The Ties That Bind

Why blacks are hit hardest by HIV.

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The U.S. Centers for Disease Control and Prevention told us last weekend that America's AIDS epidemic is 40 percent larger than it had believed, and that black America accounts for about 45 percent of new infections each year. If we're only 13 percent of the population, how can that be?

There's no one simple answer. It takes a witch's brew of toxins to create a disparity that large.

The first thing to understand is that it's not new. Blacks made up a quarter of all Americans who died from AIDS as early as 1985, though we were less than 12 percent of the population at the time. Eleven years later, in 1996, the American epidemic hit two milestones: It was both the first year in which fewer people died than the year before, and the first year in which more blacks died than whites. Since then, the disproportionate impact on blacks has grown steadily, where we now make up 40 percent of AIDS deaths annually.

These out-of-whack death rates offer a window into infection rates, too. Studies reveal that many blacks don't find out they're infected until it's too late, after they've gotten sick and treatment is more difficult. Why does that matter to the virus' spread? Because it also means they've been walking around with the virus for years, unaware of their risk to others.

The CDC says at least a quarter of all HIV-positive Americans don't know they're infected—and roughly half of those people are black. These folks are driving new infections, researchers believe. Successful treatment significantly lowers the amount of HIV in a person's blood, thus making that person much less infectious.

Similarly, African Americans, particularly young black women, have higher rates of undiagnosed STDs than their peers. And that increases the risk of infection. While it's true that you can contract HIV from a single exposure, the odds are against it when we're talking about sex. Absent a direct route to the blood stream—such as injecting drugs with a used needle—the rate of infection upon exposure is low, relative to other sexual infections. But add an untreated STD to the mix and the likelihood you'll contract HIV, as well, goes up at least five-fold.

So the severity of the black AIDS epidemic is fueled by the same factors that drive a host of other health problems have hit us harder: We either don't have access to consistent, preventive health care, or we don't use the health care we've got.

Which brings us to the broader social and economic issues driving the racial disparity in HIV infection. Yes, access to and attention to health care are central issues. But there's so much more.

One fascinating theory gaining credibility and drawing research attention focuses on what public health experts call "sexual networks"—or, the universe of people from which someone is likely to choose a sex partner. The dynamics of a given sexual network—and we've all got one—will affect the level of risk for HIV (and other STDs) that individuals in that network face.

And, to put a very fine point on it, there is much about the range and dynamism of black sexual networks that contribute to HIVs spread.

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