Missed Prevention Opportunities in Foreign-born and U.S.-born HIV-infected Black Mothers and their Infants, United States, 1995-2004

Introduction: Health research and the resulting interventions and policies that focus on black populations often treat them as a homogenous group. However, blacks represent a heterogeneous group of subpopulations with varying socioeconomic status, geographical origin and current location, culture, education, and religion. Failure by healthcare researchers to take into account the substantial diversity among U.S. blacks might overlook disease and health-related risks unique to certain subpopulations, resulting in less effective policies and interventions. Methods: We examined data from the Pediatric Spectrum of HIV Disease (PSD) Cohort study of infants born between 1995 and 2004 to identify characteristics of perinatally HIV-exposed infants born to black women in the U.S. Using the Chi-square test, we assessed differences in HIV-infected foreign-born and U.S.-born black mothers who had perinatally exposed their infants to HIV. Results: Foreign-born compared with U.S.-born HIV-infected mothers were less likely to have used crack or other non-intravenous illicit drugs or to have exchanged money or drugs for sex (2% vs 22%; p<0.0001), to have known their HIV status before giving birth (85% vs 93%; p<0.001), and to have received pre- or intrapartum zidovudine (74% vs 79%; p<0.01), and were more likely to have received prenatal care (96% vs 91%; p<0.001) or to have delivered an HIV-infected infant (16% vs 10%; p<0.001). Among foreign-born mothers, African-born compared with Caribbean-born (78% vs 64%) women were more likely to have received intrapartum zidovudine (p<0.01). Conclusions: We found significant differences in HIV risk behaviors, receipt of prenatal care and perinatal HIV prophylaxis, and perinatal HIV transmission among U.S. black subpopulations by geographical origin. Disaggregating data by subpopulation may help target scarce resources more effectively. In addition to geographic origin, we recommend health researchers also consider examining other social determinants such as health service access and utilization, housing, environment, and others, in an effort to better inform health reform policy related to reducing and possibly eliminating perinatal HIV transmission in the U.S.