#RealTalk: Melissa Harris-Perry & Racism In Media

"I will not be used as a tool for their purposes. I am not a token, mammy, or little brown bobble head. I am not owned by Lack, Griffin, or MSNBC."

Too often we see the shuffle of shows on mainstream cable media/networks, usually Black anchor is on the chopping block. MSNBC is clearly no different, We even see it in local media with the way stories are told and broadcast to the masses. The racism at play when it comes to MHP is institutional, and its easy to see when she gave voice to what so many in the BLACK community needed to see and hear. Her subject matter was inclusive of  Black people that live in many intersections (Black and LGBT or  ________ ).

When Andrew Lack took over after the Brian Williams scandal, he made it his mission to shift MSNBC toward hard news and away from liberal reporting. This clearly explains why other Black anchored shows have been nixed so easily, I guess this was harder to do with MHP and her branding because it was highly rated. My thing is, did Lack think we would not notice Melissa's absence?  Take her off air until she agrees to only report on mainstream White issues?

Apparently, talking about issues of the day that are not associated with the mainstream is exactly what Lack wants. MHP had this to say, "Here is the reality: our show was taken — without comment or discussion or notice — in the midst of an election season. After four years of building an audience, developing a brand, and developing trust with our viewers, we were effectively and utterly silenced. Now, MSNBC would like me to appear for four inconsequential hours to read news that they deem relevant without returning to our team any of the editorial control and authority that makes MHP Show distinctive." If there is any doubt in your mind about the #BlackLivesMatter movement, Trans issues, immigration and other issues that affect minorities actually matter to the media....YOU WERE RIGHT, WE DON'T MATTER. Anyway, this is why my blog exists, we have to be our own media in order to address our issues. We also have to remember to support our sistahs and brothas like MHP who are kicking the door open. I will leave you with this letter she wrote and know that we must stick together!

The letter that MHP wrote:

"Dearest Nerds,

As you know by now, my name appears on the weekend schedule for MSNBC programming from South Carolina this Saturday and Sunday. I appreciate that many of you responded to this development with relief and enthusiasm. To know that you have missed working with me even a fraction of how much I’ve missed working with all of you is deeply moving. However, as of this morning, I do not have any intention of hosting this weekend. Because this is a decision that affects all of you, I wanted to take a moment to explain my reasoning.

Some unknown decision-maker, presumably Andy Lack or Phil Griffin, has added my name to this spreadsheet, but nothing has changed in the posture of the MSNBC leadership team toward me or toward our show. Putting me on air seems to be a decision being made solely to save face because there is a growing chorus of questions from our viewers about my notable absence from MSNBC coverage. Social media has noted the dramatic change in editorial tone and racial composition of MSNBC’s on-air coverage. In addition, Dylan Byers of CNN has made repeated inquiries with MSNBC’s leadership and with me about the show and what appears to be its cancellation. I have not responded to reporters or social media inquiries. However, I am not willing to appear on air in order to quell concerns about the disappearance of our show and our voice.

Here is the reality: our show was taken — without comment or discussion or notice — in the midst of an election season. After four years of building an audience, developing a brand, and developing trust with our viewers, we were effectively and utterly silenced. Now, MSNBC would like me to appear for four inconsequential hours to read news that they deem relevant without returning to our team any of the editorial control and authority that makes MHP Show distinctive.

The purpose of this decision seems to be to provide cover for MSNBC, not to provide voice for MHP Show. I will not be used as a tool for their purposes. I am not a token, mammy, or little brown bobble head. I am not owned by Lack, Griffin, or MSNBC. I love our show. I want it back. I have wept more tears than I can count and I find this deeply painful, but I don’t want back on air at any cost. I am only willing to return when that return happens under certain terms.

Undoubtedly, television nurtures the egos of those of us who find ourselves in front of bright lights and big cameras. I am sure ego is informing my own pain in this moment, but there is a level of professional decency, respect, and communication that has been denied this show for years. And the utter insulting absurdity of the past few weeks exceeds anything I can countenance.

I have stayed in the same hotels where MSNBC has been broadcasting in Iowa, in New Hampshire, and in South Carolina, yet I have been shut out from coverage. I have a PhD in political science and have taught American voting and elections at some of the nation’s top universities for nearly two decades, yet I have been deemed less worthy to weigh in than relative novices and certified liars. I have hosted a weekly program on this network for four years and contributed to election coverage on this network for nearly eight years, but no one on the third floor has even returned an email, called me, or initiated or responded to any communication of any kind from me for nearly a month. It is profoundly hurtful to realize that I work for people who find my considerable expertise and editorial judgment valueless to the coverage they are creating.

While MSNBC may believe that I am worthless, I know better. I know who I am. I know why MHP Show is unique and valuable. I will not sell short myself or this show. I am not hungry for empty airtime. I care only about substantive, meaningful, and autonomous work. When we can do that, I will return — not a moment earlier. I am deeply sorry for the ways that this decision makes life harder for all of you. You mean more to me than you can imagine.

