Addressing Disparity

VOLUME 19 | ISSUE 2 | SUMMER 2012

In July, for the first time in more than 20 years, the International AIDS Conference will return to the U.S. As more than 25,000 people from 200 countries convene in Washington D.C. to discuss the global pandemic, there are many reasons for Americans to be optimistic.

Mother-to-child transmission of HIV has been virtually eliminated in America, and antiretroviral medications are saving thousands of lives. In 2010, the Obama Administration released the first ever National HIV/AIDS Strategy and lifted a 22-year-old ban barring persons living with HIV from entering the U.S. Health care reform is removing insurance rules that deny treatment to people living with HIV because of a “pre-existing” condition or because an insurer does not cover accepted standards of HIV-care. And last year, researchers discovered that giving antiretrovirals to healthy people living with HIV can reduce transmission risk by 96 percent, a finding that has led many voices to herald “the end of AIDS.”

We have made incredible progress in the 31 years since AIDS was first diagnosed. But one need not look beyond our borders to find gross disparities in this terrible disease. Since the beginning of the epidemic, HIV/ AIDS has disproportionately affected African-American communities and the black/white disparity has never been greater.

In 2009, African Americans represented 14 percent of the U.S. population but accounted for 44 percent of new HIV infections. At current trends, it is estimated that 1 in 32 black women and 1 in 16 black men will be diagnosed with HIV during their life. Clearly, recent advances in HIV prevention and treatment have not yielded equal benefits for all Americans.

We are often asked whether the higher rates of HIV among African Americans reflect greater risk behaviors?

The answer is a resounding no.  

Numerous studies show that black men and women have similar rates of risk behaviors to those of other Americans. However, the simple fact that people tend to have sex with partners of the same race perpetuates, and at times even accelerates, existing disparities.

Among African Americans, a high current prevalence of HIV, lack of access to HIV testing, and less awareness of HIV status, mean that sexual behaviors that would otherwise bear low to moderate risk become more dangerous.

What, then, can we do to reduce disparities in HIV? We both are involved in research that aims to answer that important question, from two different angles. Matt Epperson’s work is focused on prevalence of HIV among those involved in the criminal justice system, and Alida Bouris is conducting research to help lower the impact of HIV on black young men who have sex with men (YMSM).

Nearly a quarter of all HIV-positive Americans pass through the criminal justice system each year. Matt’s research shows that being arrested or incarcerated is a strong predictor of HIV status and sexual risk behaviors, and that these risks are often conferred to offenders’ sexual partners. Black women, whose rate of HIV is more than 15 times that of white women—and who represent nearly one-third of all incarcerated women—have a higher prevalence of HIV than that of any other incarcerated population.

However, there have been few effective interventions developed for this population. Matt is currently part of a study examining the efficacy of a culturally tailored, multimedia HIV prevention intervention targeting women involved in the criminal justice system in New York City, and is starting research to develop HIV prevention interventions for couples affected by criminal justice involvement.

From 2006 to 2009, the incidence of HIV among black YMSM aged 13-29 increased by 43 percent. Black YMSM carry the nation’s highest burden of HIV and are the only group where HIV is significantly increasing. Although effective parent-based interventions have been developed for heterosexual youth, no such interventions exist for YMSM. As such, parents of YMSM lack evidence-based guidance on how to address topics with their sons like dating, healthy relationships and safer sex.

Alida’s research shows that family members can play an important role in the lives of YMSM, and she is working to develop parent-based HIV-prevention interventions. As part of this research, she is working with black and Latino YMSM and their families to better understand their HIV-prevention needs, and how they manage homophobia, stigma, and discrimination, which can increase vulnerability to HIV.

It is our hope that research such as this will produce results that can be shared with community partners and social workers—who have played a critical role in helping communities hardest hit by HIV/AIDS since the earliest days of the epidemic—to reduce the burden of HIV/AIDS among African Americans and other vulnerable groups. The advances in the prevention and treatment of HIV/ AIDS should be equally available to all.  

Alida Bouris and Matthew Epperson are assistant professors at SSA and co-principal investigators at the School’s STI and HIV Intervention Network (SHINE).