African Americans are the racial group most affected by HIV in the United States.

Blacks/African Americans account for a higher proportion of new HIV diagnoses and people with HIV, compared to other races/ethnicities. In 2018, blacks/African Americans accounted for 13% of the US population but 42% of the 37,832 new HIV diagnoses in the United States and dependent areas.

What is Race?

Race is as much a social category as a biological one. It is a way of explaining the differences in the way people live in society, including how healthy they are, based on differences in how they look and how they are treated accordingly. Race refers to the social conditions that people live under and how they affect their health, not how they look.

“Race is a powerful idea that has been used to separate people and make opportunities available to some people based on their race, while keeping the same opportunities out of reach for people of other races. Usually this process of racial separation has occurred in many generations, and become deeply embedded in the structure of society.”

What is Racism?

Racism is the system in which people are valued differently because of their race. The system does so by:

  • Unfairly disadvantaging some individuals and communities

  • Provides unearned advantage to other individuals and communities

  • Damages the whole society, because human resources get wasted when all people are not treated as valuable and supported in fully contributing to society

 

“Racism is not just a way to describe how individual people see or treat one another. A white person may have many friends of different races and have never harmed another person on purpose because of their race. However, that person still benefits from a system that has, for many generations and in many ways, put a higher value on the lives of white people than people of color.” – the Well Project 

How does Privilege Affect Race?

What is Privilege? 

“Privilege is a set of unearned and often invisible benefits experienced by people who, based on aspects of their identity, fit into social groups that have power: white race, middle to upper class, male, heterosexual, documented citizen, native English speaker to name a few.”

Examples of Privilege:

  • assuming that most of the people you or your children study in history classes and textbooks will be of the same race, gender or sexual orientation

  • Assuming that your failures will not be thought of as  due to your race or gender

  • Disregarding thinking about your race, class, gender, sexual orientation, disabilities, ect, on a daily basis

Important Factors of Privilege:

  1. It is often easier to notice oppression than privilege

  2. Privilege doesn’t mean you didn’t work hard.

  3. Privilege describes the kind of treatment everyone ought to experience.

  4. We need to understand privilege in the context of power system

  5. Privileges and oppressions affect each other, but they don’t cancel each other out. 

“Intersectionality is the idea that many parts of a person’s identity impact their life at the same time. Some of those aspects give them privilege, and some lead them to experience oppression. The parts of a person’s identity cannot be separated. For example: All women experience sexism. But the sexism that black women and white women experience will be different, because black women experience sexism that is also affected by racism” – the Well Project.

 

Thus, in order to provide the best possible care, services, and support, it is imperative that care providers, the government and other connected systems take intersectionality into account when studying HIV. As stated by the Well Project, “the differences in our experiences – the learning edges of power and oppression, privilege and vulnerability can, for our extraordinarily diverse HIV community, be sources of strength themselves."

What is Intersectionality?

Statistics on Race and HIV 

From the CDC: 

Today, there are 1.2 million people living with HIV/AIDS in the United States, including more than 498,400 who are black. African Americans are the racial/ethnic group most affected by HIV in the United States; gay and bisexual men account for a majority of new HIV diagnoses among African Americans. Black Americans have been disproportionately affected by HIV/AIDS since the epidemic’s beginning, and the disparity has deepened over time. Although they represent 12% of the US population, Black Americans account for 44% of the new HIV diagnoses, 40% of the people estimated to be living with HIV, and 44% of HIV related deaths. They account for the largest percentage of individuals in each category out of all the racial groups in America. Among Black Americans, Black women, youth and gay and bisexual men have been especially hard hit. 

2018 CDC Study on HIV and Race: 

  • Blacks/African Americans account for a higher proportion of new HIV diagnoses and people with HIV, compared to other races/ethnicities

    • 15,133 African Americans were diagnosed with HIV in the US in 2018

    • 80% of these diagnoses were gay or bisexual men

  • 42% of those diagnosed with AIDS in the United States were African Americans

  • In 2017, there were 7,053 deaths among adult and adolescent blacks/African Americans with diagnosed HIV in the US and dependent areas. These deaths may be due to any cause.

  • The poverty rate among African Americans is high. The socioeconomic issues associated with poverty—including limited access to high-quality health care, housing, and HIV prevention education—directly and indirectly increase the risk for HIV infection and affect the health of people living with and at risk for HIV. These factors may explain why African Americans have worse outcomes on the HIV continuum of care, including lower rates of linkage to care and viral suppression.

1 in 16 black men and 1 in 32 black women will be diagnosed with HIV.

Race and Men who have Sex with Men (MSM): 

In 2018, the CDC compared the rates of New HIV Diagnoses among the population of men who have sex with men. In the study, the CDC found that among different races and ethnicities that black men who have sex with men have the highest rates of new HIV diagnoses out of all racial categories studies. Below is a graph that shows this data: 

Contributing Factors to High HIV Rates in Black Americans: 

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).

