For 2006–2007, the age‐adjusted rate of newly reported HIV diagnoses among West Indian–born blacks living in New York City was 43.2 per 100,000 population, according to findings from an epidemiologic surveillance study.¹ This rate was significantly different from that of the other groups examined: The rate of new HIV diagnoses was 28.8 among Dominican immigrants, 70.5 among Haitian immigrants, 20.0 among U.S.‐born whites and 109.5 among U.S.‐born blacks. There were also significant differences in distribution of transmission risk categories between West Indian–born blacks and the other groups.

Although black immigrants from English‐speaking Caribbean countries represent a significant minority of New York City's black population, and some evidence suggests that their HIV risk is high, data on HIV prevalence and incidence among West Indian–born blacks have not been disaggregated from those of all blacks. Using New York City HIV and AIDS surveillance data and census data, researchers calculated population‐based rates of new HIV diagnoses in 2006–2007, the number of people living with HIV or AIDS in 2007 and the distribution of new HIV infections by transmission risk category. They conducted chi‐square tests to compare data for West Indian–born blacks with those for U.S.‐born blacks and U.S.‐born whites, as well as Haitian immigrants and Dominican immigrants (to assess differences among immigrants from the English‐, French‐ and Spanish‐speaking Caribbean).

For West Indian–born blacks, the age‐adjusted rate of HIV diagnoses per 100,000 population was 43.2. The rate was 28.8 among Dominican immigrants, 70.5 among Haitians, 20.0 among U.S.‐born whites and 109.5 among U.S.‐born blacks; chi‐square testing showed that the differences in rates between West Indian–born blacks and the other groups were significant. The age‐adjusted number of people living with HIV or AIDS per 100 population was 0.5 for West Indian–born blacks, 0.4 for Dominican immigrants, 1.3 for Haitians, 0.7 for U.S.‐born whites and 3.0 for U.S.‐born blacks; all differences between West Indian–born blacks and the other groups were significant.

Heterosexual contact with an infected partner accounted for the greatest proportion of new infections among West Indian–born blacks (41%); 24% of new diagnoses were attributable to same‐sex behavior between men, and 34% were of unknown origin. Distributions of new HIV cases by transmission risk did not vary between West Indian–born blacks and Dominicans, but there were significant differences between West Indian blacks and the other groups. For example, while men who have sex with men accounted for 24% of transmission among West Indian–born blacks, they accounted for 9% of transmission among Haitian immigrants, 74% among U.S.‐born whites and 32% among U.S.‐born blacks.

The researchers cite several limitations of their study. Data on new HIV diagnoses and people living with HIV or AIDS were missing information on the individual's country of origin in 18–23% of cases, physicians filling out HIV case reports may have assumed that some West Indian immigrants were U.S.‐born, immigrant populations tend to be undercounted and restrictions on HIV‐positive people entering the United States (now lifted) may have limited the numbers of infected individuals in immigrant groups. The researchers also note that using voluntary HIV testing to estimate HIV prevalence could result in underestimates if immigrants are less likely to get tested than are those born in the United States, and that it is not possible to truly know if an immigrant's infection is new (as it is for U.S.‐born individuals receiving diagnoses from U.S. health departments). However, they believe their findings "add to the growing literature demonstrating considerable diversity in health outcomes in the U.S. black population" and suggest further research exploring "the role that race assumes for foreign and native‐born blacks in creating risk for and protection from HIV/AIDS."—L. Melhado