Institutionalized Racism: “Black people are equal on paper, but the same can’t be said in practice. Changing laws hasn’t done enough to undo almost four hundred years of oppression that have led to countless disadvantages that black people have to overcome every day. HIV impacts black populations disproportionately because the majority don’t have adequate access to the tools to prevent and treat the disease. Through policies and procedures, institutionalized racism creates a system that implicitly and sometimes explicitly disadvantages people of color.”

Poverty: 28.1% of black people are living in poverty compared to the national average of 15.9%. This is in part due to the fact that black. Americans tend to have less opportunities than their white counterparts. Often living in poverty means a lack of education, decreased access to health care, increased risk of substance use and homelessness, and increased likelihood of engaging in sex work as a source of income; all of these factors increase the risk of acquiring HIV.

Health Disparities: Health Disparities may exist according to gender, race, education or income level, disability, sexual orientation, region and more. Social determinants of health, the social realities that have an impact on a person’s physical health, like poverty, lack of education, and racism, are linked to health disparities. HIV-related health disparities are the biological expression of social inequalities (unequal or unjust social conditions).

Medicaid Obstacles: Medicaid is the single largest source of coverage for people with HIV in the US. However, a Supreme Court decision ruled that Medicaid expansion under the ACA can only be available to uninsured people living in states that choose to implement it. As a result, twenty states have opted out of Medicaid, leaving an estimated 8.5 million uninsured Americans who would have qualified for full Medicaid coverage. In those states, Black Americans are twice as likely to be insured and more than six times as likely to have HIV. Most notably, in the Deep South, nine states with high rates of HIV/AIDS have chosen not to expand Medicaid.

Sexual Networks: Black Americans are known to be less likely to have relationships outside of their race; only 19% of Black Americans report to having relationships with people of other races. Given the population size, once the black community was exposed to HIV, it spread quicker and the negative impact was, and continues to be, greater; black people who choose other black partners are more likely to come in contact with someone who is HIV-positive than people of other races who date within their race. This is especially true in the LGBTQ communities of Black Americans. 25% of black gay and bisexual men and 50% of black transgender women are testing positive for HIV, compared to 0.06% of the general population who test positive.

Exaggeration of the Down-Low Brother: “Down low” is a concept rooted in homophobia that leads to misguided assumptions about HIV in black communities. As stated by HIV Plus Magazine, “studies have shown that the majority of black men who have sex with men do identify as gay or bisexual, and those who don’t are less likely to be HIV positive, have multiple male sexual partners or have engaged in unprotected anal intercourse in the past six months.” The “Down Low” concept implies that being gay or bisexual is something to be ashamed of and it assumes that if you are a HIV-positive man who identifies as heterosexual you must be lying about your sexual partners. Additionally, “if you are a HIV-positive woman, then you must have had sex with a man who wasn’t honest about his sexual partners, which eliminates the possibility of bisexuality and makes the woman the victim and void of the ability to empower herself and require protection during sex” (HIV Plus Magazine).

Homophobia in the Church: 87% of Black People identify as religious. As described by the HIV Plus Magazine, in the face of racial discrimination and hatred, the black church has always provided a sense of togetherness and belonging. However, when a black person comes out as LGBTQ, many churches don’t provide the same support; religious black Americans continue to make up a large portion of anti-gay America. Homosexuals are often equated to demons in church. When preachers give homophobic sermons, after church no one talks about it but to LGBTQ people, it can be very damaging. Unfortunately, the reality is that “black, gay and bisexual men and transgender women are in a state of emergency when it comes to HIV/AIDS, but they don’t have the full support of the black community” (HIV Plus Magazine).