How do Prevention Challenges Relate to Race?

Some of the large prevention barriers to HIV prevention are: lack of awareness, lack of education, high poverty rate, and already existing HIV statuses. In African American communities, there is a greater prevalence of HIV. The high HIV rate compounded with the fact that African Americans tend to have sex with partners of the same race/ethnicity means that African Americans face a greater risk of HIV infection with each new sexual encounter. Additionally, the socioeconomic issues associated with poverty, including limited access to high-quality health care, housing and HIV prevention education directly and indirectly increase the risk for HIV infection and affect the health of people living with and at risk for HIV. The inadequate access to quality health care for African Americans may explain why African Americans have the worst outcomes on the HIV continuum of care, including lower rates of linkage to care and viral suppression. Finally, stigma, fear, discrimination and homophobia place many African Americans at higher risk for HIV.

 

Additionally, the epidemic of HIV among Black Americans is not uniformly distributed. The South accounts for the majority of Blacks newly diagnosed with HIV; 63% of blacks diagnosed with HIV in 2015 lived in the South.

The South, Race and HIV

The South is disproportionately affected by HIV: 

Unfortunately, many poor black Americans living in the South distrust the government. This is mainly due to the Tuskegee Syphilis Experiment, an infamous clinical study conducted between 1932 and 1972 by the US Public Health Service. The purpose of the experiment was to observe the natural progression of untreated syphilis in rural African-American men in Alabama under the guise of receiving free health care from the United States government. As a result, some black Americans in the South are skeptical of HIV medication. It is unclear if African Americans will ever get over their fear of government systems due to the Tuskegee study. Thus, the high rates of poor black Americans in the South with HIV may continue to increase if the United States government can not revert this distrust. 

Stigma and a Black Woman

Statistics of Black Women with HIV:

¼ of people diagnosed with HIV are women

  • 61% of women diagnosed with HIV are African American

  • African American and Latino women represent 30% of all women in the US but they account for approximately 80% of HIV cases among wome

Why the Stigma?

The stigmatization of HIV-positive black women is because African American sexuality has been misconstrued for decades. The stigma for Black women is "coupled with historical negative images of African American women as sexually loose and can further complicate HIV-related stigma for black women." These historical negative images of African American women was developed during slavery; “plantocracy was an industry that capitalized on the sexual misuse of the Black body, while at the same time naming the Black body as culpable. In this way, stereotypes (such as enslaved women welcomed all sexual advances) were used to highlight difference so that it would appear factual instead of bigoted, and these myths helped to formulate societal perceptions that benefited the status quo." Thus, the image that African American stereotypically signals an image of a wild, excessive sexual appetite that cannot be contained remains one of the images reproduced in the HIV/AIDS narrative.

Challenges in the African American Community

1 in 7 blacks/African Americans with HIV are unaware they have it. People who do not know they have HIV cannot take advantage of HIV care and treatment and may unknowingly pass HIV to others.

 

African American men and women have higher rates of some sexually transmitted diseases (STDs) than other racial/ethnic communities. Having another STD can increase a person’s chance of getting or transmitting HIV.

 

The poverty rate among African Americans is high. The socioeconomic issues associated with poverty—including limited access to high-quality health care, housing, and HIV prevention education—directly and indirectly increase the risk for HIV infection and affect the health of people living with and at risk for HIV. These factors may explain why African Americans have worse outcomes on the HIV continuum of care, including lower rates of linkage to care and viral suppression.


Stigma, fear, discrimination, and homophobia may prevent African Americans from accessing HIV prevention and care services.

In 2017, there were 7,053 deaths among adult and adolescent blacks/African Americans with diagnosed HIV in the US and dependent areas. These deaths may be due to any cause.

Disproportionality

Although they represent only 12% of the U.S. population, Blacks account for a much larger share of HIV diagnoses (43%), people estimated to be living with HIV disease (42%), and deaths among people with HIV (44%) than any other racial/ethnic group in the U.S.

  • The rate of new HIV diagnoses per 100,000 among Black adults/adolescents (47.5) was 8 times that of whites (5.6) and more than twice that of Latinos (20.9) in 2018 (see Figure 2).The rate for Black men (74.8) was the highest of any group, twice that of Latino men (36.4), the second highest group. Black women (23.1) had the highest rate among women.

  • In 2018, three quarters (76%) of Blacks over age 18 report ever having been tested for HIV and they are more likely than Latinos or whites to report having been tested (58% and 50%, respectively).

  • Among those who are HIV positive, 20% of Blacks were tested for HIV late in their illness – that is, were diagnosed with AIDS within 3 months of testing positive for HIV; by comparison, 22% of whites and 21% of Latinos were tested late.

