HIV has more negative effects for Black Americans than for other racial and ethnic groups in the United States. Though Black people make up just 12% of the U.S. population, they accounted for 43% of all HIV cases in 2019.
Black women, in particular, were 14 times more likely to be diagnosed with HIV than white women and five times more likely than Hispanic women, according to a 2018 CDC report.
And Black Americans who get HIV are more likely to die from it than members of other groups.
Why are the numbers so high?
Access to Education And Health Care
Part of the problem is that many Black Americans lack access to the kinds of education, testing, support, and health care options that others have.
The result is that they’re less likely to know their HIV status. And even if they know they are HIV-positive, they’re less likely to be getting the antiretroviral therapy (ART) that is the top standard treatment.
ART not only helps keep people with HIV healthy, but it also can bring viral loads low enough so that they can’t be sexually transmitted.
The reasons for these disparities in access are many and complex. While race certainly plays a part, scientists are still trying to disentangle other factors like resources, education, and cultural norms and perceptions.
And of course it may be impossible to separate race from these socioeconomic, cultural, and behavioral factors because of a history of bias and prejudice in the medical system and the society at large.
Consider something as simple as insurance. As a group, Black Americans are more likely to be uninsured or publicly insured than whites. This often makes it harder to find options for HIV testing and treatment as well as support services to help live with HIV or AIDS and related illnesses.
That could be due to a lack of sufficient financial resources. Many racial and ethnic groups are more likely to have lower socioeconomic status.
Less money means fewer resources not just for insurance, but also for medical care, transportation, child care, and other important needs. This can have a profound effect on health outcomes including for HIV.
And lower socioeconomic status doesn’t just refer to money, but it includes other factors like education.
Less education means you may not have information about how to address your illness or even when you’re likely to be exposed.
Distrust and Fear
Many black people may be HIV-positive and not know it, so they continue to spread the virus while also getting sicker. In 2018, only about half of every 100 Black people with HIV were virally suppressed.
Some African-Americans still mistakenly believe that HIV is a white, gay disease. That makes it hard to teach them about HIV or get them to talk about their HIV status.
Part of the problem may be a lingering distrust in the black community of government sources of information and research. The historic Tuskegee Syphilis Study did harmful medical testing on African-Americans, without their knowledge, for 40 years.
Stigma around homosexuality may also silence men who have sex with men. Black men "on the down low" have sex with men but may not tell their women sex partners.
How Does HIV Spread Among Black Americans?
Unprotected sex: Most Black American men and women get HIV when they don't use a condom or other protection when they have sex with a man. It's less likely for a black man to get HIV from a woman. And it's more likely for a black man than a white man to get HIV by having sex with men.
Sexually transmitted diseases (STDs): Here we refer to illnesses other than HIV/AIDS. It's easier for someone who has another sexually transmitted disease (STD), like gonorrhea, to get or pass HIV. Infection rates for STDs are higher for Black Americans.
Injecting drugs: Sharing drug needles or syringes with someone who is infected with HIV is the second-most common way Black Americans get HIV. It spreads HIV through blood contact. In addition, drug use may also lead to risky sexual behavior. Drug dependence or addiction can make money problems worse.
How to Lower the Impact
The CDC and other public and private health organizations continue to work to help remove the barriers to HIV education, testing, support, and medical care for Black Americans in their communities.
But there are things everyone can do to help lessen the spread of HIV and lessen its effects if you get it.
To avoid HIV infections, practice safe sex. Ask your partner about their HIV status. Use a latex condom and water-based lubricant each time you have sex. If you think you may have an STD, see your doctor and get treatment.
Think about whether you should get tested for HIV whenever you get a medical checkup. Make it a part of staying healthy. Don't be afraid to ask your doctor for an HIV test.
Always use clean needles and syringes for injected drugs; don't reuse one after someone else. Try counseling or treatment to help you stop using drugs.
If you test positive for HIV, start ART treatment immediately and work closely with your doctor to get your viral load down as low as possible so that you can remain healthy and help prevent transmission of the virus to your sexual partners.