Dermatology: Practical and Conceptual Commentary | Dermatol Pract Concept. 2023;13(3):e2023167 1 Kaposi's Sarcoma, a Gateway to Understanding Healthcare Disparities Present in the Racial Minority Communities of America Michelle Anthony1, Christopher Farkouh2, Parsa Abdi3 1 University of Arizona College of Medicine, Tucson, AZ, USA 2 Rush Medical College, Chicago, IL, USA 3 Memorial University Faculty of Medicine, St. John’s, Newfoundland, Canada Citation: Anthony MR, Farkouh C, Abdi P. Kaposi's Sarcoma, a Gateway to Understanding Healthcare Disparities Present in the Racial Minority Communities of America. Dermatol Pract Concept. 2023;13(3):e2023167. DOI: https://doi.org/10.5826/dpc.1303a167 Accepted: January 30, 2023; Published: July 2023 Copyright: ©2023 Anthony et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding author: Michelle Anthony 2069 East Cedar Place, Chandler, AZ 85249 Phone: 4803530913 E-mail: michelleanthony@ arizona.edu Kaposi sarcoma (KS) is a spindle cell malignancy derived from endothelium cells and is caused by human herpesvirus-8 (HHV-8) [1]. Clinically, it often presents as a patch that progresses into purple to reddish-brown nodules. KS is commonly subdivided into four known variants, namely, AIDS-associated, classic, African, and iatrogenic [2]. KS has increased incidence in individuals with human immunode- ficiency virus (HIV) due to immune dysfunction allowing for the proliferation of oncogenic HHV-8 [3]. In the United States, highly active antiretroviral treatment (HAART) for HIV has decreased the incidence of KS by improving im- mune function. Still, the current trends of KS in America il- lustrate the racial disparity prevalent in the U.S. healthcare system [4]. Hsieh et al. evaluated racial/ethnic differences in soft tissue sarcoma trends and incidence. They found that from 1995–2008 there was a higher incidence of KS in Black and Hispanic males compared to White males [5]. Similarly, Royse et al. analyzed the Surveillance, Epidemiology, and End Results (SEER) database to determine the incidence of KS by race and geographic location from 2000 to 2013. Their finds suggest KS significantly decreased in White males but increased in Black males, especially from the US south- ern states (Figure 1). Compared to other races, Black males in the south developed KS six times more frequently and were more likely to pass away (Figure 1). The increased rates of KS in southern states may be due to decreased HIV testing and treatment prevalent in these states [6,7]. Furthermore, HAART compliance and use are lower in Black males, lead- ing to an increased risk of HHV-8 activation and subsequent KS [7]. Higher rates of poverty and lower education rates adversely affect access to healthcare needed to prevent and treat HIV. In 2016, Black Americans comprised 54% of HIV diagnoses in southern individuals, of which 59% were men who had sex with men [8]. HIV is a stigmatized illness, especially in racial and mi- nority communities, and decreased acceptance of homo- sexuality in the south can hinder homosexual males from obtaining needed health care. In addition, stigma adversely reduces social support, resulting in increased psychological 2 Commentary | Dermatol Pract Concept. 2023;13(3):e2023167 distress and decreased efforts to prevent transmission through harm reduction [9]. The studies indicate an increasing need to tackle racial disparities in accessing diagnostic tools, physicians, and treat- ment for HIV to prevent unnecessary comorbidities like KS. Working with federal agencies to address socioeconomic factors like decreased education and increased incarceration rates that exacerbated HIV-related disparities is essential. To improve HIV testing in racial communities, it is crucial to implement clinical and non-clinical settings that promote feasible accessibility to HIV testing. Many Black American men distrust the medical system, which can lead to decreased access and adherence to HAART [10]. This needs to be ad- dressed by training culturally competent physicians focused on providing a therapeutic patient-provider relationship. Further studies need to be performed to understand health- care disparities and effective methods to address the trans- mission of HIV and the comorbid development of KS in racial minority communities [9]. References 1. Lebbe C, Garbe C, Stratigos AJ, et al. Diagnosis and treatment of Kaposi's sarcoma: European consensus-based interdisciplinary guideline (EDF/EADO/EORTC). Eur J Cancer. 2019;114:117- 127. DOI:10.1016/j.ejca.2018.12.036. PMID: 31096150. 2. Radu O, Pantanowitz L. Kaposi sarcoma. Arch Pathol Lab Med. 2013;137(2):289-294. DOI:10.5858/arpa.2012-0101-RS. PMID: 23368874. 3. Godbole S, Ghate M, Mehendale S. Understanding racial diversi- ties in Kaposi's sarcoma. Indian J Med Res. 2019;149(3):319-321. doi:10.4103/ijmr.IJMR_2164_18. PMID: 31249194. PMCID: PMC6607822. 4. Kumar V, Soni P, Garg M, Hashmi AT, Chandra AB. 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DOI:10.2147 /CCID.S380167. PMID: 36003526. PMCID: PMC9394645. 8. Nunn A, Jeffries WL 4th, Foster P, et al. Reducing the African American HIV Disease Burden in the Deep South: Address- ing the Role of Faith and Spirituality. AIDS Behav. 2019;23 (Suppl 3):319-330. DOI:10.1007/s10461-019-02631-4. PMID: 31444712. PMCID: PMC6800644. 9. Kenya S, Okoro I, Wallace K, Carrasquillo O, Prado G. Strat- egies to Improve HIV Testing in African Americans. J As- soc Nurses AIDS Care. 2015;26(4):357-367. DOI:10.1016/j .jana.2015.04.001. PMID: 26066691. PMCID: PMC4489406. 10. Dale SK, Bogart LM, Wagner GJ, Galvan FH, Klein DJ. Medical mistrust is related to lower longitudinal medication adherence among African-American males with HIV. J Health Psychol. 2016;21(7):1311-1321. DOI: 10.1177/1359105314551950. PMID: 25293970. PMCID: PMC4388759. Figure 1. Kaposi sarcoma incidence in the US by race, 2000–2013. Copyright © 2017 Royse et al [6].