  • Looking across the care continuum, from HIV diagnosis to viral suppression, missed opportunities are revealed. Eight-five percent (85%) of Blacks with HIV are diagnosed, 60% are linked to care, and 46% are virally suppressed. Compared with Whites, Blacks are less likely to have reached each of these goals in the continuum – diagnosis, linkage to care and viral suppression and thus disparities are likely to persist.

Effect of Geography

  • Although HIV diagnoses among Blacks have been reported throughout the country, the impact of the epidemic is not uniformly distributed.

  • Regionally, the South accounts for both the majority of Blacks newly diagnosed with HIV (63% in 2018) and the majority living with an HIV diagnosis at the end of 2017 (58%).

As with the nation as a whole, HIV diagnoses among Blacks are clustered in a handful of states, with the 10 states with the highest number of Blacks living with an HIV diagnosis accounting for the majority (84%) of cases among Blacks in 2018 (see Figure 3). Florida and New York top the list. In addition, the District of Columbia had the highest rate of Blacks living with an HIV diagnosis at the end of 2017 (3,799.3 per 100,000).

“I think it’s cruel. It’s (media coverage of African people with HIV) only expanding the stigma. It’s pushing people away instead of encouraging people with HIV to come forward and talk about stigma.”

– Linda, African woman living with HIV in Canada

“AIDS isn’t the heaviest burden I have had to bear, being black is the greatest burden I’ve had to bear. No question about it, race has always been my biggest burden, having to live as a minority in America.”

– Arthur Ashe

Quotes

“My situation is not rare; there have been hundreds of reported and unreported prosecutions in the South and all over the US with similar situations to mine. Of course, each personal experience is different, but one thing is for sure: the profoundly stigmatizing effect, our families and our future.”

– Robert Suttle (Assistant Director of the Sero Project, a network of people living with HIV and allies fighting for freedom from stigma and injustice)

“A common misconception about the higher prevalence of HIV among black people is that it is caused by engaging in more risk-associated behaviors. Several studies demonstrate that black Americans do not necessarily engage in more high-risk behaviors than others.”

– Greg Millet (CNN reporter)

“The ways they talk about us in the media – it makes you feel worthless. It’s a huge problem for us African people living with HIV. We talk amongst ourselves and we are scared.”

– Linda, African woman living with HIV in Canada

Sources

http://www.cdc.gov/hiv/group/racialethnic/africanamericans/

 

http://www.avert.org/professionals/hiv-around-world/western-central-europe-north-america/usa

 

http://www.blackaidsday.org/blacks-hiv-aids.html

http://www.hivplusmag.com/stigma/2016/1/18/5-reasons-why-black-people-are-more-affected-hiv#slide-4

 

http://kff.org/hivaids/fact-sheet/black-americans-and-hiv-aids/

http://aidsvu.org

http://www.essence.com/2015/03/08/essence-network-aids-activist-hydeia-broadbent-life-love-and-end-hiv

https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-report-vol-21-4.pdf

https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2015-vol-27.pdf

https://www.facebook.com/blackaids/

https://www.facebook.com/NBLCA/

http://www.ibtimes.com/national-youth-hiv-aids-awareness-day-quotes-10-inspirational-sayings-1876760

http://www.cnn.com/2015/02/07/opinion/millett-blacks-hiv/index.html

http://www.thewellproject.org/hiv-information/why-race-matters-women-and-hiv

https://www.cdc.gov/hiv/group/racialethnic/

http://www.kff.org/hivaids/fact-sheet/black-americans-and-hivaids-the-basics/

http://www.npr.org/templates/story/story.php?storyId=128639307

http://www.webmd.com/hiv-aids/hiv-aids-in-blacks-alarming-crisis#1

http://www.cnn.com/2015/02/07/opinion/millett-blacks-hiv/index.html

http://www.theroot.com/quote-of-the-day-arthur-ashe-on-aids-and-racism-1790897778

http://www.separatinghyperplanes.com/2014/01/that-hiv-study-doesnt-show-what-you.html

https://www.cdc.gov/hiv/basics/statistics.html

https://www.cdc.gov/hiv/group/gender/transgender/index.html

http://www.pbs.org/wgbh/frontline/article/race-and-americas-hiv-epidemic/

http://www.thebody.com/content/80034/skewed-stories-race-and-hiv-criminalization-in-the.html

http://www.pbs.org/wgbh/frontline/article/20-years-after-hiv-announcement-magic-johnson-emphasizes-i-am-not-cured/

https://newsone.com/2882057/magic-johnson-hiv-2/

http://www.amfar.org/about-hiv-and-aids/facts-and-stats/statistics--women-and-hiv-aids/

http://www.jstor.org/stable/23884880?seq=2#page_scan_tab_contents

https://www.cdc.gov/hiv/group/racialethnic/africanamericans/

https://www.kff.org/hivaids/fact-sheet/black-americans-and-hivaids-the-basics/

All graphics by Jaclyn Saik

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