Black Women and HIV Rates: A Reprieve

A decline in infection rates brings cautious optimism as the nation marks HIV Testing Day.

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Black women remain in significant danger. In fact, at some point in their lifetimes, an estimated one in 32 black women will be diagnosed with HIV, compared with one in 106 Hispanic women and just one in 526 white women.

Just what caused the decline in new HIV infections among black women remains a matter of debate between the CDC and other public-health agencies operated by the government and by entrepreneurs around the country. But McCree, who has focused on HIV prevention in communities of color since 1998, credits two things: expanded testing and simple but detailed truth telling.

"What we've tried to do over the last, I would say eight to 10 years, is really expand testing, get people who have not previously been tested," McCree said. "We've started reaching people that we haven't before, finding people who were positive but didn't know it, and in doing so, we think really prevented a lot of new infections."

Between 2007 and 2010, the CDC invested $102.3 million in a program known as the Expanded Testing Initiative. The program made free HIV testing available in 25 communities with particularly elevated HIV infection rates. Most of the 2.78 million people tested did so at existing health care facilities, but the initiative also brought HIV screening to nontraditional spaces like churches and grocery stores. Nearly 30,000, or 1 percent, tested positive.

Those figures may sound small in a nation of nearly 314 million people. But the CDC estimates that the testing initiative, as well as identifying at least 18,000 people who did not previously know that they have been infected with HIV, prevented 3,381 new infections.

"It is beyond refreshing and rewarding to see our campaigns have that sort of impact," McCree said. "But I think that what we are seeing with black women and HIV infections, if it holds as we get the 2011 and 2012 data, may also be about what I say is a growing understanding, a fact-based understanding, about risk."

After a number of years in which research on the existence, prevalence and risk created by heterosexual men who have sex with both women and men (often referred to as "on the down low"), McCree and many of her colleagues reached a conclusion: The information may be useful, even essential. But what ordinary people also need is not a set of new labels. They need actual information about their partner's sexual histories and current sexual activities, the sexual practices and habits that can put a person at greater risk on contracting HIV and which ones can reduce it.

"We know that testing saves lives. We've got the data to prove it," said McCree. "We suspect the same about that kind of detailed truth. What women need to know is not what a man calls himself, what label he likes and what he doesn't but what he has done and how. That's where I am at. "

But the truth -- telling it, hearing it and believing it -- isn't always simple.

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