Barnaby Powell|20.09.2016|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.


In the final part of our miniseries about the complex relation between race and HIV in the U.S. we delve deeper into the issues of stigma.

Research has shown that black gay men take fewer risks in the bedroom than white gay men. They are just as, if not more, consistent about condom use and STI testing. Moreover, on average, they have fewer sexual partners. Yet, they are still six times more likely than white men to contract HIV. This would seem to suggest that a lack of education is not the issue, as it shows that black people are educated on sexual health at similar levels to the rest of the population. So what can possibly explain the higher HIV infection rates among black gay men and indeed the wider black community in the U.S.?

The enduring stigmatisation of people with HIV is a vital factor in finding an explanation to the continuing high infection levels among black Americans. Whilst the stigma attached to HIV affects everyone who has the virus, it can be particularly damaging for those in the black community. Many HIV positive African Americans may view their diagnosis as a ‘double marginalisation’, because they are already (racially) marginalised in other walks of life.

The stigma surrounding HIV deters people from getting tested and those who are diagnosed with the virus will often find it difficult to disclose their status and to pursue treatment and care.

Equally damaging can be the way HIV stigma and discrimination also often limit social support to people living with HIV from family and friends. This is perhaps even more apparent in African American communities.  Because of the fact that their communities are relatively closed, black people living with HIV can often feel rejected. This in turn, affects the further spread of HIV. For example, the CDC reported that black men who have less social support are less likely to get tested for HIV, which increases the likelihood of transmission.

Whatever you make of these causes, the research shows that the HIV epidemic in the U.S. continues to disproportionately impact black people – and in particular black MSM – compared to other groups. We must therefore ask: is enough being done to tackle the issue?

Many positive steps are being taken. Roughly half of the CDC budget is directed towards African Americans, which is proportional to their share of annual HIV infections. Similarly, the National Institute of Health has increased its funding towards addressing HIV amongst black MSM, and a number of large U.S. governmental organisations (such as the CDC and Department of Health and Human Services) have attempted to prioritise black MSM in their funding and targeting. There are also greater attempts being made in the black community to promote change.  For example, the NAACP (National Association for the Advancement of Coloured People) made July 17th as the ‘Day of Unity’ whereby pastors across the U.S. should preach on HIV as a social justice issue. And a new generation of black gay leaders and influential figures are increasingly raising the profile of the issue.

This is undoubtedly promising.

However, a lack of significant change and the voices of affected groups themselves show that this is not enough. Back in 2009, the CDC reported that they were underfunded by around $850 million. And between 2009 and 2011, just 2 of 84 of the CDC’s ‘Compendium of Effective Behavioural Interventions’ have focused specifically on black gay men. So, whilst change is occurring, it is clearly not happening quickly enough.

An undeniable problem clearly persists in the United States. Black individuals with HIV/AIDS, in particular MSM, are being left behind by efforts to eradicate the virus. Even greater efforts need to be taken to tackle the issue. And most importantly maybe, we need to have a much more open and inclusive discussion about the complex relation between HIV, poverty, stigma and race.