HIV in Poor U.S. Neighborhoods as Intense as Developing World

But neither HIV nor the poverty to which it's tied is evenly distributed between races.

By Kai Wright Jul 19, 2010

Update @ 1:12p ET: Here are the cities in the study: Atlanta, Baltimore, Boston, Dallas, Chicago, Denver, Detroit, Fort Lauderdale, Houston, Las Vegas, Los Angeles, Miami, Nassau/Suffolk Counties, Newark, New Haven, New Orleans, New York City, Philadelphia, San Diego, San Francisco, Seattle, St. Louis and Washington, DC.


A number of U.S. cities with dense poverty have AIDS epidemics of similar intensity to those in the developing world, according to a new U.S. Centers for Disease Control and Prevention study. The remarkable research firmly establishes a link between poverty and HIV infection in the U.S.–something that has been plainly true from the epidemic’s start, but not previously supported by such clear and broad science. And contrary to early reports, the study reinforces a crucial point about the AIDS epidemic: It is a stark reminder that racial injustice literally kills.

CDC crunched data on 9,000 heterosexual adults from neighborhoods with high poverty rates, covering 23 cities. More than three quarters of the study’s participants were black. It generated two related and deeply important findings.

The first is straightforward: Poverty and HIV are tied in the U.S. To establish this fact, researchers looked at HIV prevalence, or the share of a given population that is infected. They found HIV prevalence in high-poverty neighborhoods to be more than double that of the nation overall. Moreover, within high-poverty neighborhoods, prevalence among people living below the poverty line was double that of those living above it. If silence equals death, so does poverty.

The study’s focus on heterosexual adults is significant and generates the second important finding: that epidemics in poor U.S. neighborhoods are of similar intensity as those in poor nations globally.

Global health divides communicable-disease epidemics into two camps–those that are "generalized," meaning they’ve spread widely in the entire population, and those that are "concentrated," meaning they’ve hit a specific group most deeply. If more than 1 percent of your overall population is infected, you’ve got a generalized epidemic. These epidemics are considered more acute because they’re harder to control; they are the sort of HIV epidemics found in places like South Africa and other hard-hit nations. The U.S. and European HIV epidemics have been considered concentrated among gay men and injection drug users from the start.

Today’s CDC study establishes that the U.S. epidemic is instead best understood as two separate epidemics–one in poor neighborhoods and one in the rest of the nation. That’s because HIV prevalence is a shocking 2.1 percent among heterosexuals in the poor neighborhoods CDC studied. These are explosive findings that ought to fundamentally redefine our understanding of the U.S. epidemic and its gravity.

That said, what they don’t do is prove class is more important than race in confronting HIV in the U.S. If poverty breeds deadly disease, as this study suggests, neither the disease nor the poverty is evenly distributed in society. African Americans account for roughly half of all people living with HIV in the U.S. That ought to be no surprise, given the remarkable poverty rates among black people. My colleagues at the Black AIDS Institute put it well in a statement today:

Some media organizations are erroneously concluding that race is not a factor in HIV transmission in this population. This is a false choice and an absurd and dangerous conclusion. The point is not whether race or poverty matters, the point is race and poverty matter. Black people are disproportionately impacted by HIV/AIDS. One of the reasons this is so is because we are poor. Seventy-seven percent of the participants in the study were Black and the majority of the residents in the communities surveyed were Black. 

According to a study by U.S. Department of Agriculture, nine out of every 10 Black Americans who reach the age of 75 spend at least one of their adult years in poverty. By the age of 25, the findings show, 48.1 percent of black Americans will have experienced at least one year in poverty. By age 40, the number grows to two-thirds and to more than three-fourths by age 50. More than 90 percent will have lived below the poverty line by age 75. 

The researchers say that by age 28, the Black population will have reached the cumulative level of lifetime poverty that the white population arrives at by age 75. "In other words, Blacks have experienced in nine years the same risk of poverty that whites experience in 56 years," the report stated. 

"Does poverty matter? Of course, but to pretend that race is not a huge factor in who is poor in America is naïve at best and maliciously racist at worst. The fact that virtually every Black American will experience poverty at some point during their adulthood speaks volumes about AIDS in America," says Phill Wilson, President and CEO of the Black AIDS Institute. "Poor people get AIDS. Black people are poor."

Expect lots more AIDS news this week, as researchers and community leaders from around the world are gathering in Vienna for the International AIDS Conference, a massive event where scientists and policymakers often unveil major new findings and programs. The Black AIDS Institute will be covering the conference all week on its website, where you can also sign up for an email news service.

(Photo by Win McNamee/Getty Images)