Yours always,

Melissa"

SOURCE: Jamil Smith - https://medium.com/@JamilSmith/melissa-harris-perry-s-email-to-her-nerdland-staff-11292bdc27cb#.ywhfzhu42

#RealTalk: CDC Report Says Half Of Black Gay Men Will Contract #HIV In Their Lifetime

People living in the South are more likely to be diagnosed with HIV over the course of their life than people in other parts of the country. States where risk is greatest include Maryland (1 in 49), Georgia (1 in 51), Florida (1 in 54), and Louisiana (1 in 56).

Yesterday during CROI the CDC released a report on a study it conducted, which "provides the first-ever comprehensive national estimates of the lifetime risk of an HIV diagnosis for several key populations at risk and in every state. Overall, the likelihood that an American will be diagnosed with HIV at any point during his or her life is now 1 in 99, an improvement from a previous study using 2004- 2005 data that reported lifetime risk at 1 in 78. Despite overall progress, this study reveals stark disparities by race, risk group and geography."

African American men overall are almost 7 times more likely than white men to be diagnosed with HIV in their lifetimes. The disparity among women is even greater: 1 in 48 African American women will be diagnosed with HIV in their lifetimes, compared with 1 in 227 Hispanic women and 1 in 880 white women.

Honestly Black gay men deserve respect and attention in a sincere and holistic way, as a good friend of mine stated:

"If you love Black gay men, you won't place us into boxes. If you love Black gay men, you won't care to only tell salacious stories. If you love Black gay men, you will be critical of headlines. If you love Black gay men, you will care about us before seroconversion. If you love Black gay men and want to help the HIV pandemic, you won't simply try to throw a condom onto everything to erase the very real social determinants. If you love Black gay men, you would care about access. If you love Black gay men, you would care about poverty. If you love Black gay men, you would care about stigma, slut-shaming, sex-shaming, bottom-shaming, resources, race, and sexuality. If you love Black gay men living with HIV, you would consider what recent CDC studies could mean for outdated criminalization laws. If you love Black gay men, you would care about nuance and complexity.

But that would be too much to ask because funding only matters once people have a positive diagnosis. Then the world pretends to care.‪#‎InMyFeelings‬ ‪#‎FightingForABetterTomorrow‬" - Preston D. Mitchum

So this mean that the Trans community deserves the same respect and attention in a sincere and holistic way too. It is problematic that ALL of the projections in reference to MSM (Men who have sex with men) don't separate or give proper attention to the population of TransWomen at risk for HIV. This report is truly misgendering and institutionally Transphobic, I ask that those, including myself with influence in the HIV community to force the CDC and federal government overall to be more thoughtful toward Black and Latinx Transwomen. I Cannot trust this report if it excludes entire communities and provides a gateway to criminalization on a level we have not seen before in states with archaic HIV laws. Same goes for the treatment of TransMen, but think on the fact that as Cisgender folks (me included), we must let the Trans community speak for themselves and that means breaking our silence in a LOUD voice to make space for them to do so. 

The trans community is not a Monolith, nor is being Black or Latino, but we have to make sure everyone counts and that means recognizing that gender identity and sexual orientation are not the same thing. Recognize that there are TransWomen that are attracted only to women and TransMen who are attracted to other men, in other words there are Lesbian, Gay and Bisexual Trans folks.

Sex - refers to biological differences; chromosomes, hormonal profiles, internal and external sex organs.
   
Gender - describes the characteristics that a society or culture delineates as masculine or feminine.
    
Gender identity - is a person's private sense and subjective experience of their own gender. This is generally described as one's private sense of being a man or a woman, consisting primarily of the acceptance of membership into a category of people: male or female.
Gender expression

Gender expression - refers to all of the external characteristics and behaviors that are socially defined as either masculine or feminine, such as dress, grooming, mannerisms, speech patterns and social interactions. Social or cultural norms can vary widely and some characteristics that may be accepted as masculine, feminine or neutral in one culture may not be assessed similarly in another.

Transgender - is an umbrella term for people whose gender identity or expression is different from those typically associated with the sex assigned to them at birth (e.g., the sex listed on their birth certificate). Not all people who consider themselves (or who may be considered by others as) transgender will undergo a gender transition. 

Gender transition - Transitioning is the process some transgender people go through to begin living as the gender with which they identify, rather than the sex assigned to them at birth. This may or may not include hormone therapy, sex reassignment surgery and other medical procedures.

http://www.cdc.gov/nchhstp/newsroom/docs/factsheets/lifetime-risk-hiv-dx-us.pdf

http://www.cdc.gov/nchhstp/newsroom/2016/croi-press-release-risk.html

#RealTalk: Nothing About Us Without Us - The Black Community & HIV

As a person living with HIV, I have come to quickly learn that many, if not all organizations that have anything to do with HIV & AIDS in existence do not have people with the lived experiences of being HIV positive on their boards. I keep thinking about the The Denver Principles, a list of demands that changed healthcare as we know it. The second recommendation "2. Be involved at every level of decision-making and specifically serve on the boards of directors of provider organizations...." comes to mind. When did we get away from  being the leaders of our own movement? Moreover, when did we drop the ball on HIV 101 in the Black community?

