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.  

UPDATED: National HIV/AIDS Strategy

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

One of the signature domestic policy accomplishments under the Presidency of Barack Obama was the first-ever unveiling of a National HIV/AIDS Strategy in the United States. It might have been decades overdue, but it represented a significant paradigm shift in how public health addressed HIV in this country. On World AIDS Day 2021, President Joseph R. Biden, Jr. renewed the commitment made by his former boss with the release of the updated National HIV/AIDS Strategy for the United States 2022-2025. The news was received by the HIV community with applause.

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Upon issuing the Proclamation on World AIDS Day, 2021, President Biden referenced the updated Strategy by saying: 

"My Administration remains steadfast in our efforts to end the HIV epidemic, confront systems and policies that perpetuate entrenched health inequities, and build a healthier world for all people.  Earlier this year, I reinstated the White House Office of National AIDS Policy to coordinate our efforts to reduce the number of HIV infections across our Nation.  This week, my Administration is releasing an updated National HIV/AIDS Strategy to decrease health inequities in new diagnoses and improve access to comprehensive, evidence-based HIV-prevention tools. This updated strategy will make equity a cornerstone of our response and bring a whole-of-government approach to fighting HIV.

My budget request includes $670 million to support the Department of Health and Human Services’ Ending the HIV Epidemic in the U.S. Initiative — to reduce HIV diagnoses and AIDS-related deaths.  My Administration has also strengthened the Presidential Advisory Council on HIV/AIDS by adding members from diverse backgrounds who bring the knowledge and expertise needed to further our Nation’s HIV response."[1]

According to the updated Strategy, it sets forth bold targets for ending the HIV epidemic in the United States by 2030, including a 75% reduction in new HIV infections by 2025 and a 90% reduction by 2030.[2] It also aligns with the ongoing Ending the HIV Epidemic (EHE) in the United States.

The updated Strategy includes four pillars. They include preventing new HIV infections, improving HIV-related health outcomes of people living with HIV, reducing HIV-related disparities and health inequities, and achieving integrated, coordinated efforts that address the HIV epidemic among all partners and interested parties.[3]

Of particular interest to the ADAP Advocacy Association is addressing health disparities, namely because Black and Hispanic men are being left behind on the declining HIV rates in the United States.[4] The racial and ethnic health disparities are even more evident among men who have sex with men (MSM), according to the Centers for Disease Control & Prevention (CDC).[5]

The CDC's Vital Signs demonstrates the challenges with ongoing racial/ethnic differences in knowledge of status and HIV prevention and treatment outcomes among gay and bisexual men. Approximately one in five (1:5) Hispanic/Latinos and Black/African Americans are unaware of their status. Among gay and bisexual men who could benefit from PrEP, communities of color lag behind their white peers, and they also have lower rates of viral suppression. Additionally, HIV-related stigma disproportionate impacts Black/African American and Hispanic/Latino gay and bisexual men.[6]

Equally important is the updated Strategy emphasizing the importance of the ‘Undetectable equals Untransmissible’ message around HIV treatment as prevention. It reads: "Evidence has definitively shown that people with HIV who achieve and maintain an undetectable viral load by taking HIV medication as directed will not sexually transmit the virus to an HIV-negative partner." 

The ADAP Advocacy Association is among the 1,053 organizations from 105 countries have signed on to share the U=U message. Doing so has complemented our organization's efforts around promoting HIV medication adherence. Much work remains ahead of us, but it just got a bit easier with the updated Strategy.

The updated National HIV/AIDS Strategy is available online here.

[1] White House, The (2021, November 30). A Proclamation on World AIDS Day, 2021. Retrieved online at https://www.whitehouse.gov/briefing-room/presidential-actions/2021/11/30/a-proclamation-on-world-aids-day-2021/
[2] White House, The (2021, December 1). National HIV/AIDS Strategy 2022–2025. Retrieved online at https://www.whitehouse.gov/wp-content/uploads/2021/11/National-HIV-AIDS-Strategy.pdf?utm_campaign=wp_the_health_202&utm_medium=email&utm_source=newsletter&wpisrc=nl_health202
[3] White House, The (2021, December 1). National HIV/AIDS Strategy 2022–2025. Retrieved online at https://www.whitehouse.gov/wp-content/uploads/2021/11/National-HIV-AIDS-Strategy.pdf?utm_campaign=wp_the_health_202&utm_medium=email&utm_source=newsletter&wpisrc=nl_health202
[4] Firth, Shannon (2021, November 30). Black, Hispanic Men Left Behind on Declining HIV Rates in the U.S.. MedPage Today. Retrieved online at https://www.medpagetoday.com/hivaids/hivaids/95943?xid=nl_mpt_DHE_2021-12-01&eun=g1964022d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%20Top%20Cat%20HeC%20%202021-12-01&utm_term=NL_Daily_DHE_dual-gmail-definition
[5] Centers for Disease Control & Prevention (November 2021). Vital Signs - HIV and Gay and Bisexual Men. U.S. Department of Health & Human Services. Retrieved online at https://www.cdc.gov/vitalsigns/hivgaybimen/index.html
[6] Centers for Disease Control & Prevention (November 2021). Vital Signs - HIV and Gay and Bisexual Men. U.S. Department of Health & Human Services. Retrieved online at https://www.cdc.gov/vitalsigns/hivgaybimen/index.html

