“HIV knows no boundaries” is a common sentiment within the HIV/AIDS advocacy community, but it elides a simple reality: black men and men who have sex with men (MSMs) are at staggeringly higher risk for contracting the disease.
Here is the breakdown of new HIV/AIDS cases by race/ethnicity and sex in 2009:
Black men, overall, bear a six-fold higher incidence rate than white men, and the relative disparity is even wider between black and white women (albeit from a much lower base rate). The disparity for MSMs is starker still. They comprise an estimated 2% of the U.S. population, but account for more than 60% of new HIV/AIDS cases.
Perhaps you were already familiar with these figures, but try to put them into proportion.
There are very few diseases that so selectively prey on communities of color in the United States. Homicide is one of the few cases where the mortality risks are as extremely skewed. In fact, the growth of black-white disparities in mortality across small regions in the United States is substantially accounted for just through higher HIV/AIDS burden among African Americans, a factor noted by Ezzati and colleagues.
Although the number of incident cases is down from the highpoints in the late 1980s, the downward slide has been slow for all racial/ethnic groups. Paradoxically, longer life expectancy may be a contributor. Thanks to effective combination antiretroviral therapies, people with the disease are living longer. This is a fact that should be celebrated, but it also creates a challenge. Older men are staying sexually active in the population and sometimes not taking adequate precautions to protect their sexual partners.
This phenomenon is particularly striking for African Americans, where the growth of incident cases of HIV/AIDS has been greatest among men age 50 and older. This population of men has a pool of sexual partners that is likely to be engaged in riskier sex, and measures to engage in safer sex have been slower to be adopted among older African American men. Moreover, education and stigma are still pervasive barriers among African American MSMs.
The fact that HIV/AIDS remains so prevalent within deeply disadvantaged communities should give us some pause. What effective interventions does public health have in its toolkit to really reverse risky sexual behavior? Behavior change at the individual level is a slow process, especially when the behavior in question is so intimate and stigmatized. The hope for an AIDS vaccine also remains elusive, in part because the retrovirus is so aggressively mutable and the latency period of the disease is so very long.
We need to change the entire social discourse around stigmatized behavior. That’s why President Obama’s support of gay marriage – long delayed as it was – sent a powerful message to many gay and lesbian communities. Not only did it signal the legitimacy of same sex unions, it sent a message that people of all sexual orientations are deserving of full respect and dignity. It’s just a very small ripple in a larger process that many hope will unfold over the next decade. Will de-stigmatizing homosexuality be enough to stem the tide of HIV/AIDS? Time will tell.