It is frightening to me that I had to explain to a man, a Black man, a straight Black man who is one year older than me (he is age 32) what HIV is and how it works. While I graciously explained and told him he could reach out to me in the future, I thought about those who look like me that work as service providers. They are forced to only focus on MSM or Men who have Sex with Men in their work of getting to ZERO. Many of the the coordinators, prevention specialists, and others who work on the community level are not in management and are Black. There are very few Black persons in management when it comes to organizations that provide care, on top of that, the ones (not all) who are in high level positions tend to come off as elitist and out of touch.

Even more problematic is that the majority are Gay/SGL men, which speaks to the lack of education in the heterosexual, Bisexual and Trans communities. Straight Black women and men are at peril, especially women, IF we are to truly get to ZERO in the black community why are we ONLY focusing on Gay black men. If our community organizations like churches and leaders won't, why can't we table in the areas ourselves? When will there be a movement to hold the federal government to the fire to create a tracking system that is more holistic and respectful to the Trans community? After all, why keep counting Transwomen as men, while ignoring Transmen completely?

The point is that those of us in the know have an opportunity to take positions of leadership and take it upon ourselves to educate those we know that are not getting properly educated. We more than just testing if the prevention methodology has not teeth. Below you will find the The Denver Principles along with a little background about why it exists. 

"Nothing About Us Without Us!" (Latin: "Nihil de nobis, sine nobis") is a slogan used to communicate the idea that no policy should be decided by any representative without the full and direct participation of members of the group(s) affected by that policy. This involves national, ethnic, disability-based, or other groups that are often thought to be marginalized from political, social, and economic opportunities.

"It was 1983. Just a year prior, Acquired Immune Deficiency Syndrome (AIDS) became the fearful

nameplate for the murderer of gay friends and lovers. The virus that caused it, HIV, had only been identified a few weeks earlier. Amidst this atmosphere of unremitting grief and fear, a group of activists met in Denver as part of a gay and lesbian health conference. Among them, a dozen men with AIDS. And among their number, the inspirational Michael Callen of New York City, pictured at right, and safe sex architect Richard Berkowitz (Sex Positive), the only surviving member of the group today. They were about to do something that would change our response to AIDS -- and health care in general -- forever.

As the conference drew to a close, the activists asked to address the attendees. Rather than having a report presented about the state of the AIDS crisis, they wanted to speak for themselves. If the word "empowerment" hadn't yet been a part of the health care lexicon, it was about to be.

The group took turns reading a document to the conference they had just created themselves, during hours sitting in a hospitality suite of the hotel. It was their Bill of Rights and Declaration of Independence rolled into one. It would be known as The Denver Principles, and it began like this: "We condemn attempts to label us as 'victims,' which implies defeat, and we are only occasionally 'patients,' which implies passivity, helplessness, and dependence upon the care of others. We are 'people with AIDS.'"..." - POZ: How 'The Denver Principles' Changed Healthcare Forever, By Mark S. King

THE DENVER PRINCIPLES (1983)

(Statement from the advisory committee of the People with AIDS) We condemn attempts to label us as "victims," a term which implies defeat, and we are only occasionally "patients," a term which implies passivity, helplessness, and dependence upon the care of others. We are "People With AIDS."

RECOMMENDATIONS FOR ALL PEOPLE

1. Support us in our struggle against those who would fire us from our jobs, evict us from our homes, refuse to touch us or separate us from our loved ones, our community or our peers, since available evidence does not support the view that AIDS can be spread by casual, social contact.

2. Not scapegoat people with AIDS, blame us for the epidemic or generalize about our lifestyles.

RECOMMENDATIONS FOR PEOPLE WITH AIDS

1. Form caucuses to choose their own representatives, to deal with the media, to choose their own agenda and to plan their own strategies.

2. Be involved at every level of decision-making and specifically serve on the boards of directors of provider organizations.

3. Be included in all AIDS forums with equal credibility as other participants, to share their own experiences and knowledge.

4. Substitute low-risk sexual behaviors for those which could endanger themselves or their partners; we feel people with AIDS have an ethical responsibility to inform their potential sexual partners of their health status.

RIGHTS OF PEOPLE WITH AIDS

1. To as full and satisfying sexual and emotional lives as anyone else.

2. To quality medical treatment and quality social service provision without discrimination of any form including sexual orientation, gender, diagnosis, economic status or race.

3. To full explanations of all medical procedures and risks, to choose or refuse their treatment modalities, to refuse to participate in research without jeopardizing their treatment and to make informed decisions about their lives.

4. To privacy, to confidentiality of medical records, to human respect and to choose who their significant others are.

5. To die--and to LIVE--in dignity.

SOURCE: http://data.unaids.org/pub/ExternalDocument/2007/gipa1983denverprinciples_en.pdf

This document is a goldmine that has been the template time and time again when it comes to healthcare and politics. Its about time we have education, TRUE representation, advocacy & Activism by us, for us.

Seven Words: A Tribute to Jordan Baker

credit: 

Burnell McCray 

Last night during an installation of the HERstory series, Janet Baker honored us by breaking her silence and telling her account on the events surrounding the loss of her beloved son. You see, she is the mother of Jordan Baker, a young Black man  who had his life tragically  cut short by HPD officer Juventino Castro. When Janet spoke about her fight to attain justice for Jordan against the brick wall of a broken criminal justice system, the emotional, physical & financial toll, it saddened me and encouraged me at the same time.

