What Black Women Should Know About HIV/AIDS
Without question, there is a higher rate of HIV and AIDS in the Black female population in the United States than among any other group next to Black men. Recent reports fromthe Centers for Disease Control and Prevention document the devastating fact that black women account for nearly 70 percent of the female cases, while whites made up 18percent and Hispanics 8.5 percent. The disproportionate number of HIV and AIDS cases among Black women as compared to their representation in the overall female populationof the United States is compelling evidence of the scope and depth of this problem in ou rcommunities.
Often buried within the statistics of the general AIDS population, or lumped togetherwith Black men, the statistics on how this disease affects Black women are startling.There is an epidemic of AIDS among us and it is poised to wipe out a generation. AIDSis the No. 1 cause of death for black women ages 25 to 44, beating out heart disease,cancer and homicide. According to the U.S. Centers for Disease Control and Prevention,black women made up 69 percent of AIDS diagnoses among women in 2004 and of all women living with AIDS, 64 percent are estimated to be black.
Heterosexual transmission is now the most commonly reported mode of HIV transmission among women. Although non-Hispanic blacks constituted 13% of thepopulation of the 32 states during these 4 years, they accounted for more than half(51.3%) of the HIV/AIDS diagnoses, including 68.8% of diagnoses among females and 44.5% of those among males.
What is HIV/AIDS?
The human immunodeficiency virus (HIV) is a viral infection that affects cells present inour blood, semen, and other bodily fluids. It is passed primarily through oral, vaginal oranal sex. The infection affects the body's immune system, destroying infection-fightingcells called T-cell lymphocytes, leaving the person highly susceptible to illnesses that their body would otherwise be able to fight off. This is why those who acquire HIV often develop acquired immunodeficiency syndrome (AIDS).
What Are the Issues for Black Women?
With Black women continuing to be the fastest growing population group becoming infected with HIV, it is important to acknowledge and understand how social, gender and cultural factors impact these rapid rates of infection and help to shape the perceptions and realities many Black women face. While race and ethnicity alone are not risk factors for HIV infection, Blacks, in particular Black women are more likely to face certain risk factors for HIV infection and barriers to testing and treatment, including poverty andlimited access to health care and HIV prevention education. Testing, health-care,education, and prevention services remain critical to stopping the spread of HIV in our community.
Much has been made in the media about the poor health status of Black women that wemay have become desensitized to the constant health statistics and are tuning outimportant messages related to HIV and AIDS. But this is one crisis that we cannot andshould not ignore. In addition to killing us, AIDS is seriously compromising the qualityof the lives of our families and the vitality of our communities.
So why does this problem exist? No compelling evidence suggests that Blacks have any special genetic susceptibility to HIV. There are many factors that have been cited asreasons why African American men and women have relatively high rates of HIVinfection and AIDS. The two most convincing explanations are the high rates of povertyand sexually transmitted diseases. The 2000 U.S. Census found that one in four Blackslived in poverty, and studies clearly have shown a strong link between poverty, limitedaccess to quality health care and the risk of HIV infection.For Black women, the consequences of not having effective primary and secondaryprevention and intervention strategies to reduce the inequities that exist related topoverty, gender, relationships, education and socioeconomic status can result in:
- Having unprotected oral, vaginal or anal sex; or having unprotected heterosexualsex with injecting drug users and/or men who have sex with men or who havebeen in prison.
- Limited self efficacy and coping skills, i.e., communication, resistance, accessingservices, and diminished self-image
- Resistance to learn one’s HIV status because of fear and the belief that HIV willnot affect them personally.
- Little or no discussion about HIV with family, friends, and peers, and a lack ofpeer and community support
- Perceived safety within relationships
- Family stressors that can result in increased depression and deteriorating health status
It also seems that Black females are not on the radar when it comes to politicians andother decision makers in this country. During a past presidential election, candidates wereat a loss regarding how to respond to questions about the devastation of HIV/AIDS in theBlack female community when told that Black women between the ages of 25 and 44 are13 times more likely to die of the disease than their white counterparts. This is why Black women must keep this issue in the forefront of the public policy health agenda while taking responsibility for saving ourselves.
What Are the Risk Factors?
Socioeconomic and cultural factors—including poverty, discrimination, and inadequateaccess to health care, among others—often render black women more vulnerable to HIV than other racial/ethnic groups.
Many women of color are paralyzed by fear—of being stigmatized, of abandonment bytheir partners, and of deportation by immigration authorities. Fear of being stigmatizedby HIV/AIDS appears to have at least some relationship to people's decisions aboutwhether or not to get tested for HIV. But most important for women of color who areoften the family caregiver and breadwinner, they are afraid of their families’ reactions toeither their HIV status or disclosure of sexual orientation. What we know about the socialand cultural impact on Black women’s lives is that HIV-related stigma and denialregarding how the disease is spread, particularly among self-identified heterosexuals whoare positive, and stigmatization about the disease remains an enormous barrier toeffectively fighting the epidemic.
Contributing to the risk factors and barriers is the fact that there is much misinformationin communities of color related to how the virus is transmitted. This combined withlimited social and community support for HIV education and prevention initiatives, lackof tolerance for perceived differences in sexual orientation and sexual practices, and anoverwhelming reluctance to discuss issues that are considered “personal business” inAfrican American communities create major barriers to determining personal risk.
There also exists community denial about injection drug use and homosexuality, but there is scant evidence to support the notion that those risk factors are somehow higher in Blacks. In fact, injection drug use, one of the common modes of HIV transmission, isactually lower in Black women than in white women.
Then there is the much hyped "down low" phenomenon. Some men on the DL arebecoming infected by anal intercourse with men and then spreading the infection to their female partners, a transmission route that became widely discussed a few years back withthe publication of J.L. King's On the Down Low: A Journey Into the Lives of "Straight" Black Men Who Sleep With Men. But the great unknown is how frequently this occurs,and whether it's truly different in blacks versus whites or Hispanics.
Equally important is the fact that Black women have a smaller pool of Black men tochoose from at any given time. "African American women are the only group in theUnited States where there are fewer men than women," says Gail Wyatt, an associatedirector of the AIDS Institute at the University of California, Los Angeles. "The availability of a partner who shares the same values is much less likely. The women are more likely to be educated than their partners. They're more likely to be employed." As a result of the shortage of black men, Black women are vulnerable to becoming involvedwith men who are engaging in risky behaviors that they don't know about, whether it behaving unprotected sex with other partners, female or male; visiting sex workers; or injecting drugs.
What Can We Do?
There is a clear, urgent need for HIV prevention and education efforts that are culturallygrounded, culturally relevant, woman-centered and effective. It has become increasingly evident that any effective means of addressing this continuing epidemic is throughcommunity-based agencies and organizations that have strong ties to and a genuinecommitment and investment in the communities they represent. The basic premise of thisconviction is that women in our communities – those closest to the problem, onceequipped with needed information, tools, and resources, are best able to bring aboutchange in their respective communities.Because there is the ongoing stigma and denial associated with HIV/AIDS in the AfricanAmerican community, we must call for a new and different way for thinking and talkingabout this epidemic. It is time for us to move beyond the pervasive myths andstereotypes. We must create opportunities that elevate the conversation aroundHIV/AIDS, allow for personal stories to be told, social support networks to be developed,community forums to be held to help reduce the discrimination and isolation to fight this epidemic and improve the quality of life for women at risk and positive women.As Black women, we have a reputation for and a legacy of strength, resilience andendurance in the face of hardships that would defeat others. However, strength alone is not enough. We must be committed to develop strategies to educate ourselves on theissues. We must be strong enough to save ourselves.
Talking with your partners and friends