The HIV epidemic in the African American community is an under-reported story[i] with huge significance for North Carolina and the South as a whole.
HIV/AIDS, which has long been thought of as an urban epidemic, has moved south to communities that lack the resources or education to combat it.[ii] In many southern communities, people who try to get help face the added hurdle of poor access to comprehensive healthcare.[iii]
Nearly 50 percent of new HIV infections in the United States are in the South, even though the region only makes up a third of nation’s population. And African American men and women are the hardest hit by far.
It’s estimated that 1 in 5 African American gay and bisexual men in the South is living with HIV. The rates are even higher among African-American transgender women.
In 2010, African American gay and bisexual men accounted for almost as many new infections as white gay and bisexual men, despite the differences in population size.
In 2010, there where an estimated 10,600 new infections among African American gay and bisexual men in the US. By comparison, in the same year, there were 11,200 new infections among White gay and bisexual men, and 6,700 among Hispanic/Latino gay and bisexual men.[iv]
Young African American gay and bisexual men ages 13 to 24 are especially affected by HIV. In 2010, they accounted for approximately 4,800 new HIV infections – more than twice as many estimated new infections as either young White or Hispanic/Latino gay and bisexual men.[v]
In the South, a multitude of factors have created a perfect environment for HIV to thrive, especially in the African American community.[vi]
These factors include widespread poverty, lack of HIV testing and education, racial discrimination, stigma, incarceration, barriers to health care and housing, a shortage of accessible medical specialists in rural areas, and persistent prejudices by many in the Bible Belt.
There are specific factors that put African American gay and bisexual men at risk.
African American men more likely than any other ethnicity or race encounter limited access to and use of quality healthcare. They also experience lower incomes, with an average income of $20,000 a year; lower educational attainment; and higher rates of unemployment and incarceration.[vii]
All of these factors explain why African American gay and bisexual men living with HIV have lower rates of linkage to health care, retention in care, being prescribed HIV treatment, and experiencing viral suppression.[viii]
Greater risk of exposure
African American gay and bisexual men are a small subset of all gay and bisexual men, and their partners tend to be men of the same race.[ix]
Because of the small size of the community and prevalence of the disease within it, African American gay and bisexual men have a greater risk of being exposed to the virus within their sexual networks.[x]
Sexual relationships between older and younger men
Sexual relationships with older men, who are more likely to have HIV, may also increase the risk to exposure among young African American gay and bisexual men.[xi]
This is due to the dynamics of the relationship where the older man may have the power and control because of his educational background, maturity, financial stability.
It can be situation where transaction sex is involved. The younger man may need a place to live or financial support, and the older individual provides those in exchange for sex, which can contribute to high-risk activities.
Lack of awareness of HIV status
Many African American men living with HIV are unaware of their status. This is especially true for young men.[xii] Individuals who do not know they have HIV do not get into medical care and may not adopt behaviors that will lower their risk factors. They can therefore unknowingly infect others.
Stigma, homophobia, discrimination and religion beliefs
The stigma associated with HIV and AIDS can lead to denial. Many believe they are not at risk of acquiring a virus that affects gay people. This is sometimes true even for people who are men who sleep with men.[xiii]
Stigma puts African Americans at risk for bullying, shame, loss of family and friends support, love and interpersonal relationships, and isolation.
Young African American gay and bisexual men have been put out of their family homes and forced to live with friends, strangers, or on the streets, which can contribute to their risk of being exposed to HIV.
We are at a crossroads. We must combat this pandemic that has taken over our community.
Our house is on fire. If we don’t do something to control the raging flames, it will burn down to the ground, and all that are inside will perish.
We must take the dis-ease out of the disease, and save our brother’s lives.
— Brodderick Roary serves on the Board of Directors of the North Carolina AIDS Action Network, a statewide organization dedicated to improving the lives of people living with HIV/AIDS and affected communities.
[i] Brock, Rosyln M. July, 2013. “Moving Beyond the Taboo: HIV/AIDS and the Black Community.” Huffington Post. http://www.huffingtonpost.com/roslyn-m-brock/hiv-aids-black-community_b_3672738.html.
[ii] Creek, Ashley. July, 2014. “HIV/AIDS has migrated to Deep South, where stigma endures.” Al-Jazeera America. http://america.aljazeera.com/articles/2014/7/26/hiv-aids-in-the-deepsouth.html.
[iii] Heitz, David. April 26, 2014. “Battling HIV in the American South.” Healthline News. http://www.healthline.com/health-news/battling-hiv-in-the-american-south-042614#3.
[iv] Centers for Disease Control. 2014. HIV Among Gay and Bisexual Men. http://www.cdc.gov/hiv/risk/gender/msm/facts/.
[v] Centers for Disease Control. 2014. HIV Among African American Youth. http://www.cdc.gov/nchhstp/newsroom/docs/CDC-Youth-AAs-508.pdf.
[vii] Centers for Disease Control. 2013. HIV Among Black/African American Gay, Bisexual, & Other Men Who Have Sex With Men. http://naacp.3cdn.net/1e29424350071fb7cf_ibm6i2v2p.pdf.
[viii] Centers for Disease Control. 2014. HIV Among African Americans. http://www.cdc.gov/hiv/pdf/risk_HIV_AfricanAmericans.pdf.
[ix] Centers for Disease Control. HIV Among Gay and Bisexual Men.
[xi] Centers for Disease Control. HIV Among Black/African American Gay, Bisexual, & Other Men Who Have Sex With Men.
[Ed. Note (Dec. 22, 2014) — This post has been updated to include several citations mistakenly omitted at the time of publication.]