As an Atheist I am still a Black man and I recognize that my Blackness, our Blackness is intersectional. I may not believe in a God, but that does not stop me from standing in solidarity with and for those who seek justice in an unjust society.

Janet, during her moments of grief and happiness told us her story, a mother's story about her son Jordan, there was a moment in which her face lit up. In that moment she spoke about the prayers with her dad one at 7a or at 7p, with seven words and repeated 7 times. In that moment I saw her eyes glow about the good memories of her time with her son and how it also left a void, not only for her, but the entire family including little Jordan.

While I may not pray and may even be swamped at different points in time, saying seven words for Jordan seems like a great thing to do. I speak in tribute of Jordan Baker and his family seven words that helped me and I encourage you to think of seven words as well.

* Strength * Resilience * Love * Vibrance * Humility * Patience * Teach

Yes #BlackLivesMatter and so does the ability to be a community, I stand with you Janet Baker, I love your strength, resolve and wisdom. Special shout out to Alibi X Nation and my fellow Avengers from Truth2Power for last night Andrea, Biko, Brandi, Secunda & Stevens.

credit: Lanecia Rouse-Tinsley

National Black HIV/AIDS Awareness Day #NBHAAD #HIV

National Black HIV/AIDS Awareness Day 

February 7 is National Black HIV/AIDS Awareness Day, which is intended to raise awareness of human immunodeficiency virus (HIV) infection, which causes acquired immunodeficiency syndrome (AIDS). The observance also encourages action, such as HIV testing, to reduce the disproportionate impact of HIV/AIDS on non Hispanic blacks/African Americans (blacks) in the United States. 

This year's theme this year is “I am my brother/Sister’s Keeper: Fight HIV/AIDS.” We have to challenge the mindset in our homes, communities, workplace, churches, mosques and temples, because we all need to take a stand against HIV/AIDS.

Background:

February 7, 2016 marks the 16th year for National Black HIV/AIDS Awareness Day (NBHAAD), a national HIV testing and treatment community mobilization initiative targeted at Blacks in the United States and the Diaspora. NBHAAD was founded in 1999 as a national response to the growing HIV and AIDS epidemic in African American communities.

The NBHAAD initiative leverages a national platform to educate, bring awareness, and mobilize the African American community. NBHAAD has four key focus areas which encourage people to:

• Get Educated about HIV and AIDS;
• Get Involved in community prevention efforts;
• Get Tested to know their status; and
• Get Treated to receive the continuum of care needed to live with HIV/AIDS.

The governing body of NBHAAD has evolved over the last 15 years into the Strategic Leadership Council (SLC). The SLC provides guidance, direction, and strategic thought to engaging more African American community stakeholders and organizations to make NBHAAD a success.

Bottom line:

I encourage you, my readers to participate in or plan events during the entirety of Black History month and all year. We all are affected HIV and AIDS in various ways in the Black community, whether we are living with it or lack access to testing and care. In the words of Louis Carr "Far too many of us are never seen and never heard. Too many of us are suffering, never making it into care, falling out of care and DEAD because care has not kept pace. Too many of us live in fear. Too many of us do not have housing or live in stigma filled housing." This day is important as it comes on the heels of data released by the CDC in its weekly report outlining "Disparities in Consistent Retention in HIV Care" when it comes to the Black community.  Retention in care among Blacks, our retention in care is dangerously low and I suspect that stigma & lack of education are contributing to this issue.

According to the CDC:

• African Americans are the racial/ethnic group most affected by HIV.
• The rate of new HIV infection in African Americans is 8 times that of whites based on population size.
• Gay and bisexual men account for most new infections among African Americans; young gay and bisexual men aged 13 to 24 are the most affected of this group.

• African Americans accounted for an estimated 44% of all new HIV infections among adults and adolescents (aged 13 years or older) in 2010, despite representing only 12% of the US population; considering the smaller size of the African American population in the United States, this represents a population rate that is 8 times that of whites overall.
• In 2010, men accounted for 70% (14,700) of the estimated 20,900 new HIV infections among all adult and adolescent African Americans. The estimated rate of new HIV infections for African American men (103.6/100,000 population) was 7 times that of white men, twice that of Latino men, and nearly 3 times that of African American women.
• In 2010, African American gay, bisexual, and other men who have sex with men**b represented an estimated 72% (10,600) of new infections among all African American men and 36% of an estimated 29,800 new HIV infections among all gay and bisexual men. More new HIV infections (4,800) occurred among young African American gay and bisexual men (aged 13-24) than any other subgroup of gay and bisexual men.
• In 2010, African American women accounted for 6,100 (29%) of the estimated new HIV infections among all adult and adolescent African Americans. This number represents a decrease of 21% since 2008. Most new HIV infections among African American women (87%; 5,300) are attributed to heterosexual contact.c The estimated rate of new HIV infections for African American women (38.1/100,000 population) was 20 times that of white women and almost 5 times that of Hispanic/Latino women.d

** Referred to as gay and bisexual men in this fact sheet.

Estimates of New HIV Infections in the United States for the Most-Affected Subpopulations, 2010

Source: CDC. Estimated HIV incidence among adults and adolescents in the United States, 2007–2010. HIV Surveillance Supplemental Report 2012;17(4). Subpopulations representing 2% or less are not reflected in this chart. Abbreviations: MSM, men who have sex with men; IDU, injection drug user.

