7

Premium Essay

Family Project

...Family Health Assessment A health assessment is used by many individuals in understanding about their health status or lack of, as well as assisting them in making health-related decisions. Each family is very unique with different ways of life and perceptions about their health. Getting to know the family, structurally as well as functionally helps to identify health behaviors along with risk factors that may be helpful or harmful to the family. This is an extended family; consisting of grandma and grandpa, their oldest daughter who moved in two years ago, and her four children. LZA, grandma is 55, RAA, grandpa is 57, KMG, mother is 30, her daughters; KAG-8, MMG-6, RAG-3, and baby ZLG-1. This family had a very religious upbringing and is still very active in the Catholic Church, attending mass every Sunday. They strongly believe in the importance of family and religion. They value sentiments like compassion, respect and consideration of others. The family is at stage IV of the Duvall’s developmental stages of the family: (the oldest child in the household is eight) families with school-age children; children develop peer relations, and parents adjust to peer and school influences. This family’s home is situated in a nice quiet neighborhood, close to a park where the girls can play. KMG states that “very nice people live here, and we are going to live here forever.” Grandma rolled her eyes after hearing this. This is a......

Words: 1976 - Pages: 8

Premium Essay

Intersec of Religon and Lit saying that killing is no real pleasure in life. How lit illustrates and challenges gender roles: At the beginning of the play "A Doll's House," Nora is clearly shown as the silly housewife whose only concern is clothes, housekeeping, and caring for her 3 children while her husband Trovald is shown as the strong in-control husband who is the "man of the house." These are the gender roles we continuously see in societies as well as much of old literature since a woman's worth was equal to almost nothing back then. But throughout the play, we see that slowly, Nora's real stand in her house unravels. She is not the silly girl that is first portrayed to be. It is revealed to us that Nora's father did not give her the money for their family trip, but that she borrowed money as a loan from the man who was also Travold's classmate. Nora had to hide...

Words: 585 - Pages: 3

Free Essay


...Under the demographic segmentation, Perodua Alza can be segmented to customer income, family size, and age. Perodua Alza is mainly for average income potential buyer who needs an MPV to fit a big family members with low budget and monthly payment. Besides that, Perodua Alza also suitable for the customer with social lifestyle, such as, going out or in vacation with family members which is 5 until 7 person. No more regret or offense because have to stay while the others be on a holidays. Perodua Alza mainly bought by a customer in the middle age between 30 to 50 years old and married due to family size. Young people not very interested with Alza because they tend to choose a car which suit their wild, young and free personality such as ferrari Using a psycographic segmentation, Perodua targeting Alza to customer based on their attitudes, values and lifestyle. Potential customer who’s always hang out with friend also can be a target customer because their active lifestyle such as camping, tend to make them choose the convenient and more ample space car to fit all the members and stuff. . Family values also one of the main characteristic for customer to buy Perodua Alza especially for potential customer with big family and always spend their holiday at village mainly on big festival such as, Chinese New Year, Hari Raya, Christmas, Deepavali and so on. The purpose is perodua Alza can fit all the family members with comfortable and safety...

Words: 382 - Pages: 2

Free Essay

Things Falls Apart

...and broke the kola nut. Then threw one of the lobes on the ground for the ancestors. Okonkwo’s final feast is noted for its copious amounts of food – it’s almost like a wedding celebration. Though the feast is a show of gratitude, Okonkwo also emphasizes that the gathering is justified merely because “it is good for kinsmen to meet. At the feast, one man expresses surprise that Okonkwo has been so generous with his food and another praises Okonkwo’s devotion to the kinship bond. At the end of the feast, one of the elders speaks up and gives a warning to the younger generation. He fears for them because he feels the bonds of kinship are breaking, which allows Christianity to pollute their land and steal their men from their gods and their families. With that ominous note, he thanks Okonkwo for his generosity....

Words: 276 - Pages: 2

Free Essay

My Works

...My Story Hi! My name is LOIS S. BALIONG. Today, I’m going to tell you my vacation in the month March to April. I think everything changes. I thought that, when school is over (or its vacation) things will be fun. All we’re going to do is to follow schedules and chores, what our mother tell us to do. Here what happened the past few days? CHORES: What a boring thing to do. This is the part were I don’t like especially mother’s around. I know we must clean, because living in a messy place in uncomfortable! But in our house, chores never stop!!! I mean, my mother always work! You know no break! Sometimes I don’t like when my mother’s around, while we are working. If we make mistakes, she will shout at us. Sometimes she shouts at me in front of the carpenters who work in our little house. “Lois! Use your common sense! You must know how to work, for there will be the day that your father and I, will be gone in this world, and you don’t know how to work, what will become of you!” Uh!!! How many times did I hear that word, ‘work’, that is so embarrassing! I always murmur in working. I know its bad, but I can’t take it anymore. Can she please take a break? I hope that my mother will stop murmuring in one day! Just one day? You know what; I really feel it, truly, inside my heart that they don’t love me. Just like on April 13, 2009, my bigger sister told my mother to buy a NARNIA book, my mom nod. Then when I say to buy a Nancy Drew Book, she just ignores it. Well......

Words: 428 - Pages: 2