Background:  It is well documented that black and Hispanic individuals are significantly overrepresented among persons living with HIV/AIDS in the United States. Despite representing only 12% of the US population blacks account for nearly 50% of the HIV/AIDS cases.  Latino Americans account for roughly19% of HIV/AIDS cases but only 13 to 14% of the US population. The list of possible contributors to this disparity is extensive and includes behavioral, societal, environmental, and genetic factors that are increasing well described in the medical literature. Equally alarming is the fact that US blacks suffer poorer treatment response, higher mortality rates, and shorter time to mortality due to HIV than US whites. In 2006, the HIV-related mortality rate for black males was nearly 8 times that of white males, and the rate for black females was more than 20 times that of white females.  In 2007, 9436 black or Latino persons died as a result of HIV-related disease; this is more than double the number of US whites who suffered the same fate. Numerous recent clinical trials and cohort studies have documented poorer treatment response among blacks and to a lesser degree Latinos and women. Again the contributors are numerous and include higher rates of co-morbid conditions, late diagnosis, inadequate access to care due to poverty, lack of health insurance, poor health literacy, inconsistent adherence to clinic visits and therapy, active substance use, language barriers, and lack of trust in the medical establishment.  Inadequate cultural competence and social supports, as well as clinicians’ and researchers’ biases may also play a role in the outcomes disparities.

Conclusions:  Despite the significant gains in survival from HIV in the HAART era, the survival gap between blacks and whites in the US widens. Moreover, little progress is being made in lowering the rates of new infections in communities of color. Our challenge as clinicians and scientists is to better understand the drivers of these disparities, to design better prevention strategies for high-risk populations, and to improve outcomes in hard-to-reach populations. Improving the care for those with the most challenges raises the level of care for all, and that should be our goal.