HIV and AIDS Diagnoses and Deaths

• At some point in their lifetimes, an estimated 1 in 16 African American men and 1 in 32 African American women will be diagnosed with HIV infection.
• In 2012, African Americans had the largest percentage (47%) of the estimated 47,989 diagnoses of HIV infection in the United States.
• In 2012, an estimated 14,102 African Americans were diagnosed with HIV infection ever classified as stage 3 (AIDS) in the United States.
• By the end of 2011, an estimated 265,812 African Americans diagnosed with HIV infection ever classified as stage 3 (AIDS) had died in the United States.

To be honest, when dealing with HIV outside and within the Black community, stigma has a stronghold. The lack of HIV 101 plays a large part in why stigma is such a huge issue, it is saddening. It is one of the reasons that came out of the HIV closet, which was for everyone who has been ostracized and made to feel nasty.  While many of us who have HIV are healthier than most out in the general population, Black gay men die at a higher rate from HIV than those who are in the group where HIV infection is actually the highest. Now think about how the Black heterosexual community is affected, especially Black women. People living with HIV not nasty people, we are not contagious, we are doctors, lawyers, teachers, students, sons, daughters, mothers and fathers! Yes, we are HIV positive and we live a healthy life, We are human beings and we exist. The data showing how HIV affects the Black community is staggering. In a publication called HIV/AIDS Inequality: Structural Barriers to Prevention, Treatment, and Care in Communities of Color many of the issues that I have pointed out, such as Residential segregation and housing discrimination, Education, Criminal justice (including HIV exposure laws) and much more.

HIV - stands for human immunodeficiency virus. It is the virus that can lead to acquired immunodeficiency syndrome, or AIDS. Unlike some other viruses, the human body cannot get rid of HIV. That means that once you have HIV, you have it for life.

AIDS - HIV disease becomes AIDS when your immune system is seriously damaged. If you have less than 200 CD4+ cells or if your CD4 percentage is less than 14%, you have AIDS.

TRANSMISSION - Only certain fluids—blood, semen (cum), pre-seminal fluid (pre-cum), rectal fluids, vaginal fluids, and breast milk—from an HIV-infected person can transmit HIV. These fluids must come in contact with a mucous membrane or damaged tissue or be directly injected into the bloodstream (from a needle or syringe) for transmission to possibly occur. Mucous membranes can be found inside the rectum, the vagina, the opening of the penis, and the mouth.

In the United States, HIV is spread mainly by

Having sex with someone who has HIV. In general:
- Anal sex is the highest-risk sexual behavior. Receptive anal sex (bottoming) is riskier than insertive anal sex (topping).

- Vaginal sex is the second highest-risk sexual behavior.
- Having multiple sex partners or having other sexually transmitted infections can increase the risk of infection through sex.
Sharing needles, syringes, rinse water, or other equipment (works) used to prepare injection drugs with someone who has HIV.

SEROCONVERSION:

- Seroconversion is the period of time during which HIV antibodies develop and become detectable.
- Seroconversion generally takes place within a few weeks of initial infection.
- It is often, but not always, accompanied by flu-like symptoms including fever, rash, muscle aches and swollen lymph nodes. These symptoms are not a reliable way to identify seroconversion or to diagnose HIV infection.

#HIV: CDC Report on Disparities in Consistent Retention in HIV Care

Disparities in Consistent Retention in HIV Care - 11 States and the District of Columbia, 2011–2013

*This is the full report on retention in HIV care care released yesterday by the CDC in its Morbidity and Mortality Weekly Report (MMWR)*

In 2013, 45% of new human immunodeficiency virus (HIV) infection diagnoses occurred in non-Hispanic blacks/African Americans (blacks) (1), who represent 12% of the U.S. population.* Antiretroviral therapy (ART) improves clinical outcomes and reduces transmission of HIV, which causes acquired immunodeficiency syndrome (AIDS) (2). Racial/ethnic disparities in HIV care limit access to ART, perpetuating disparities in survival and reduced HIV transmission. National HIV Surveillance System (NHSS) data are used to monitor progress toward reaching the National HIV/AIDS Strategy goals to improve care among persons living with HIV and to reduce HIV-related disparities.† CDC used NHSS data to describe retention in HIV care over 3 years and describe differences by race/ethnicity. Among persons with HIV infection diagnosed in 2010 who were alive in December 2013, 38% of blacks with HIV infection were consistently retained in care during 2011–2013, compared with 50% of Hispanics/Latinos (Hispanics) and 49% of non-Hispanic whites (whites). Differences in consistent retention in care by race/ethnicity persisted when groups were stratified by sex or transmission category. Among blacks, 35% of males were consistently retained in care compared with 44% of females. Differences in HIV care retention by race/ethnicity were established during the first year after diagnosis. Efforts to establish early HIV care among blacks are needed to mitigate racial/ethnic disparities in HIV outcomes over time.

