Why HIV/AIDS persists in Black America

Dec. 1 was World AIDS Day. The international theme for 2024 was "Take the Rights Path: My Health, My Right!" The World Health Organization (WHO) wants health professionals to address the social determinants of health to combat AIDS. Specific populations continue to be hard-hit in the ongoing struggle to battle HIV/AIDS.

For African Americans, the disparities within the healthcare system contribute disproportionately to the high number of HIV/AIDS, directly affecting the quality of life and its spread.

According to an almost two decades old report by the Black AIDS Institute's August 2008 report, "Left Behind," the number of people living with HIV in black America exceeds the HIV population in seven of the 15 focus countries in the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) initiative, an initiative helping to save the lives of those who have HIV/AIDS around the world in countries like Haiti, Dominican Republic, India, South Africa, to name a few. In other words, if black America were its own country, standing on its own like Haiti or Nigeria, black Americans would rank 16th in the world.

The epidemic is heavily concentrated in urban enclaves like Detroit, New York, Newark, and Washington, D.C. Sadly, much of this is still present today. Also, with the South's propensity to avoid speaking about uncomfortable subjects, unfortunately, the South has evolved into one of the HIV/AIDS hot spots in the country. And so, too, are prisons. HIV/AIDS among black male inmates is five times the rate of the general population and is transmitted primarily through male-to-male sex or tattooing.

However, when The New York Native, a now-defunct gay newspaper, in its May 18, 1981, issue first reported on a virus found in gay men then known as GRID (Gay-Related Immune Deficiency), an editorial noted that "even if the disease first became apparent in gay men, it is not just a gay disease."

Back in the day, famous HIV-positive heterosexual African Americans, like tennis great Arthur Ashe, news anchorman Max Robinson, and rapper Eazy all died of AIDS, and basketball giant Earvin "Magic" Johnson, who is still living with the virus, highlighted the fact that anyone can contract the virus. However, many still see the epidemic as a "white gay disease," suggesting being gay or having sex with someone of the same gender puts you immediately at high risk.

Over time, we got to see that some "heterosexual" African-American men were not honest about their sexuality, and the virus showed up in the women they slept with. Throughout the 1990s and 2000s, a sex scare hit the African-American heterosexual women's population due to black men living life "on the down low" or "(on the DL."). As an underground subculture of African-American men who have sex with other men (MSM), they don't identify as gay, bisexual or queer.

The feminization of this disease made many of us AIDS activists and scholars wonder if the same amount of money, concern, communication, and moral outrage that was put into white gay men with the disease would be put into curbing its spread among black women. It wasn't!

There are still many persistent social and economic factors contributing to the high rates of the epidemic — racism, poverty, healthcare disparity, and violence, to name just a few. While we know that the epidemic moves along the fault lines of race, class, gender, and sexual orientation and that HIV transmission is tied to specific high-risk behaviors that are not exclusive to any one sexual orientation, the significant barriers to ending the AIDS epidemic still today are lack of information, health disparities and access to health care, which overrides homophobia. As a matter of fact, homophobia heightens because of a lack of information, health disparities, and access to health care.

As we enter the season of Advent in the Christian calendar, my prayer is one of health equity. I pray for health professionals to heal not only those suffering from the disease but also address the social determinants of health that surround it, causing more lives to be lost.