Black AIDS: Complex Risk Factors Defy Easy Explanations

By Michelle Chen Oct 31, 2009

In the political minefield surrounding the AIDS epidemic, myth and fact often trip over each other, especially in communities most deeply scarred by the disease. The striking prevalence of HIV/AIDS among Black Americans has set off much speculation and confusion. Some research suggests the epidemic is driven in part by men having sex with men—on the “down low”—and then infecting straight Black women. But researchers are discovering that the real story of Black AIDS has far more twists and turns than previously thought. It’s clear that Blacks are hit harder by HIV/AIDS than other racial groups, making up roughly half of AIDS cases nationwide but only 12 percent of the population, according a 2007 CDC analysis. And Black women are especially devastated; some 60 percent of women living AIDS are Black. On NPR’s Tell Me More, Dr. Kevin Fenton, director of the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention at the Centers for Disease Control, shed some light on the epidemic. He said the public focus on male-to-male sexual transmission doesn’t capture the range of risk factors: He noted HIV/AIDS infection rates among Black women are tied to both heterosexual contact as well as intravenous drug use. Yet “about 80 percent of women acquire the infection through sexual transmission from male partners who are HIV infected.” Fenton stressed that only a small proportion of Black men are identified as bisexual, and "therefore, you need to look at the risk factors which are far more prevalent in the community–having multiple sexual partners with unprotected sex with heterosexual partners, injecting drugs. Those are going to be factors which are far more prevalent in the population and are driving risks." On the issue of men secretly having sex with men, he said, "this sort of diversity in sexual attitudes or lifestyles is certainly seen across all racial and ethnic groups. So you wouldn’t want to say that this is something which unique to the black male community." Fenton said researchers are looking into the mechanics of HIV/AIDS transmission in the incarcerated population. While transmission inside the prison population does pose a risk, a potentially greater threat is the influence of demographic imbalances stemming from mass incarceration. High imprisonment among Black men could leave women on the outside more vulnerable, he said:

African-American women who are looking for African-American male partners have fewer choices in their sexual partnerships and relationships and may be forced into relationships where they have multiple partners or males who will have multiple female partners, etc. Or those women may not be able to negotiate safer sex and protected behaviors because of fear of losing eligible male partners in the community.

As they struggle for visibility in the national discussion on HIV/AIDS, Black women are finding solidarity and a collective voice through forums like the Black AIDS Institute and the upcoming Breaking the Silence conference in Los Angeles. Irene Monroe, an activist on Black and LGBT issues, wrote last December on Huffington Post that while “down low” is one issue, racial and gender health care disparities exacerbate the crisis Black women face. And the complex knot of risk factors is bound up in the denial of leaders in the Black community:

…the invisibility of my group’s plight has less to do with African-American women’s agency to combat the epidemic than with how the government, African-American men, the Black Church, and race and gender biases inherent in the problem collude with African-American women’s efforts to get help…. The Black Church continues to play a part in the death of African Americans with AIDS. While its silence on the issue is appalling and unconscionable, so too is its various forms of heterosexualized rituals and pronouncements that denigrate both LGBT people and women.

While political tensions shape the spread of HIV/AIDS, the community’s reaction to the crisis is colored by politics as well, for good or for ill. Having honest discussion on race and AIDS means charting a course between active outrage and scientific understanding. Image: Black Agenda Report