All states and U.S. territories report cases of HIV infections and associated demographic and clinical information to NHSS. CDC analyzed data from NHSS reported through July 2015 from 12 jurisdictions with complete laboratory reporting from January 2010–December 2013.§ These jurisdictions accounted for 25% of HIV diagnoses reported in the United States for 2010. This analysis includes persons aged ≥13 years who received a diagnosis of HIV infection in 2010 and were alive in December 2013. Retention in HIV care, defined as having two or more CD4+ or viral load tests ≥3 months apart during a given calendar year, was assessed annually for 2011, 2012, and 2013. The percentage of persons retained in care for 0, 1, 2, and 3 years during 2011–2013 was determined. Persons retained in care for all 3 years were considered to be consistently retained in HIV care. Differences in consistent retention in care were assessed by race/ethnicity, sex, transmission category, and state of residence at diagnosis. Results were statistically adjusted for missing information on transmission category using multiple imputation (3).

In the 12 jurisdictions, a total of 9,824 adults and adolescents received a diagnosis of HIV infection in 2010 and were alive in December 2013. Of the 9,824, 54% were black, 17% were Hispanic, and 24% were white. Overall, 61% were retained in HIV care in 2011, 50% were retained in both 2011 and 2012, and 43% were retained during 2011–2013 (Figure 1). Among persons retained in care in 2011, 82% were retained in both 2011 and 2012. Among persons retained in care during both 2011 and 2012, 85% were retained during 2011–2013. A lower proportion of blacks were retained during 2011–2013 (38%), compared with Hispanics (50%) and whites (49%).

FIGURE 1. Percentage of persons aged ≥13 years with human immunodeficiency virus (HIV) infection diagnosed in 2010 who were alive in December 2013 and who were retained in HIV medical care* during 2011–2013, by race/ethnicity and years retained in care — National HIV Surveillance System, 11 states and the District of Columbia†

*Retention in HIV care was defined as having two or more CD4+ or viral load tests ≥3 months apart during a given calendar year and was assessed annually for 2011, 2012, and 2013.

† Only jurisdictions with complete laboratory reporting were included in the analysis: District of Columbia, Illinois, Indiana, Iowa, Louisiana, Michigan, Missouri, New Hampshire, New York, North Dakota, South Carolina, and West Virginia.

Differences in consistent retention in care by race/ethnicity persisted when stratified by sex or transmission category, with a lower proportion of blacks retained in HIV care for all 3 years, compared with other groups (Table). Further, retention in care for all 3 years was lower among blacks in seven of the 12 jurisdictions (District of Columbia, Illinois, Iowa, Michigan, Missouri, New Hampshire, and New York).

TABLE. Consistent retention* in human immunodeficiency virus (HIV) medical care among persons aged ≥13 years with HIV infection diagnosed in 2010 who were alive in December 2013, by race/ethnicity† and selected characteristics — National HIV Surveillance System, 11 states and the District of Columbia

