Black Women and HIV Rates: A Reprieve

A woman, Tyshuanna Jackson, gets blood drawn for HIV/AIDS and STD testing at Los Angeles health fair. (Kevork Djansezian/Getty)
A woman, Tyshuanna Jackson, gets blood drawn for HIV/AIDS and STD testing at Los Angeles health fair. (Kevork Djansezian/Getty)

(The Root) — Usually, when Quinn Gentry stops talking, the women in the audience spend a few seconds sitting, shell-shocked and silent.

Around Atlanta, Gentry's speeches — rife with the nitty-gritty and completely true stories of women infected with HIV collected over the course of her research career — are the stuff of legend. In no uncertain terms, Gentry, a sociologist who studies the way economic and social dynamics influence the spread of diseases such as HIV/AIDS, talks about the lifetime risk that black women — even those with decent incomes, houses, degrees, husbands and church homes — face of contracting HIV. Gentry's stories are delivered along with epidemiological data, charts and graphs that all make one thing plain: Black women are in peril.

"You should see the faces," said Gentry, the president and founder of Messages of Empowerment Productions, an Atlanta-based public health education company. "When they look stunned, I know that I may have reached them. What I bring, it's not the story about sex workers and men on the down low that they've already grown used to hearing. What I talk about is the way that blind trust and silence, stuff that may be a part of their life, can be deadly."


It turns out that shocking presentations like Gentry's and a turnaround in federal HIV-prevention strategy that began near a decade ago may be saving lives. As the country marks National HIV Testing Day (click here to find a free HIV-testing location near you) today (June 27), officials with the nation's chief health monitoring agency, the Centers for Disease Control and Prevention, say that something interesting and encouraging seems to be happening with black women and HIV.

For the first time in two decades, the number of new HIV infections reported among black women — a group bearing the brunt of one of the nation's most disproportionately high HIV-infection rates — has declined. In fact, between 2008 and 2010, the most recent detailed data (pdf) available, the number of new infections among black women slid a full 21 percent.

"It's probably a little too early to declare victory," said Donna Hubbard McCree, associate director for Health Equity in the CDC's Division of HIV/AIDS Prevention. "But are we evolving as the epidemic evolves? Are we cautiously optimistic? I'd have to say yes."

The story of HIV and its impact on black America has for so long been so bad that when the CDC released its annual HIV Surveillance Report earlier this year, the news came as a welcome but true surprise.


After all, African Americans make up only about 12 percent of the nation's population but more than 40 percent of those living with HIV/AIDS. Black women represent the fourth-largest group of HIV-infected individuals, behind white, black and Latino men who do not necessarily consider themselves gay or bisexual but do have sex with men. In portions of the Deep South, HIV-infection rates have spent the last three decades soaring so high that the share of people living with the disease rivals the situation in some developing nations.

The slide in new HIV infections among black women had not gone unnoticed in previous years, said McCree. But in the public health world, a one-year event is considered a possible blip. A two-year public health event registers as something worth monitoring and noting. And a three-year pattern is cautiously but excitedly regarded as the possible start of a health trend.


When it comes to a disease like HIV/AIDS — one for which effective but expensive treatments have been developed but for which a cure remains elusive — good news is always relative.

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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.

Nearly 90 percent of black women (pdf) infected with HIV contracted the disease through heterosexual sex. But heterosexual black men rank behind black women in the prevalence of HIV infection. Given what is known about sexual behavior and demographics — most people have sex with people who are members of the same racial group — the figures suggest that at least some black women are being infected by men who have, at some point, also had sex with men.


Talking about that publicly gets tricky. Black women, gay men of all races and heterosexual men who secretly have sex with men suffer no shortage of woefully inaccurate, demeaning stereotypes and myths about their sexual behavior and moral character.

Researchers at the CDC also produced a study in 2009 that called into question the role that black men who secretly have sex with men has really played in infecting black women with HIV. Among other things, the study found no evidence that the share of black men who secretly have sex with men is larger than the share of white men who do the same. Yet far fewer white women are infected with HIV.


Lest the public leap to the conclusion that black women's sexual behavior may be to blame, the CDC also has plenty of data indicating that black women do not engage in more risky behavior than others. But a disproportionate share of black women do not have access to regular health care.

What people need is a deep understanding of the way that relationship dynamics — blind trust versus reasonable and respectful faith in a partner; fear and shame about negotiating condom use versus confident and calm discussions about sexual health; the challenge of querying black men already so widely distrusted in broader society — can determine the amount of risk of contracting HIV that a black woman faces, Gentry said.


The stuff that makes us all uncomfortable, even the stuff that is unclear, must be discussed, she said.

"If we cannot talk openly about our experiences and which sexual activities and partners are actually higher risk than others, then we cannot talk openly about our truth or save our own lives."


Janell Ross is a reporter in New York currently writing a book about race and the recession, due out next year.

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