The Ties That Bind

Why blacks are hit hardest by HIV.

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The biggest factor is that black sexual networks appear to be smaller and more segregated than other racial groups. That means that once HIV is introduced into the circle, it can spread more quickly.

The fact that black sexual networks are smaller and more segregated also makes them more egalitarian. When targeting resources, public health officials seek to identify what they call "core" members of a network. These are the ones who are taking the most sexual risks, such as juggling multiple partners at one time. In other communities, those folks tend to have sex only with each other, and thus the risk remains contained. Not so in black communities, where there is far greater mixing in all aspects of life, including sex. That helps explain why, despite the far higher infection rate, blacks overall report no more risky sexual behavior than other groups.

But the cutting edge sexual-network researchers are considering how public policy, particularly criminal justice, turned what should be idle trivia about mating habits into life or death information. At the current rate of incarceration, one in three black men will spend time locked up before they die. And it looks like moving black bodies in and out of neighborhoods with that sort of rapidity has made the whole community unhealthy.

There's the question of HIV transmission inside prisons. What we know is that HIV prevalence—the percentage of people infected—is five times higher behind bars than in the overall population, according to the CDC. Prison officials argue that it's because the people getting locked up are more likely to have HIV in the first place, and at least one CDC study supports that assertion. Others, however, note that condoms are banned inside all but two state prison systems and clean needles are banned in all of them. With sex and drugs readily available and HIV widespread, it's hard to imagine people aren't contracting HIV.

Set that debate to the side, though, and the high incarceration rate of black men still appears to impact the overall black HIV infection rate. By moving so many men in and out of already small, segregated sexual networks, the criminal justice system drives multiple, overlapping relationships. A boyfriend gets locked up for a couple of years, and his girlfriend gets a new boyfriend. He gets out and they get back together, but in the meantime she's had two sexual partners instead of one. Some researchers argue this sort of serial monogamy inside a small group fuels HIV's spread.

A common thread runs throughout these seemingly diverse theories: HIV attacks black America as a communal whole. And that fact points to what may be the most honest answer to the question of why blacks are so much more affected. In black America, HIV is a disease that binds us all together, but we've spent most of the last three decades distancing ourselves from it as someone else's problem.

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