Barnaby Powell|16.09.2016|Case Study Feature

There are currently 1.2 million people living with HIV in the United States. Although compared to the total population of the country this is a relatively small number, the virus is disproportionately affecting a number of key populations. One of the key groups that is relatively hard hit by the HIV epidemic in the U.S. is the African American community. In this miniseries, we will be looking into some of the reasons that can explain why such a disparity exists.


Part 2: HIV, race and healthcare

In the previous article in this miniseries we talked about how race, economic status and HIV are intrinsically interlinked. This time we will have a look at how access to healthcare is affecting HIV infection rates among racial minorities in the U.S.

Access to healthcare is a crucial element in explaining why African Americans are disproportionately affected by HIV. People’s economic status significantly impacts their ability to access healthcare in the U.S. In 2012, around 19% of African Americans did not have a health insurance.  This has an effect on HIV testing rates, which are integral to stopping its transmission. Young black MSM between 15 and 22 are tested for HIV less regularly than white MSM. It is perhaps unsurprising therefore that significantly more HIV positive young black MSM are unaware that they have the virus (91%, compared to 60% of white MSM). This undoubtedly raises the likelihood of HIV transmission in the black LGBT community.

For HIV positive people who do know their status, health insurance is vital in order to be able to cover the high costs of HIV medication and care. Research has demonstrated that being on HIV medication and starting it early can help prevent someone from transmitting the virus. Hence, the lack of access to healthcare among African Americans negatively impacts both HIV mortality rates and transmission. From 2011 to 2013, only 38% of black HIV patients received consistent treatment and care (compared to 50% of white and Hispanic people in the same period) and only 29% of African Americans living with HIV at the end of 2012 were prescribed antiretroviral therapy (compared to a national average of 40%).

A final issue related to healthcare, and one evidenced by academics and experts alike, is the higher prevalence of other sexually transmitted infections (STIs) amongst black men in the U.S., facilitating greater HIV transmission.  Research shows that inflammation caused by many STIs increases the likelihood of HIV infection. The fact that Chlamydia rates amongst black men are 8 times higher than in white men and Gonorrhoea rates 12 times higher, complicates the situation regarding HIV among black minorities in the U.S.

So far, we’ve discussed how poverty and access to healthcare have a negative impact on HIV transmission rates in the African American community. However, despite increased levels of HIV prevention funding diverted towards the black community in the U.S. (half of the CDC budget), little seems to be changing. In the next and final part of this miniseries we will try to find an answer as why that is.


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