Failure and Opportunity: HIV/AIDS in Black America

Release Date: 
Tuesday, February 7, 2012

Op-Ed from the STI/HIV Intervention Network

Alida Bouris and Matthew Epperson
Assistant Professors, University of Chicago School of Social Service Administration

Today is National Black HIV/AIDS Awareness Day. America has made incredible progress in the 31 years since AIDS was first diagnosed. Mother-to-child transmission of HIV has been virtually eliminated and antiretroviral medications have saved thousands of lives. In 2010, the Obama Administration released the National HIV/AIDS Strategy, the first plan to coordinate local, state and federal efforts in the fight against HIV/AIDS. That same year, President Obama lifted the 22 year-old travel ban barring persons living with HIV/AIDS from entering the U.S., a long overdue victory for human rights. With the enactment of health reform, American children living with HIV can no longer be denied treatment because of a "pre-existing" condition or because an insurer does not cover accepted standards of HIV care. Similar protections for adults will commence roughly two years from now. And last year, researchers discovered that giving antiretrovirals to healthy people living with HIV can reduce the risk of transmitting the virus by 96%, a finding that has led many voices to (once again) herald "The End of AIDS."

These victories should be celebrated. Yet on a day such as today, we must also recognize one of our greatest failures in combating this terrible disease: Since the earliest days of the epidemic, HIV/AIDS has disproportionately affected African American communities, and the Black/White disparity has never been greater.

According to the Centers for Disease Control and Prevention, Black men and women represented 44% of all new HIV cases in 2009, with the majority of infections occurring among young Black men who have sex with men (MSM). Among all Americans, Black MSM aged 13-29 is the only group for whom HIV has been increasing.

HIV is also concentrated within the U.S. criminal justice system, a system that so disproportionately impacts African Americans. Black women, whose rate of new HIV infections is more than 15 times that of White women and who represent nearly a third of all incarcerated women, have a higher prevalence of HIV than any other incarcerated population in the U.S.

If current trends continue, it is estimated that 1 in 32 Black women and 1 in 16 Black men will be diagnosed with HIV during their lifetime.

These statistics should give us all pause—the face of HIV/AIDS in the U.S. is increasingly young and Black. This alarming trend is exemplified in our city of Chicago, where Blacks represent one third of the city's population but accounted for 61% of HIV diagnoses in 2009, and where HIV diagnoses among 13-19 year olds increased by 50% from 2003 – 2009. Numerous studies have shown that African American men and women have similar levels of risk behaviors to those of other Americans. Yet the simple fact that people tend to have sex with partners of the same race perpetuates, at times even accelerates, existing disparities across different population groups. Among African Americans, a high current prevalence of HIV, lack of access to HIV testing, and less awareness of HIV status, mean that sexual behaviors that would otherwise bear low to moderate risk become more dangerous.

In the midst of proclamations that we will eliminate HIV and AIDS in the U.S., we must advocate for the political and financial resources to support the Black community in the fight against HIV/AIDS. Focused efforts to combat stigma and discrimination towards people living with HIV/AIDS are desperately needed. This advocacy is especially important given political rhetoric that demonizes homosexuality, condoms, and contraception. It is equally important to rebut attempts to cut key state and federal public health programs, as these cuts have disproportionate racial impacts. Numerous states have already reduced support for the AIDS Drug Assistance Program, which has restricted access to life-saving medications for thousands of low-income persons. Business as usual cannot be allowed to continue.

Right now, advances in biomedical, behavioral, and structural interventions have the potential to stem the epidemic among African Americans. Such progress will only occur if these approaches are strategically and effectively made available in a manner that respects, supports, and joins forces with the Black community. Our success as a nation in combating HIV/AIDS is inextricably linked to how and when we remedy the unequal burden of this disease on African Americans.

In July, the world will come to Washington DC to address the global HIV/AIDS pandemic. The return of the International AIDS Conference to this country comes at a critical time. As the world's attention is drawn to the U.S. and the unique impact of HIV/AIDS on Black America, one question remains: Will we seize this moment, or will we once again miss a precious opportunity to save lives?