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.  

HIV & COVID-19 in Southern Black Communities

By: Venton C. Hill-Jones, Chief Executive Officer, Southern Black Policy & Advocacy Network

It is no secret that Black Americans in the U.S. South lead our nation in diagnoses and deaths caused by HIV, cancer, diabetes, hypertension, obesity, high cholesterol and lack of mental health resources. Knowing this, it came as no surprise that the Black community would also lead the nation per capita in diagnosed and undiagnosed cases of COVID-19, as well as the virus’ mortality rate. According to amfAR, The Foundation for AIDS Research, Black communities are facing a disproportionate impact of COVID-19 in the U.S. South. 

In a May 2020 study conducted by amfAR, it was reported that in the United States: “COVID-19 diagnoses and deaths increased in counties with a greater proportion of Black residents. While disproportionately Black counties constitute only 22% percent of U.S. counties, they account for 52% and 58% of COVID-19 cases and deaths, respectively. Ninety-one percent of disproportionately Black counties are located in the Southern U.S.” 

During the COVID-19 pandemic, SBPAN has worked to utilize social media and digital engagement (web meetings, virtual conferences, etc.) to continue the dialogue with Black public health and community leaders representing, and serving, these Southern Black communities. Through our engagement, we have found that many leaders feel that, prior to COVID-19 pandemic, conversations and actions surrounding the overarching state of public health in the South were limited. As a result, Black communities living in the U.S. South face a disproportionally high number of health disparities directly linked to the social and economic barriers rooted in the unique history of racism, religion, segregation, and slavery in the U.S. South. Because of this environment, the U.S. South remains the epicenter of health disparities that continue to reduce the morbidity and mortality of Black communities living in this part of the United States.

As we navigate the COVID-19 pandemic, social unrest and the ongoing call for racial equity in the South, we must focus our conversations and mobilization efforts on addressing intersecting epidemics and social challenges. Now is not the time to regress in having open dialogues, showing human solidarity and human perseverance, nor showing collective support for our society. Look at how promptly we bonded together to administer personal prevention essentials (PPE), enacted federal/state legislations and local ordinances to assist families and individuals with food, housing, and supplemental income that have been financially impacted, or ensured everyone that wants to get tested has the unencumbered availability to do so. Now imagine if we utilized those same strategies, focus, and fortitude and applied them to the same public health emergencies that will remain once COVID-19 is gone?  

People living with HIV/AIDS in the Black community mirror the same external barriers that require the exact same meaningful impact that we have responded to COVID-19 with. There are basic human right essentials including employment and housing that we need all local municipalities to pass anti-discrimination ordinances against. Only through solidarity and perseverance can we collectively make further progress in addressing health disparities for southern Blacks."

About the Southern Black Policy & Advocacy Network. SBPAN is a non-profit 501(c)(3) organization that was created in 2018 to improve health, social, and economic conditions facing Black communities living in the U.S. South. SBPAN's mission is to improve health outcomes and reduce social, and economic disparities impacting Black communities living in the U.S. South through training, education, advocacy and mobilization. SBPAN is committed to building and strengthening programs and partnerships focused on improving the health and quality of life for diverse populations of Black southern communities in the U.S., specifically those living at the intersection of marginalized Black communities including, but not limited to those who are same gender loving (SGL), lesbian, gay, bisexual, transgender (LGBT), youth, women, and persons over the age of 55. Donate to Southern Black Policy and Advocacy Network.

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. 

Black, Gifted & COVID-19 Free

By: Guy Anthony, President/CEO, Black, Gifted & Whole Foundation

Recently, as I scrolled through the news, I froze reading a headline: “Only 6% of coronavirus deaths caused by COVID-19.” 

Suddenly unable to hear, see, or feel my surrounding, I was taken back to March on the day I began experiencing COVID-19 symptoms. I was taken back to three weeks that followed. I was taken back to the anxiety and the immense feeling of the unknown. 

I was symptomatic when I was self-diagnosed. Every day I dreaded the possibility of waking up to the realization that I was becoming sicker by the minute. Would my symptoms be taken seriously? Would I be able to see a doctor before my symptoms got too severe? Would a hospital treat me with the same care knowing I have a preexisting condition?

I am a Black, queer, HIV-positive man living in America. I have lived with HIV for 15 years. I have learned that society is not built to protect me. Laws are not made to protect me. Healthcare is not built to protect me. 

When the pandemic started, I immediately became concerned about getting food and my daily medications. In order to keep my immune system healthy, more so than the average person, I rely on fueling my body with healthy foods and religiously taking my prescribed medicine. I also know that healthcare in the United States is segregated. As a Black, queer, HIV-positive man, I am almost guaranteed to get inadequate healthcare compared to my white, heterosexual, HIV negative male counterparts. Black men are more likely than white men to have their pain ignored or deemed not severe. Queer men are more likely than heterosexual men to be refused care and abused in medical settings. HIV positive patients are more likely than HIV negative patients to have other health conditions go undiagnosed or untreated.

I live daily in fear that being Black, being queer, and being-HIV positive negatively influence the healthcare I receive. As doctors and medical professionals dealt with an influx of COVID-19 patients, priority was given to patients who were the most ill. I worried that by the time I got “bad enough” to receive care, my HIV status and weakened immune would complicate my care, and it would be too late. 

Fortunately, after three weeks, my immune system fought off the virus. I tested negative. A small sense of relief washed over me. But I still carry the weight of knowing my Blackness, my queerness, and my HIV-status puts me at risk when I am walking down the street, when I tell someone who my partner is, and when I develop any illness in the future, including a possible recurrence of COVID-19. 

After a few minutes of staring at the headline that brought me back to March, I grounded myself. As I sat with the article proclaiming just 6% of coronavirus deaths are caused by COVID-19, I knew this number would be used to minimize deaths of people similar to me who were HIV-positive at the time of their death. HIV may have complicated their deaths, but if it were not for COVID-19, they would still be alive. 

In light of what I experienced, we created the The BLACK BOX Care Program to address the myriad of concerns affecting Black queer students during the COVID-19 global pandemic. Many student have been displaced and are in need of tangible support.  Each box varies and is stocked full of our 5-year anniversary merchandise, offerings from Black Queer authors such as Yolo Akili and George Johnson, and additional contributions from Black Queer entrepreneurs like The Blairisms, THRIVE SS, The Mindful Techie & The LAMDA Lounge. We have already sent out 50 Blackboxes to students in need.

The future of the COVID-19 pandemic is unclear. No one knows precisely when it might end. There is a possibility that I can be infected again. Thousands of people, similar to me, are dying weekly. However, I realize while it can be easy to live in immense fear and despair, I look towards the community, the encouragement, and the positivity at the Black, Gifted, and Whole Foundation. It gives me the motivation and inspiration to keep moving forward. 

About Black, Gifted & Whole Foundation: The Black, Gifted & Whole Foundation (BGW) represents a revolutionary attempt to improve the collective narrative of Black Queer folx. Their mission is to empower, educate and mobilize Black Queer folx by acknowledging, celebrating and affirming their whole selves. BGW believes that Black Queer folx are multifaceted and deserve innovative and meticulously researched approaches when being engaged. They believe that Sexual Health + Higher Education + Access to Resources can drastically improve the trajectory of their lives. BGW — conduct intake of — young Black Queer folx while in High School, College, or Graduate School, assess their needs, aspirations and sexual health awareness and provide them with financial and emotional support. Donate to Black, Gifted & Whole Foundation.

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.