Poverty and HIV in Black America
February 7th, 2012 was National Black HIV/AIDS Awareness Day. HIV affects African Americans more than any other racial or ethnic group in the United States. In 2009, African Americans accounted for 44% of new HIV infections, while making up only 14% of the U.S. population. What factors contribute to this disparity?
Despite the stigma that surrounds HIV in this community, African Americans have the highest rates of HIV testing among all other racial and ethnic groups in the U.S. The real problem lies in the underlying racism still prevalent in the U.S., and the poverty that results from this discrimination.
In 2010, the U.S. Census Bureau counted 27.4% of African Americans as living in poverty, compared with a national average of 15%. Poverty affects all areas of life, from housing, education, and safety, to nutrition and overall health. Without a steady income, African Americans living in poverty struggle to find affordable housing and routine access to quality healthcare becomes nearly impossible. Nutrition falls on the priority list and hunger turns into a daily issue. These challenging conditions lead to increased drug use, crime, and incarceration in communities fighting to maintain safe and productive neighborhoods.
In the midst of such desperate situations, sexual health inevitably falls to the wayside. Today, new HIV infections among men who have sex with men are highest among African American men aged 13-29. While African Americans have a high rate of HIV testing, the testing itself often happens too late because of fear and stigma tied to homosexuality and HIV, high unemployment, no insurance, and lower overall health literacy in poorer areas. The lag time between initial infection and treatment means higher viral loads for those yet to be diagnosed, and a higher chance of transmitting the virus to others.
These African American men and women must make difficult choices and prioritize daily survival over long term health. They must choose between buying food or condoms, or in some cases, food or drugs. Those struggling with addiction cannot seek help from Temporary Assistance for Needy Families because of required drug screening that disqualifies active or recovering users. As a result of joblessness, limited social programs, and other related factors, impoverished African Americans end up resorting to illegal activities for income. African American men face an incarceration rate 6 times higher than that of their white counterparts, leaving many African American mothers raising their children alone when their partners end up in jail or prison. Some women may turn to sex work, often referred to as “survival sex,” as a means of providing for their families. According to the CDC, 1 in 2 African American female youths today has an STD, making these women even more susceptible to HIV infection.
Poverty’s cyclical nature means that African American children will endure similar, if not worse, challenges as those of their parents. The public schools in low-income neighborhoods often lack the funding to offer sex education programs, or extracurricular activities that keep children in school. 40% of African American children will never graduate from high school and, as adults, may struggle with illiteracy, job placement, and navigating a complex and bureaucratic health care system.
It’s no wonder that the African American population deals with HIV and AIDS more than any other minority group in the U.S. Poverty remains a seemingly insurmountable issue with unlimited consequences in the black community. In our quest to end HIV, we must contend with the socio-economic problems that place African Americans at the epicenter of this epidemic.
The Criminalization of HIV
Recently, Senator Norman Stone of Baltimore, Maryland introduced a bill (SB 60) that would classify intentional HIV transmission as a felony. Right now, the state classifies any “attempt” at transmitting HIV as a misdemeanor.
In the US, 32 of the 50 states currently have criminal statutes on HIV transmission. This means that an HIV-positive individual who knowingly infects another person faces incarceration and a permanent criminal record. Because HIV has no cure, the US legal system sees both exposure and non-disclosure as a crime, even though having HIV is no longer a death sentence. Most other STDs like syphilis and gonorrhea can be fully treated and cured with medication, and thus carry no penalty if intentionally transmitted.
While knowingly infecting another person with HIV should be taken seriously, what indirect consequences do laws like these have? Will people who fear an unforgiving legal system postpone getting tested, possibly indefinitely, to avoid incrimination? Will consensual sex become a criminal act marred by fear and doubt? How can we help those people who bear the responsibility of disclosure?
Creating an open and accepting atmosphere around HIV can help lift the stigma that surrounds this disease, and make the daunting obligation to share one’s status a lot easier. By focusing prevention efforts on safer sex, routine HIV testing, and easy access to treatment and care, we can address infection rates without treating HIV like a deadly weapon.