Greg Millet, MPH Vice President and Director, Public Policy amfAR, The Foundation for AIDS Research

1. HIV & Global Health Rounds
The UC San Diego AntiViral Research Center sponsors weekly
presentations by infectious disease and global public health clinicians,
physicians, and researchers. The goal of these presentations is to
provide the most current research, clinical practices, and trends in HIV,
HBV, HCV, TB, and other infectious diseases of global significance.
The slides from the HIV & Global Health Rounds presentation that you
are about to view are intended for the educational purposes of our
audience. They may not be used for other purposes without the
presenter’s express permission.

2. COVID-19 disparities in Black & Latinx
Communities: Implications for Vaccine
Recruitment
Greg Millett
amfAR, Foundation for AIDS Research
UCSF Grand Roun ds
December 4, 2020

4. COVID-19 death rates by race greater in every age
cohort
•Risk of dying at age
50 among blacks is
same as risk of
dying among whites
at age 65

5. COVID-19 Diagnoses and Deaths among Youth (<21 yrs
old) are Disproportionately Latinx

6. • 91% of disproportionately black
counties are located in the
southern US
• COVID-19 cases and deaths
increased with proportion of blacks
residents in counties
• 97% of disproportionately black
counties had at least one COVID-19
diagnosis by mid-April
• compared to only 80% of all
other counties
• 49% of black counties had at least
one COVID-19 death by mid-April
• compared to 28% of all other
counties
COVID-19 Impact in Counties with Greater than Average Black Residents

8. Proportion of COVID-19 cases among Latinx across States
Greater than Percent of Latinx Residents, May 20, 2020

9. COVID-19 diagnoses in Latinx counties
• Latino counties 4%
• Latino counties 32%
of cases
• Latino counties 11%
• Latino counties 63%
of cases

10. COVID-19 Cases & Urbanicity Black & Latino U.S. Counties
Latino Counties
●
●
●
●
●
●Noncore
Micropolitan
Small metro
Medium metro
Large fringe metro
Large central metro
0.8 1.2 1.6 2.0
Risk Ratio (95% CI)
Urbanicity
Black Counties
COVID cases
higher in
counties w more
black residents
no matter metro
size or level of
urbanicity
COVID cases
higher in
counties w
more Latino
residents in
medium
metro to rural
areas

11. Both HIV & COVID-19 disproportionately impact
communities of color
(O’Neill Institute, 2020)

12. • “….while health care accounts for
some 10 to 20 percent of the
determinants of health,
socioeconomic factors and factors
related to the physical environment
are estimated to account for up to
50 percent of the determinants of
health”

14. The Social Determinants of Health
Underlying health
conditions
Social determinants
of health
(Poteat et al, 2020)

16. COVID-19 is concentrated in poorer communities of color
COVID-19 mortality 19
times higher in racially
diverse counties with
lower incomes compared
to primarily white
counties with higher
incomes

19. (Fairlie et al, May 2020)Stanford Institute for Economic Policy Research

20. Uninsurance due to job loss by race/ ethnicity

21. COVID-19 and Residential Segregation
(Millett et al, 2020)

22. (amfAR infographic available at: https://ehe.amfar.org/amfAR_Context_Matters_COVID-19.pdf )

23. Cities with greater Latino-White segregation
have higher COVID-19 cases and deaths
COVID-19 cases COVID-19 deaths

24. COVID-19 Testing not Located in Black or Brown
Communities

25. COVID-19 Risk is Rising in the Latinx Community
Since Economy Re-Opening

26. Figure 1: 7-Day Moving Average of New COVID-19 Cases per 100,000 by Percentage of Latinx
Population in California, Florida, Texas, and Nation (March 1 – June 29, 2020)
California Florida
Texas National
Counties > 18.6% Latinx Population Counties < 18.6% Latinx Population
May 15: Many
states begin to
re-open
https://ehe.amfAR.org COVID-19 diagnoses since reopening the US have disproportionately impacted Latinx communities

27. Non-English speakers are more likely to be
diagnosed with COVID-19

28. Detention centers record more than 5,000
COVID-19 infections nationally

29. Latinx life expectancy has decreased due to COVID-19

30. COVID-19 Diagnoses Differ by Latinx Population
(greater among Puerto Ricans & Central Americans)

31. COVID-19 and H1N1: Same Outcomes A Decade Apart

32. The current surge and impact on Black
communities
(ehe.amfar.org/inequity )

33. The current surge and impact on Latinx
communities
(ehe.amfar.org/inequity )

34. Similar COVID-19 disparities in
Canada, Europe and South
America

35. Early emergence of COVID-19 disparities in Nordic Countries
• In Norway, 15% of residents born
abroad accounted for 25% of COVID-
19 diagnoses by April 19
o425 cases among Somalis (6% of all
confirmed cases -- more than 10 times
their share of the population).
• Immigrants in Sweden also at risk
o5% of cases between March 13 and April
7 (7 times their share of the population)
oIraqis, Syrians, also Turks also a greater
risk in Rinkeby-Kista district north of
Stockholm
• 47 cases per 10,000 vs regional average 13
cases per 10,000

36. Racial and Ethnic COVID-19 disparities in Toronto

37. Racial Disparities
in Brazil
Proportion of
COVID-19 deaths
according to
race/color, date of
publication, and
Epidemiological
Week
Proportion of
COVID-19
hospitalizations
according to
race/color, date of
publication, and
Epidemiological
Week

38. COVID-19 disparities by income and education levels
Brazil education level
(deaths vs recovered)

40. Implications for COVID-19 vaccine
participation

41. Black Americans, Mistrust and HIV
(Bogart, 2005)
Mistrust is enduring…. A 2016
update believed that:
• HIV is man-made (31%)
• the government is
withholding a cure for HIV
(40%)
(Bogart, 2018)

42. Black Americans and COVID-19 Vaccine
Mistrust, April-May 2020

45. Flu Vaccination Coverage Remains Low
Among Blacks, Latinos & American Indians

47. The messenger matters…..
• “barely two in 10 Americans”
would take a COVID-19 vaccine if
President Trump declared it safe.
• In comparison, 62% would take
it if their doctors declared it safe
• 54 % would take it if the Food
and Drug Administration
deemed it safe. (Ipsos-Axios poll)

48. Can we address people’s basic needs first?

49. Other leverage points for recruitment
• Transparency
• Depoliticization
• (new admin, more trust?)
• (trial results being released after the
election is good)
• Influencers in black community
(morning show hosts, sports stars,
musical artists, HBCU)
• Enduring established relationships
• Don’t parachute in and out of
community
• Learn from HIV work and community
engagement
• Use volunteer testimonials
• Particularly those who were
adamantly opposed and changed
their minds
• President Obama/ VP Kamala
Harris taking the vaccine

50. Summary
• Communties of color are at
greater risk for COVID-19
• These disparities appeared early
and are enduring
• Same disparities observed for
other health issues
• Failure to address SDOH
reinforce disparities
• The COVID-19 pandemic affects
communities of color financially
as well as disease burden
• Policies magnify risk
• Reopening country too soon
• Segregation
• Lack of testing in communities at
risk
• The latest COVID-19 surge may
impact communities of color
• COVID-19 racial disparities are
also evident in other countries
• Recruitment in vaccine trials is
possible despite mistrus

52. (Photo: Mario Tama; Artist: Pony Wave)
Greg Millett
Greg.Millett@amfAR.org
DASHBOARD
Race & COVID data
https://ehe.amfar.org/inequity/