HIV & African American Communities: What Factors Drive the Epidemic By Chris Wade, Director of Prevention Services, Central Illinois Friends

The racial disparity of HIV in the United States has reached almost startling proportions. This is apparent in African Americans who, despite representing only 12 percent of the U.S. population, account for 48 percent of all new HIV incidences.

The reasons for this are complex and often misunderstood. While some may suggest that culture and sexual behavior are solely to blame for this, the fault lies more with the social and economic inequities that can fuel any communicable disease outbreak. Poverty, social injustice, and the lack of an effective government response together enable the spread of disease in communities that simply are not equipped with the resources to combat it.

In many ways, the HIV epidemic is but a snapshot of the growing disparity in healthcare which places many African American communities at greater risk of contracting HIV and other preventable illnesses and infections.

While many people will all too readily assign blame to behaviors they believe to be cultural, these kinds of responses only serve to perpetuate negative stereotypes that reinforce stigma, discrimination, and social inaction.

Many of the more common stereotypes (“black men sleep around” or “drug use is rampant among black people”) have simply proved untrue within the context of HIV. For example:

  • African American women are far less likely to acquire HIV through injecting drugs than white women. African American women primarily acquire HIV through heterosexual sex, while white women acquire HIV through shared needles.
  • Neither African American men nor women have higher rates of sexual risk behaviors than any other racial group.
  • Black Men who have Sex with Men (MSM), in fact, report fewer sex partners, less unprotected anal sex, and less drug use than white MSM.
  • African Americans, on the other hand, are far more likely to be tested for HIV than whites (75 percent versus 14 percent).
  • African Americans are just as likely to seek and remain in continuous, HIV-specific medical care as whites (54 percent versus 58 percent).
  • The rate of undiagnosed infection is more or less the same for African Americans as it is whites (11 percent versus 13 percent). Of all the racial groups, Asians were, in fact, most likely to be undiagnosed (21 percent).

Where the differences lie, therefore, is not so much in the community’s response to HIV but other factors that are far more difficult to pin down or isolate.

Today, HIV remains the sixth leading cause of death in African American men and the fourth leading cause of death in African American women between the ages of 35 and 44. By contrast, HIV is no longer listed as a leading cause of death for any other race.

Additionally, HIV does not affect all communities in the same way. While being African American, white, or Latino doesn’t necessarily alter the way in which a person responds to the disease, there are vulnerabilities that can place a person of one race at greater risk of infection and illness than another.

We see this, for example, with the differing responses to HIV treatment. While nearly 70 percent of whites are able to achieve an undetectable viral load while on treatment, less than 50 percent of African Americans are able to do the same.

Culture or sexual behavior cannot explain away these differences. Rather, the issue appears far more deep-seeded and institutional, impacted by such things as:

  • Poverty
  • Stigma
  • Lack of access to healthcare
  • Failure of governmental, social, police, and legal services
  • Discriminatory rates of arrest and incarceration
  • High-density urban populations

These inequities play one-off the next in a way that creates a cycle of vulnerability that is often difficult to break.

As a result, African Americans are more likely to state that there is a lot of stigma and discrimination toward people living with HIV versus their white or Latino counterparts. These attitudes play themselves out in many negative ways:

  • HIV-positive people who perceive stigma are more likely to drink excessively or report substance abuse.
  • People fearing HIV stigma and disclosure are more likely to avoid testing and consistent medical care.
  • Increased rates of depression often translate to an increase in high-risk behaviors.

In the end, the factors fuel HIV transmission by limiting and/or influencing the choices a person can make. Where other, resource rich communities have the means to overcome many of these barriers, African Americans in lower socio-economic communities do not. The spread of HIV within these communities, therefore, occurs simply because there is nothing to stop it. We need voices from those living with HIV and our allies. Join us at the intersection of HIV and social determinants of health.

For information on what you can do to increase education, prevention and testing services as well linkage to HIV care providers, visit: or call (309) 671-2144.