Characteristic	Race/Ethnicity
	Overall		Black/African American		Hispanic/Latino		White
	Total	Consistently retained	Total	Consistently retained	Total	Consistently retained	Total	Consistently retained
	No. (%)	No. (%)	No. (%)	No. (%)	No. (%)	No. (%)	No. (%)	No. (%)
Total	9,824 (100.0)	4,201 (42.8)	5,286 (100.0)	1,993 (37.7)	1,682 (100.0)	833 (49.5)	2,358 (100.0)	1,145 (48.6)
Sex
Male	7,566 (77.0)	3,173 (41.9)	3,712 (70.2)	1,297 (34.9)	1,356 (80.6)	673 (49.6)	2,094 (88.8)	1,024 (48.9)
Female	2,258 (23.0)	1,028 (45.5)	1,574 (29.8)	696 (44.2)	326 (19.4)	160 (49.1)	264 (11.2)	121 (45.8)
Transmission category
Male-to-male sexual contact	5,953 (60.6)	2,530 (42.5)	2,732 (51.7)	956 (35.0)	1,056 (62.8)	526 (49.8)	1,844 (78.2)	903 (49.0)
Male-to-male sexual contact and injection drug use	285 (2.9)	110 (38.6)	111 (2.1)	29 (26.3)	50 (3.0)	22 (44.0)	103 (4.4)	51 (49.8)
Injection drug use, males	474 (4.8)	181 (38.2)	279 (5.3)	91 (32.6)	114 (6.8)	53 (46.5)	66 (2.8)	30 (45.5)
Injection drug use, females	332 (3.4)	146 (44.0)	210 (4.0)	85 (40.5)	43 (2.6)	24 (55.8)	67 (2.8)	28 (41.8)
Heterosexual contact, males	843 (8.6)	348 (41.3)	584 (11.0)	218 (37.3)	134 (8.0)	71 (53.0)	78 (3.3)	39 (50.0)
Heterosexual contact, females	1,918 (19.5)	879 (45.8)	1,359 (25.7)	610 (44.9)	282 (16.8)	135 (47.9)	197 (8.4)	92 (46.7)
Other	20 (0.2)	7 (35)	12 (0.2)	4 (33.3)	3 (0.2)	2 (66.7)	3 (0.1)	1 (33.3)
Jurisdiction
District of Columbia	794 (8.1)	278 (35.0)	620 (11.7)	207 (33.4)	52 (3.1)	22 (42.3)	103 (4.4)	46 (44.7)
Illinois	1,570 (16.0)	421 (26.8)	806 (15.2)	179 (22.2)	280 (16.6)	99 (35.4)	372 (15.8)	102 (27.4)
Indiana	444 (4.5)	184 (41.4)	200 (3.8)	76 (38.0)	40 (2.4)	14 (35.0)	185 (7.8)	87 (47.0)
Iowa	102 (1.0)	51 (50.0)	23 (0.4)	10 (43.5)	10 (0.6)	5 (50.0)	60 (2.5)	32 (53.3)
Louisiana	1,027 (10.5)	387 (37.7)	755 (14.3)	262 (34.7)	36 (2.1)	10 (27.8)	210 (8.9)	107 (51.0)
Michigan	723 (7.4)	292 (40.4)	438 (8.3)	152 (34.7)	43 (2.6)	19 (44.2)	216 (9.2)	109 (50.5)
Missouri	543 (5.5)	193 (35.5)	272 (5.1)	68 (25.0)	29 (1.7)	11 (37.9)	221 (9.4)	104 (47.1)
New Hampshire	50 (0.5)	30 (60.0)	2 (0.0)	1 (50.0)	3 (0.2)	2 (66.7)	40 (1.7)	24 (60.0)
New York	3,759 (38.3)	1,997 (53.1)	1,613 (30.5)	788 (48.9)	1,147 (68.2)	640 (55.8)	756 (32.1)	435 (57.5)
North Dakota	12 (0.1)	6 (50.0)	3 (0.1)	1 (33.3)	3 (0.2)	1 (33.3)	5 (0.2)	4 (80.0)
South Carolina	725 (7.4)	343 (47.3)	542 (10.3)	245 (45.2)	33 (2.0)	10 (30.3)	136 (5.8)	80 (58.8)
West Virginia	75 (0.8)	19 (25.3)	12 (0.2)	4 (33.3)	6 (0.4)	0 (0.0)	54 (2.3)	15 (27.8)

*Defined as retained in HIV care each year during 2011–2013. Retention in HIV care was defined as having two or more CD4+ or viral load tests ≥3 months apart during a given calendar year.
† Because the estimated totals were calculated independently of the corresponding values for each population group, the individual values might not sum to the totals.

A smaller percentage of black males, who accounted for more than two thirds of blacks with HIV diagnosed in 2010, were consistently retained in care during 2011–2013 compared with black females (35% versus 44%, respectively) (Table). Among blacks, consistent retention in care was highest for persons with infection attributable to heterosexual contact, and among these persons, consistent retention in care was higher for females (45%) than for males (37%).

Overall, 43% of all persons included in the analysis were retained in HIV care for all 3 years during 2011–2013. Nineteen percent were retained 2 of the 3 years; 14% were retained 1 of the 3 years, and 25% were not retained in any of the 3 years (Figure 2). A larger proportion of blacks (28%), compared with Hispanics (23%) and whites (19%), were not retained in care during any of the 3 years.

FIGURE 2. Percentage of persons aged ≥13 years with human immunodeficiency virus (HIV) infection diagnosed in 2010 who were alive in December 2013 and who were retained in HIV medical care* for 0, 1, 2, or 3 out of 3 years, by race/ethnicity — National HIV Surveillance System, 11 states and the District of Columbia†

*Retention in HIV care was defined as having two or more CD4+ or viral load tests ≥3 months apart during a given calendar year and was assessed annually for 2011, 2012, and 2013.

† Only jurisdictions with complete laboratory reporting were included in the analysis: District of Columbia, Illinois, Indiana, Iowa, Louisiana, Michigan, Missouri, New Hampshire, New York, North Dakota, South Carolina, and West Virginia.

Discussion

A substantial percentage of persons with HIV infection (39%) were not retained in care in the year after their diagnosis. However, among persons retained during earlier years after diagnosis, the proportion not retained during subsequent years was low (18% in 2012 and 15% in 2013, respectively). Fewer blacks were retained in HIV care compared with other racial/ethnic groups. These findings are consistent with previous reports on racial/ethnic differences in HIV care engagement (4) and demonstrate that these disparities remain over multiple years. The racial/ethnic differences in HIV care retention are established during the first year after diagnosis, underscoring the importance of early engagement in care to reduce disparities in sustained retention in care and thus improve the resulting outcomes (e.g., initiation of treatment and viral suppression).

Retention in care facilitates ART adherence and early detection of comorbidities, which can result in improved survival and reduced transmission of infection to others (2,5). Barriers to retention in care, such as lack of health insurance, limited access to health services, and stigma, are particularly prevalent among blacks (6). Continuing to identify barriers to HIV care engagement, including those leading to prolonged lack of retention in care, can inform development of effective interventions to improve HIV care engagement among blacks (7). Developing such interventions might narrow racial/ethnic disparities in clinical outcomes.