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 Advocacy Must Apply Denver Principles for Trans Communities

By: Jen Laws, Board Member, ADAP Advocacy Association, and HIV/transgender health advocate 

In July of this year, Terrance Higgins Trust issued a statement of unequivocal solidarity in support of rights for transgender people, representing the position of numerous HIV advocacy and service organizations located in the United Kingdom. The statement focuses on the health disparities transgender people face and the necessity to address these in order to meet public health goals of ending the HIV epidemic in the UK by 2030.

I often like to say, “integrity is the integration of stated values in action.” Over the last several years large, queer umbrella organizations have taken up the banner of both transgender advocacy and, more recently, HIV advocacy as pillars of their activities, rather than back burner issues. This mirrors certain advocacy from legacy HIV organizations and service entities taking up activities of transgender advocacy and community specific programming. Much of this shift can be attributed to a greater national spotlight on transgender people (often centered on bigoted policy moves from the previous administration) or because of any number of reports with newly released data finally being gathered on our population pointing toward extraordinary disparities requiring address. Numerous domestic HIV organizations have issued similar statements, mostly independently of one another, as that of the Terrance Higgins Trust.

As it turns out, all of this attention is quite profitable for advocacy and service organizations, regardless of their mission orientation (HIV or LGBTQ issues). Both public and private funders have issued notices of funding opportunities and grants focused on assessing and addressing the health needs of transgender people and extending cultural competency trainings for service providers. While these funds and their intended activities are absolutely necessary, they are a sore replacement for consistent, operations funding to by-for transgender and non-binary organizations – of which many would be greatly served by these funds and, likely, more affectual than offering funding to organizations with limited experience or token personnel.

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That’s the problem, isn’t it? For a community of advocates and providers who have trumpeted the core values of the Denver Principles, HIV organizations have largely failed in integrating these principles in terms of advocacy and programming for transgender people. More importantly, these same organizations have few if any transgender or non-binary people in positions of program leadership or administration or on the boards of these organizations. Indeed, if we are to realize “nothing for us, without us” as critically necessary in order to adequately address the needs of a very diverse population of people living with HIV and AIDS, organizations seeking to represent our interests and meet our needs must include us in every stage of decision making – not just community advisory boards. 

Recently, Black AIDS Institute has provided an excellent example in ensuring leadership reflects the needs of combating the epidemic in appointing Ms. Toni Newman as interim chief executive officer. And funders should absolutely prioritize those organizations reflecting this value up and down their “food chain” including integration of these values in terms of compensation, plans of succession, hiring practices (ie. prioritizing lived experience over that of college experience), and human resource policies (including benefit designs – ie. if an organization does not ensure vocal training or comprehensive medical and pharmacy formularies in their benefit design, they are not “culturally competent” in their compensation offerings). In addition, funders should consider 5- and 10-year commitments of operations funding to by-for transgender and non-binary organizations equal to or exceeding that of shorter-term funding being offered to broader LGBTQ and HIV organizations.

Similarly, private funders – specifically foundations with massive granting power – should not prioritize funding larger, well-funded LGBTQ umbrella organizations based on their calls for HIV advocacy unless and until those organizations include partnership and shared funding to existing HIV organizations for these activities. 

Ultimately, lack of funders integrating the values behind the Denver Principles in their funding choices risks pushing out interests in advocacy wholesale. If those impassioned enough to take on these fights cannot pay their bills, feel respected for their expertise, see a path to promotion, and can realize their priorities in success through funder support, they will simply leave the field. Our funders should also readily recognize our interests intersect – our success is theirs – and, while some may argue the advocacy pipeline is broken, it can be fixed.

Lastly, coalition statements are more than welcomed. They signal an intention and frankly, we need more of them – across broader interest organizations. 

Integrity, like love, requires more than words. Integrity, like love, cannot exist in the absence of action. We need to see some integrity from HIV and umbrella queer organizations and funders.

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.