Barnaby Powell|14.09.2016|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 1: HIV, race and socio-economic status

In 2014 it was reported that 44% of all new HIV diagnoses in the U.S. were among African Americans.  This is despite the fact they make up just 12% of the population. Perhaps most worryingly, in 2013, 54% of total HIV-related deaths were amongst African Americans.

Young black gay and bisexual men are particularly at risk – the number of diagnoses among this group rose by 87% between 2005 and 2014.

What is clear is that one blanket explanation cannot explain the issue. There are instead a number of interlinked causes that have led to what we see today.

On the surface it may seem that the relative poverty of many black Americans is the main problem. There is a clear correlation between socio-economic status and HIV transmission, with the U.S. Centre for Disease Control and Prevention (CDC) reporting that HIV is highest among people at or below the poverty level. No less than 26% of black people in the U.S. live below the relative poverty line (compared to 10% of non-Hispanic white people). But why does being black and less wealthy mean you are more at risk of HIV?

One of the explanations for this could be the residential segregation in many parts of the U.S., which was not only caused by poverty, but also reinforced poverty. Many black communities in the U.S. are very concentrated and relatively closed off. This means that, for instance, African American men who have sex with men are more likely to transmit HIV to other African Americans than to people outside their community. As a result, HIV transmission rates are far higher among black MSM than other racial communities.

As mentioned, this is only part of the explanation as to why African Americans are disproportionately affected by the HIV epidemic in the U.S. The next part of the miniseries will delve into how unequal access to healthcare, which is closely interlinked with economic status, further contributes to the relatively high HIV infection rates among the African American community.