The findings in this report are subject to at least four limitations. First, HIV surveillance data do not include markers of socioeconomic status (e.g., health insurance status, annual household income, or education), which could help explain observed disparities in HIV care engagement by racial/ethnic groups. Second, analyses were restricted to 12 jurisdictions with complete laboratory reporting during the entire analysis period; these 12 jurisdictions might not be representative of all persons living with diagnosed HIV infection. Third, this analysis was limited to persons with HIV infection diagnosed during a 1-year period; for this reason, estimates are different from those previously published (4). Finally, these multiyear estimates of retention in HIV care might be artificially lower if persons moved to a jurisdiction with incomplete laboratory reporting after receiving an HIV diagnosis; however, a previous analysis of HIV surveillance data concluded that interstate migration is relatively uncommon.¶

Focusing HIV prevention and care efforts on early diagnosis of HIV infection and early establishment of HIV care among blacks might be beneficial in reducing racial/ethnic disparities in HIV outcomes. Through partnerships with federal, state, and local health agencies, CDC is pursuing high-impact prevention strategies to address the principal goals of the National HIV/AIDS Strategy to increase access to care and reduce disparities in HIV outcomes.** CDC supports projects that aim to reduce the proportion of undiagnosed infections in the United States, improve linkage to and retention in care, and reduce HIV-related morbidity and mortality across all racial/ethnic groups (8). CDC also supports using surveillance data to 1) identify persons who are not currently in care, 2) improve HIV care engagement, and 3) increase viral suppression (9). Continued collaboration among health care providers, community-based organizations, and state and local health departments can strengthen programs that support both early linkage to care after HIV diagnosis across all racial/ethnic groups and expansion of proven methods for improving retention in care (e.g., HIV case management, patient navigation systems, and co-location of medical services) (7,10).

For PDF of report: http://www.cdc.gov/mmwr/volumes/65/wr/pdfs/mm6504.pdf

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Corresponding author: Sharoda Dasgupta, sdasgupta@cdc.gov, 404-639-5191.

1Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC; 2Epidemic Intelligence Service, CDC.

References

1. CDC. HIV surveillance report: diagnoses of HIV infection in the United States and dependent areas, 2013. Atlanta, GA: US Department of Health and Human Services, CDC; 2015.http://www.cdc.gov/hiv/library/reports/surveillance/.
2. Mugavero MJ, Amico KR, Westfall AO, et al. Early retention in HIV care and viral load suppression: implications for a test and treat approach to HIV prevention. J Acquir Immune Defic Syndr 2012;59:86–93.  CrossRef PubMed
3. Harrison KM, Kajese T, Hall HI, Song R. Risk factor redistribution of the national HIV/AIDS surveillance data: an alternative approach. Public Health Rep 2008;123:618–27. PubMed
4. CDC. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2012. HIV surveillance supplemental report 2014. Vol. 19, no. 3. Atlanta, GA: US Department of Health and Human Services, CDC; 2014. http://www.cdc.gov/hiv/pdf/surveillance_Report_vol_19_no_3.pdf.
5. Mugavero MJ, Lin HY, Willig JH, et al. Missed visits and mortality among patients establishing initial outpatient HIV treatment. Clin Infect Dis 2009;48:248–56.  CrossRef PubMed
6. Moore RD. Epidemiology of HIV infection in the United States: implications for linkage to care. Clin Infect Dis 2011;52(Suppl 2):S208–13.  CrossRef PubMed
7. CDC. Compendium of evidence-based interventions and best practices for HIV prevention. Atlanta, GA: US Department of Health and Human Services, CDC; 2014.http://www.cdc.gov/hiv/prevention/research/compendium/ma/index.html.
8. CDC. The Care and Prevention in the United States (CAPUS) Demonstration Project. Atlanta, GA: US Department of Health and Human Services, CDC; 2015.http://www.cdc.gov/hiv/prevention/demonstration/capus/.
9. CDC. Data to care: using HIV surveillance data to support the HIV care continuum. Atlanta, GA: US Department of Health and Human Services, CDC; 2015.https://effectiveinterventions.cdc.gov/en/highimpactprevention/publichealthstrategies/DatatoCare.aspx.
10. Thompson MA, Mugavero MJ, Amico KR, et al. Guidelines for improving entry into and retention in care and antiretroviral adherence for persons with HIV: evidence-based recommendations from an International Association of Physicians in AIDS Care panel. Ann Intern Med 2012;156:817–33.  CrossRef PubMed

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* U.S. Census Bureau. Population estimates. http://www.census.gov/popest/data/.

† https://www.aids.gov/federal-resources/national-hiv-aids-strategy/nhas-update.pdf.

§ District of Columbia, Illinois, Indiana, Iowa, Louisiana, Michigan, Missouri, New Hampshire, New York, North Dakota, South Carolina, and West Virginia.

¶ Espinoza L, Hall HI, Surendera-Babu A, Tang T, Chen M. Migration after HIV diagnosis, United States. Presented at the Conference on Retroviruses and Opportunistic Infections, March 3–6, 2014, Boston, Massachusetts.

** http://www.cdc.gov/hiv/policies/hip.html.