Every Feb. 7, National Black HIV/AIDS Awareness Day calls attention to an urgent and enduring reality: Black communities in the U.S. continue to be disproportionately affected by HIV. This inequity is not driven by individual behavior, but by deeply rooted structural barriers. Poverty, housing instability and limited access to culturally responsive health care shape health outcomes long before a diagnosis is made.
HIV-related stigma, compounded by racism and discrimination, remains a powerful force which can delay testing, complicate disclosure, erode trust in health care systems and weaken the social support networks that are essential for long-term wellness. The impact of these barriers is evident in national data.
Black individuals account for approximately 40% of all new HIV diagnoses despite representing only about 13% of the U.S. population. Among Black adults diagnosed with HIV, only about 77% are linked to care within one month of diagnosis, and just 63% achieve viral suppression within six months. Both data points fall short of the Ending the HIV Epidemic initiative’s ambitious but necessary 95% targets.
The statistics present a sobering reality, highlighting the urgent need to dismantle the systems that restrict access to timely, high-quality care and to expand low-barrier care options.
Addressing the root causes of inequity
Geography plays a significant role in HIV disparities. The Southern U.S. bears a disproportionate share of new HIV diagnoses, particularly among Black Americans. In many Southern states, the lack of Medicaid expansion has created persistent gaps in coverage, limiting access to preventive services, HIV testing and continuous care. These challenges are further compounded by health care provider shortages, transportation barriers and systemic discrimination within medical settings.
Medical mistrust is another critical barrier, rooted in both historical injustices and ongoing experiences of discrimination. Mistrust has a measurable impact on HIV outcomes, as perceived discrimination in health care settings has shown to be associated with lower engagement in care and poor adherence to antiretroviral therapy. When patients experience stigma or bias, trust in providers erodes, leading to missed appointments, reduced medication adherence and lower likelihood of achieving viral suppression.
Addressing these root causes requires more than clinical expertise. It requires intentional efforts to rebuild trust and redesign care systems around the needs of the Black communities.
Building trust through collaborative care
Ending the HIV epidemic in Black communities requires more than effective medications. It requires coordinated, compassionate and collaborative care. Interdisciplinary care teams, including providers, HIV-specialized pharmacists, case managers and peer specialists each play a vital role in improving outcomes and restoring trust.
Health care providers lead diagnosis and clinical decision-making, but they do not work alone. HIV-specialized pharmacists contribute critical expertise by optimizing ART regimens through medication reconciliation, drug-drug interaction screening, regimen simplification and side-effect management. Pharmacist-led interventions are highly valued by clinicians, with physician acceptance rates exceeding 90%, and are associated with improved adherence and viral suppression.
Case managers address the social and structural barriers that so often interfere with care. By helping individuals navigate insurance, secure stable housing, access transportation and connect with mental health or substance use services, case managers support retention in care and continuity over time. Their work recognizes the fundamental truth that viral suppression is not achievable when basic needs are unmet.
Peer specialists further strengthen this model by bringing lived experience into care delivery. Through shared understanding and empathy, peers help reduce stigma, foster trust and encourage sustained engagement in care, particularly for individuals who may feel alienated from traditional health care systems.
The impact of this collaborative approach is well documented. The Patient-Centered HIV Care Model, which integrates community-based pharmacists with HIV providers and coordinated care plans, demonstrated significant improvements among Black participants. In that model, retention in care and viral load suppression both improved by approximately 23%. These outcomes highlight the power of collaboration in advancing equity.
Confronting mortality disparities
Disparities in care translate directly into disparities in survival. Black people with HIV in the U.S. experience higher mortality rates than any other racial or ethnic groups. Lower rates of linkage to care, retention in care and viral suppression are key contributors to these inequities.
Yet, these outcomes are not inevitable. Programs like the Ryan White HIV/AIDS Program demonstrate what is possible when comprehensive, community-centered care is made accessible. Serving approximately half of all people with diagnosed HIV in the U.S., the Ryan White Program addresses both medical needs and social determinants of health. By 2024, viral suppression rates within Ryan White-funded clinics reached over 91%, with documented reductions in racial disparities. This is clear evidence that equity-driven care works.
Moving forward: A vision for health equity
On this National Black HIV/AIDS Awareness Day, we must recommit to dismantling the structural barriers that perpetuate HIV-related disparities. Collaborative care models, particularly those that integrate pharmacists, case managers and peers, offer a proven blueprint for improving outcomes among Black Americans with HIV. Achieving health equity will require sustained investment in several key areas:
- Expanding and strengthening integrated HIV care models, especially in underserved Southern communities
- Training and supporting a diverse HIV workforce who reflect the communities that we serve
- Educating our community about knowing HIV status and incorporating testing as part of routine care to remove stigma
- Addressing social determinants of health through policies that expand Medicaid, improve housing stability and reduce poverty
- Actively confronting stigma and discrimination within the health care setting and society at large
- Protecting and strengthening the Ryan White HIV/AIDS Program, a cornerstone of equitable HIV care
While the statistics remain stark, the path forward is clear. When we combine pharmaceutical expertise with compassionate case management; when we address medication access and poverty; and when we build trust through consistent, culturally responsive care, health equity is achievable. Collaborative care models also work for Black communities. Now is the time to scale these interventions, address systemic barriers and move decisively toward ending the HIV epidemic for all.
Image credit: My Brother’s Keeper Inc.