HIV can affect anyone. Fortunately, great strides have been made in the HIV prevention and care. Improved awareness of the disease, access to testing, and availability of pre-exposure prophylaxis (PrEP) medicine can help prevent you from getting HIV. And antiretroviral therapy (ART) can suppress the virus low enough that it can prevent you from spreading it to others if you have it.
Yet research shows that certain groups, especially Black and Hispanic people, are less likely to use these preventative measures and have higher rates of infection than other groups. And they’re also more likely to have worse outcomes.
Here’s a look at the different factors that contribute to racial, gender, and sexual disparities in HIV infections and prevention and care.
Disparities in HIV Prevention and Care
Not everyone who’s at risk for HIV or gets diagnosed with it is able to get quality and timely care. That’s because for some people, there are a number of interconnected challenges and inequalities, such as socioeconomic status, race, gender, and political identities, that can influence their overall health and HIV status. This is known as intersectionality.
Certain marginalized groups, especially Black and Hispanic people, are more likely to get HIV than others. And they’re also more likely to have worse outcomes. The reasons for that can stem from a lack of testing and HIV awareness to limited access to prevention and care and fear of stigma.
Gay, bisexual, and other men who have sex with men make up about only 2% of the country’s population. Yet, studies show they make up close to 7 in 10 new HIV infections each year.
Among them, Black and Latino men who have sex with men are most at risk for a new infection. In fact, they make up nearly half of all new infections each year. And on a deeper look, young Black gay and bisexual men, especially those between ages 13 and 24, make up more than half of the new infections.
Black women are 11 times more likely to be affected by HIV than white and Latina women. And transgender people, especially those who are Black, are disproportionately affected by new HIV infections.
Black and Hispanic/Latino people also have the lowest rates of PrEP use when compared with all other racial or ethnic groups. In 2020, studies showed that only 9% of Black people and 16% of Hispanic or Latino people who were candidates for PrEP actually had a prescription for it.
Causes for HIV Prevention Disparities
Many things can lead to these disparities. For example, the growing number of HIV infections and Black and Latino folks can be pointed to poverty, racism, sexism, lack or limited access to health care, lack of awareness about HIV status and risk, higher rates of some sexually transmitted infections, and stigma, among other things.
Research shows Black people often bare the worst brunt of HIV discrimination, homophobia, and stigma. In fact, according to the CDC, because of this, 1 in 7 Black people who are HIV positive don’t know their HIV status. And when you don’t know, you’re less likely to get proper care and risk spreading HIV unknowingly to others around you.
Discrimination can also take a mental toll on your well-being. When you internalize the fear and stigma around HIV, it can often cause you to feel lonely, depressed, and sad, plus feelings of shame and anxiousness.
Implicit bias can play a role, too. It’s a form of bias that you may form accidentally and unintentionally about a group of people, which can affect how you attach certain negative stereotypes to their existence, especially if they’re HIV-positive or are more likely to get it.
This can create many barriers to care, especially from health care providers and how they practice medicine. For example, they may deny or give lower-quality HIV care, delay treatment, lower a patient’s ability to stick to treatment, verbally harass or neglect patients, and have poor communication.
Structural issues like food insecurity, homelessness, lack of transport for health care, lack of childcare, violence, discrimination, criminalization, police brutality, and racism also worsen HIV outcomes for people of color.
Some Hispanic people are more likely to face additional hurdles due to their immigration status. Undocumented immigrants are less likely to get routine HIV screenings and tests for prevention and care, due to fear of being caught or deported. They’re also not able to access affordable care because they’re often not covered by health insurance or government programs like Medicare and Medicaid. And without coverage, prescription PrEP can cost over $2,000 for a month’s supply.
Hispanic people are also more likely to face language barriers than other people who are U.S.-born English speakers. That’s because most HIV prevention campaigns are communicated in English. This includes volunteers and health care providers. Few campaigns include information in Spanish.
Hispanic people tend to give a lot of importance to the immediate and extended family structure. This is also known as "familismo" in Spanish, or familism. Among Hispanic men who have sex with men, studies find that fear of family rejection and overall negative attitude toward HIV in the wider culture often acts as a strong barrier to getting preventative care.
What Efforts Are Being Made to Reduce Disparities in HIV Prevention?
According to the CDC, they are focusing on specific efforts to improve HIV prevention and care for all. They’re doing this by:
- Collecting data and monitoring HIV testing trends among minorities who are most affected
- Funding research to find strategies to help Black and Latino populations at risk for HIV
- Conducting HIV prevention research to reduce overall social and structural disparities
- Improving PrEP coverage at a local level
- Strengthening and improving the country’s HIV prevention workforce
- Supporting local community-based organizations working to increase HIV testing and knowledge.
- Offering resources in both English and Spanish, like Let’s Stop HIV Together/Detengamos Juntos el VIH.
Nonprofit organizations have also stepped up to educate marginalized groups with targeted outreach to ensure that access to testing and PrEP is available to all. For example, the Black AIDS Institute created a PrEP toolkit for Black women to use to educate other Black women on the importance of PrEP and how to get it.
How to Self-Advocate for HIV Prevention and Why
Learning how to advocate for yourself and your health can be one of the best ways to prevent HIV and fight back against discrimination.
Moreover, self-advocacy will not only help you learn more about your rights, but it will also help you get the best possible health care you need for a healthy life in the long run.
To begin advocating for yourself, you should:
- Learn as much as you can about HIV, its history, its impact on your health, and how you can protect yourself.
- Find a health care provider who’s a good fit for your needs.
- If you’re unsure about your doctor, don’t hesitate to get a second opinion.
- For your doctor’s appointment, make a list of all the questions you have about your HIV prevention options.
- During your meeting, ask for clarifications, especially when you don’t understand medications or certain medical terms.
- Take notes during or after an appointment.
- If you’re not able to speak up for yourself, take a family member or a loved one along for support and to advocate on your behalf.
- Keep a copy of all your medical records and bills. If you see medical reports or insurance claims that don’t make sense, call your doctor’s office or insurance company for clarification. PrEP is covered by most insurance companies.
- Communicate openly with your health care team. This can reduce any miscommunication, patient shaming, or mistrust. Don’t hold back from giving feedback on ways they can improve.
- Educate yourself about HIV-related policies and laws both locally and nationally as this can directly affect your quality of care. Some rules may vary by state.
- Keep up with the latest research and clinical studies.
Show Sources
Photo Credit: LeoPatrizi / Getty Images
SOURCES:
CDC: “HIV Discrimination and Stigma,” “PrEP (Pre-Exposure Prophylaxis)” “PrEP for HIV Prevention in the U.S.” “HIV Treatment,” “HIV and African American People: PrEP Coverage,” “HIV and Hispanic/Latino People,” “HIV and African American People,” “HIV and Hispanic/Latino People: What CDC Is Doing.”
The Well Project: “How to Be an Advocate for Yourself and Others.”
KFF.org: “Black Americans and HIV/AIDS: The Basics.”
Intersectionaljustice.org: “What is Intersectionality.”
Black AIDS Institute: “Black Women and PrEP.”
American Journal of Public Health: “Stigma, Implicit Bias, and Long-Lasting Prevention Interventions to End the Domestic HIV/AIDS Epidemic.”
AIDS Research and Treatment: “Attitudes towards and Beliefs about HIV Testing among Latino Immigrant MSM: A Comparison of Testers and Nontesters.”
Plos One: “You are not alone: Family-based HIV risk and protective factors for Hispanic/Latino men who have sex with men in San Juan, PR.”
Prepdaily.org: “How to Access PrEP if You’re an Undocumented Immigrant.”
