Specific populations facing unique risks for infection with HIV or viral hepatitis include African Americans, men, women, youth, and LGBT individuals.
Racial and Ethnic Groups
African Americans comprise 12% of the population but bear the greatest HIV burden in the United States. In 2010, they made up 44% of all new HIV infections. The Centers for Disease Control and Prevention (CDC) reported that the rate of new HIV infection among African Americans was 8 times greater than that of Caucasians. The CDC also reported that chronic hepatitis C rates are higher among African Americans and that hepatitis B rates are higher among Asian and Pacific Islanders compared to other ethnic groups. New HIV and AIDS cases for other racial and ethnic groups in 2010 are as follows:
- Hispanics or Latinos represented 21% of new HIV infections.
- Asian Americans accounted for 2% of new HIV infections.
- Less than 1% of new HIV infections were among Native Hawaiians and Other Pacific Islanders. However, from 2008 to 2011, this group had the third highest estimated rate of HIV diagnosis behind African Americans, Hispanics, or Latinos.
American Indians and Alaska Natives made up less than 1% of the estimated 47,500 new HIV infections. However, American Indians and Alaska Natives had the highest percentage of injection drug-related, new HIV infections in 2011 compared with all other races and ethnicities. Injection drug use is also a serious issue among African Americans and Hispanics or Latinos. The CDC’s HIV Surveillance in Injection Drug Users – 2011 (PDF | 1.6 MB) found that 47% of African American injection drug users were diagnosed with HIV. Among Hispanic or Latino injection drug users, 25% were diagnosed with HIV.
In 2010, the rate of new HIV infection in men was 4.2 times that of women. Men accounted for 76% of people living with HIV and AIDS in the United States. Among men, greater percentages of undiagnosed HIV infections were attributed to male-to-male sexual contact (19%) and heterosexual contact (19%) compared to other transmission categories.
- Men accounted for 75% of AIDS diagnoses made in 2010.
- Seventy-eight percent of male HIV infection results from male-to-male sexual contact.
- Injection drug use is linked to 6% of male HIV infections.
- New HIV infections among African American men were 6.5 times that of white men and more than twice the rate of Hispanic or Latino men.
The CDC has investigated several outbreaks of hepatitis C among HIV-positive gay men and recommends that men who have sex with men get vaccinated against hepatitis A and B. Learn more from Viral Hepatitis: Information for Gay and Bisexual Men – 2013 (PDF | 791 KB).
In the United States, women represented 20% of new HIV infections in 2010 and 25% of AIDS diagnoses in 2011. Eighty-four percent of these new HIV infections were contracted from heterosexual contact. The CDC’s HIV Surveillance in Injection Drug Users – 2013 (PDF | 1.6 MB) indicates that 14% of women diagnosed with HIV contracted the infection from injection drug use. African American women are severely impacted by the HIV/AIDS epidemic, making up 64% of new HIV infections among women, followed by white women (18%), and Hispanic or Latina women (14%).
SAMHSA seeks to expand substance use treatment and HIV services for racial and ethnic minority women regardless of sexual orientation or preference. Additionally, partners and family members are being included to further facilitate harm reduction and reduce risky behaviors for those dealing with substance use or co-occurring disorders and who are living with or at risk for HIV and AIDS.
The burden of HIV infection falls disproportionately on youth. In the United States in 2009, 39% of all new HIV infections were among young people ages 13 to 29 (PDF | 292 KB). The rates are even higher among young men who have sex with men (YMSM), who represented 27% of new HIV infections in the 13 to 29 age group. Young, black MSM have emerged as being among the fastest growing segments of the population contracting HIV. In 2009, 69% of new HIV infections among young people ages 13 to 29 were young black MSM. New HIV infections among this group increased 48% from 2006 through 2009. According to a 2013 report from the Department of Health and Human Services (PDF | 4 MB), hepatitis C infection among young injectors is on the rise, particularly among young, white males and females. The research also found these young people often transitioned to heroin injection use from prescription opioid use. Learn more at the Prescription Drug Misuse and Abuse topic.
Lesbian, Gay, Bisexual, and Transgender Individuals
More than a decade of research indicates (PDF | 2 MB) lesbian, gay, bisexual, and transgender (LGBT) populations have been associated with high rates of alcohol consumption and substance use, which may lead to risky behaviors linked to the infection and spread of HIV. Gay, bisexual, and other men who have sex with men (MSM) are the population most affected by HIV and AIDS.
MSM represent the largest numbers of new HIV infections, accounting for 78% of new HIV infections among males and 63% of all new infections in 2010. The term “men who have sex with men” covers a wide variety of settings and contexts in which male-to-male sex takes place. This group may or may not self-identify as gay or even bisexual, but they represent the highest percentage of men living with HIV. In 2011, gay and bisexual men made up a little more than half of all adult and adolescent AIDS diagnoses (52%). In 2010, Caucasian MSM represented 78% of new HIV infections.
Transgender women (PDF | 186 KB) (particularly those who are African American) are also at high risk for HIV infection. HIV data on this population is limited and more culturally competent research is needed. This group faces a number of behavioral health challenges that are directly related to HIV transmission such as elevated rates of substance use and sex work in high-risk settings. In 2009, the highest percentage of new HIV infections was among African American and Hispanic or Latino transgender people.
SAMHSA provides a detailed, comprehensive guide for health practitioners serving the LGBT community. A Provider’s Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual, and Transgender Individuals – 2012 discusses the health and social challenges facing this population and how these issues relate to substance use disorders. A 17-module training curriculum to accompany this publication is available for self-paced learning.
A grant that strives to decrease the rate of substance abuse and new HIV infections in these populations by providing information and training for those who serve this population is the 2014 Program Supplement for the Addiction Technology Transfer Center (ATTC): Center of Excellence (CoE) on Behavioral Health for Racial/Ethnic Minority Young Men Who Have Sex with Men (YMSM) and Lesbian, Gay, Bisexual, Transgender Populations (LGBT).
Learn more about behavioral health issues affecting Specific Populations.