HIV Disproportionately Affects African-American Women

By: Ranier Simons, ADAP Blog Guest Contributor

African-Americans are disproportionately burdened with HIV in comparison to other racial and ethnic groups. In 2019, African-Americans were 13% of the population but represented 42% of the new HIV diagnoses in the United States.[1] As a population group, African-Americans have higher rates of HIV in their communities, which increases the risk of infection by sexual contact or intravenous drug use.[2] Compared with other racial/ ethnic groups, there is no significant difference in the frequency of unprotected sex or practice of having multiple sex partners. The increased prevalence is positively correlated with the concentration of the number of infected people.

Men who have sex with men (MSM) of all ethnicities are the most affected subgroup of the national population in regards to HIV-infection. However, African-American women are significantly more impacted by HIV than women of other racial/ethnic groups. The rate of new infections in 2019 among black women was 11 times that of white women and four times that of Latina women.[2] Additionally, most of the transmission of HIV among black women occurs in heterosexual relationships.[3]

Disparities in various social determinants of health directly influence the disproportionate burden of HIV on the African-American community. Uniquely, African-American women sit at the intersection of many of those issues. Improving the HIV status quo among African-American women can not be viewed through individual discrete lenses of inequity. Intersectionality is what makes dealing with HIV among black women a challenge. 

Photo Source: CDC

African-American women are a gender minority, racial/ethnic minority, and sexual minority (those who are non-heterosexual). They simultaneously hold a heightened awareness of wearing many social and familial hats such as mother, sister, community leader, healer, friend, minister, etc. Race, class, and gender interact with social systems and power dynamics that work against African-American women.

Race and ethnicity have sociologically identified stigma that negatively affects African-American women's mental and physical health. They already deal with discrimination in terms of employment, microaggressions within and outside of the workplace, and even inequalities of treatment within the healthcare system. This negative self-view view regarding things external is further exacerbated by other devaluated identities such as sexual orientation, history of incarceration, or substance abuse.[4]

Layers of stigma and external societal infrastructure decrease the likelihood of HIV-positive African-American women coming forward to take care of themselves for the betterment of themselves and their communities. They not only hide their HIV-positive status from their friends and family but from themselves. Simultaneous devalued identities keep many African-American women on the sidelines and at home instead of seeking out and engaging in the services they need along the HIV care continuum.[4]

History of discrimination and mistrust of the healthcare system are established causes for disparities in healthcare utilization among African-Americans.[5] Culturally, African-American women are further affected by how sexually repressive African-American norms are regarding women and sexuality. Seeking out testing for sexually transmitted diseases (STD) or in-person resources regarding sexual health requires an open discussion about sexual behavior that many view as unacceptable. Moreover, culturally many African-American women feel it is unnecessary to think about STD testing and sexual health when they are in monogamous relationships with or without marriage. Additionally, studies have shown the widespread suspicion that most black women contract HIV from black men who secretly have sex with men is untrue.[6] 

Photo Source: The Root

The HIV problem in the African-American community cannot be solved externally or by the government. It requires efforts by members of the community. "The government can support research and training opportunities to prioritize women-centered prevention efforts led by African American or culturally competent women."[6] However, prevention and education initiatives need to be gender and culturally specific.

Reductions in stigma and increased social support have been correlated with viral suppression in African-American women.[6] Social support enables women to openly discuss their stresses with racism, relationships, health, and sexuality. Self-efficacy, empowerment, spirituality, and self-esteem enable African-American women to build resilience that allows them to reduce the effects of stigmas on their lives.[6]

Increased social support results in better self-efficacy, the belief that one is in control of their own life. Feeling in control of your life means you embody the self-value you need to make your health a priority. Empowerment can come in the form of racial pride, community pride, and economic empowerment.[6] Community empowerment results from creating spaces and networks to share skills, knowledge, and resources. Coupling HIV education with spirituality means soliciting faith-based organizations to develop relatable programs that create a safe space to discuss HIV and religion. Increased self-esteem leads to more robust mechanisms with which to handle and process stress and an increased likelihood of seeking out healthcare.[6]

One company that understands the need for focused intervention for black women and HIV is ViiV Healthcare. ViiV Healthcare has launched a program called 'Risk to Reasons'. The program's purpose is to refocus the dialogue from ‘risk’ to ‘reasons for HIV prevention’.[7] Over the next five years, ViiV will invest five million dollars to increase awareness and action around HIV prevention for black women. The funding is for grants to be utilized for programs and initiatives such as improving community-based initiatives that improve client/provider communication and collaboration with organizations outside of HIV-specific services that connect wholistically to women’s health and wellness. Requests for proposals can be submitted at https://viivhealthcare.fluxx.io/user_sessions/new.

[1] Centers for Disease Control and Prevention. (2022, February 4). HIV Diagnoses. Retrieved from https://www.cdc.gov/hiv/group/racialethnic/africanamericans/diagnoses.html
[2] HIV.gov. (2022, January 26). What Is the impact of HIV on racial and ethnic minorities in the U.S.? Retrieved from https://www.hiv.gov/hiv-basics/overview/data-and-trends/impact-on-racial-and-ethnic-minorities
[3] Mahon, C. (2019, May 10). Black women in the USA continue to be disproportionately affected by HIV, but there’s evidence that the gap may be slowly starting to close. Retrieved from https://www.avert.org/news/black-women-usa-continue-be-disproportionately-affected-hiv-there%E2%80%99s-evidence-gap-may-be-slowly
[4] VRao, D., Andrasik, M. P., & Lipira, L. (2018). HIV Stigma Among Black Women in the United States: Intersectionality, Support, Resilience. American journal of public health, 108(4), 446–448. https://doi.org/10.2105/AJPH.2018.304310
[5] Wyatt, G., Davis, C. (2020) Foreword: The paradigm shift–The impact of HIV/AIDS on black women and families: Speaking truth to power. Ethnicity and Disease. 30(2), 241-246. doi:10.18865/ed.30.2.241
[6] NPR.org. (2009, October 28th). Myth: HIV/AIDS rate among black women traced to 'down low' black men. Retrieved from https://www.npr.org/templates/story/story.php?storyId=114237523
[7] ViiV Healthcare. Risk to Reasons Initiative. https://viivhealthcare.com/content/dam/cf-viiv/viivhealthcare/en_US/pdf/2022-risk-to-reasons-pafw-rfp.pdf#:~:text=About%20Risk%20to%20Reasons%20ViiV%20Healthcare%20is%20expanding,HIV%2C%20with%20Black%20women%20bearing%20the%20greatest%20burden

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.