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Background: Although a large proportion of HIV diagnoses in Western Europe occur in African-born persons, analyses of US HIV surveillance data do not routinely assess the proportion of diagnoses occurring in African-born US residents.
Objective:
To determine the percentage of newly reported HIV diagnoses occurring in African-born persons in selected areas of the United States with large African-born immigrant populations.
Methods:
We collated and analyzed aggregate data on persons diagnosed with HIV in 2003–2004 and reported to HIV surveillance units in the states of California, Georgia, Massachusetts, Minnesota, and New Jersey and in King County, Washington; New York City; and the portion of Virginia included in the Washington, DC, metropolitan area.
Results:
African-born persons accounted for 0.6% of the population and 3.8% of HIV diagnoses in participating areas (HIV diagnoses range: 1%–20%). Across all areas, up to 41% of diagnoses in women (mean: 8.4%, range: 4%–41%) and up to 50% of diagnoses in blacks (mean: 8.0%, range: 2%–50%) occurred among African-born individuals.
Conclusions:
In some areas, classifying HIV cases among foreignborn blacks as occurring in African Americans dramatically alters the epidemiological picture of HIV. Country of birth should be consistently included in local and national analyses of HIV surveillance data.
Key Words:
HIV, AIDS, foreign born, Africa, epidemiology, immigration ( J Acquir Immune Defic Syndr 2008;49:102–106)
INTRODUCTION
Sub-Saharan Africa accounts for roughly 10% of the world’s population but in 2005 was home to approximately 65% of the estimated 4.1 million persons newly infected with HIV worldwide.
2
4,5 Although the national HIV/AIDS reporting form includes country of birth, collection and reporting of these data vary,
6–8 and recent CDC analyses of country of origin data have focused exclusively on foreignborn Hispanics.
1 In 2004, more than 25% of all HIV diagnoses in Western Europe occurred among African immigrants. The number of African-born persons residing in the United States increased by 130% from 1990 to 2000,3 but little is known about how much cases among African-born persons contribute to the US epidemic, and few prevention activities are specifically designed for that population. The US immigration law requires persons applying for lawful permanent residence (LPR) to test HIV negative as part of a mandatory medical examination. Waivers may be granted to HIV-positive individuals seeking LPR, who otherwise qualify as refugees or who meet other waiver criteria. Temporary workers, students, and visitors are not subject to mandatory HIV testing but are generally denied entry into the United States if they declare a positive HIV status, with a few exceptions. This ban has been in place since 1987 and was strengthened when it became law in 1993. Those individuals seeking refugee or asylum status in the United States are not tested unless they apply to become LPR, at which time they must undergo a medical examination that includes an HIV test.In the 1980s and early 1990s, US HIV/AIDS surveillance guidelines included an exposure category for persons born in HIV-endemic countries where the predominant means of transmission was heterosexual contact. In 1994, the Centers for Disease Control and Prevention (CDC) discontinued its use with the goal of making exposure categories more consistently focused on specific risk behaviors.
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