Why is the HIV prevalence rate for black women 18 times greater than the rate for white women?

BACKGROUND: The HIV prevalence rate (U.S., 2006) for black women is 1,122.4 per 100,000 and that for white women is 62.7 per 100,000. This rate for black women is nearly 18 times greater than that for white women. Why and what to do about it? OBJECTIVES: (1) Analyze the epidemiology of HIV transmission in the black community and establish the routes of transmission most responsible for maintaining this epidemic. (2) Document the estimated per-act risk for HIV transmission for each of the three major exposure routes for women: vaginal intercourse (VI), anal intercourse (AI), and injection drug use (IDU). METHODS: The medical literature was searched for scientific articles related to the above objectives. RESULTS: The reasons for the high HIV prevalence rate for black women are: (1) In HIV epicenters, multiple sex partners (VI and AI) and IDU fuel the epidemic that is largely driven by AI. (2) The high rates of sexually transmitted diseases in the young black community increase the risks for HIV transmission in VI and AI. (3) Unprotected receptive anal intercourse has a 5 times greater per-act risk for HIV transmission than unprotected receptive vaginal intercourse. (4) The per-act risk for HIV transmission in unprotected receptive AI nearly equals and can exceed that of IDU. CONCLUSIONS: There is an urgent need for an information paradigm shift that unbundles the sexual routes of HIV transmission and addresses the driving forces of the epidemic affecting black women: multiple sex partners, receptive anal intercourse, and drug abuse.