Background: Although HIV diagnoses have declined among most HIV risk groups, non-Hispanic blacks (NHBs) continue to be disproportionately affected.  Understanding changes in HIV diagnoses among NHBs over time is important if significant reductions in HIV diagnoses are to occur.

Methods: Data from 33 states reporting HIV diagnoses since 2000 to the HIV/AIDS Reporting System (HARS) were used. HARS stores reports without identifying information for persons tested confidentially and diagnosed with HIV/AIDS.  Data for persons with an HIV diagnosis and aged >13 years were analyzed.  The estimated number of HIV diagnoses by race/ethnicity was calculated and adjusted for reporting delays and for cases reported without transmission risk. Trends in HIV diagnoses were assessed using the estimated annual percent change (EAPC) and 95% confidence intervals (CI).   

Results: From 2001 to 2004, there were an estimated 156,052 new HIV diagnoses in the 33 states. NHBs accounted for 51% (n=79,404) of HIV diagnoses but were approximately 13% of the population of these states. Non-Hispanic whites accounted for 29% of diagnoses but about 72% of the population.  Among all NHBs, annual HIV diagnoses remained stable (EAPC, -3.68%; 95% CI, -7.53, 0.33).  Annual HIV diagnoses among NHB males were also stable (EAPC, -2.65%; 95% CI, -6.91, 1.80).  The decline among NHB females was significant (EAPC, -5.34%; 95% CI, -8.47, -2.10).  Trends in transmission by NHB men who have sex with men (MSM) remained stable (EAPC, 2.14%; 95% CI, -3.08, 7.63).  Trends in transmission by injection drug use (IDU) (EAPC, -9.72%; 95% CI, -12.84, -6.47) and heterosexual contact (EAPC, -4.93%; 95% CI, -7.32, -2.48) declined significantly.  Among NHB women, trends in transmission by IDU (EAPC, -9.77%; 95% CI, -16.40, -2.63) and heterosexual contact declined significantly (EAPC, -4.22%; 95% CI, -6.98, -1.38).

Conclusions: NHBs accounted for most HIV diagnoses from 2001 to 2004.  Among NHBs, trends in transmission remained stable or declined in all categories analyzed except MSMs.  However, a large disparity in HIV diagnoses remains between NHBs and other race/ethnic groups.  These results underscore the impact of the HIV/AIDS epidemic on NHBs and the need to continue monitoring trends particularly among MSM, the largest transmission category.  Accelerating the decline in HIV diagnoses among NHBs and narrowing the race/ethnic disparity remains a significant public health objective.