Viruses and infections are a part of navigating your journey on earth. You can catch a cold, the flu, COVID-19 and a sexually transmitted infection. In fact, many educators and doctors like Dr. Ina Park, as she shared on the podcast That Sexciting, explain that for sexually active folks, STIs are as common as the flu. They are a normal part of life. Some infections come and go, some remain in your body like Human Immunodeficiency Virus (HIV). Certain communities are more at risk of being exposed to and contracting this virus. If you think of COVID-19, marginalized communities are most at risk of contracting it. This is similar to HIV. A 2019 report says that “Black/African American persons [contributed] for 41% of HIV infections”. You may be wondering: Why is that? What does this mean? Should I be worried? Let’s talk about it!
To help you better understand these numbers, here are three things to know about HIV and the systemic barriers that contribute to these statistics.
Understanding HIV is the first step to awareness and understanding why the Black population is vulnerable to contracting the virus. So, put on your goggles and white coats because we’re jumping into our express science class!
The immune system is like a fort with many different fighters. Among this army, the white blood cells, specifically those called lymphocytes (T cells), are responsible to fight against unwanted infections and infected cells — like cancer and HIV. When HIV enters the body, the virus enters the T cell’s armor and overwhelmingly clones itself. If you would like a visual explanation, this video from Nature Video Channel brilliantly explains the science behind what happens. The virus has one purpose: weaken the defenses of your immune system. Once inside your body, HIV stays in your body. The terms used for people with HIV are HIV positive or seropositive.
When detected in its early stages, HIV can be treated with medications to the point of being undetectable and non-transmissible! This means that the chances of you transmitting the virus to a partner are extremely low. When undetected over a long period of time, we’re talking around 10 years here, your immune system is extremely weakened and is unable to fight off infections and other viruses efficiently. This stage is called Acquired ImmunoDeficiency Syndrome (AIDS). So far, we learned what HIV does to the body, and how HIV and AIDS are not the same things. Let’s look at how someone can contract it.
You may have heard that HIV only affects certain communities. This is false. Anyone can contract HIV, regardless of ethnicity, sexual orientation, gender and age. Contrary to popular belief, HIV is not simply transmitted sexually. In fact, there are various ways someone can contract the virus:
Systemic barriers are stumbling blocks embedded in our current society. They are defined as laws, policies and/or practices resulting in unequal access and/or exclusion. Here are some examples: poverty, racism, judicial system, carceral system, education level, ableism, heterosexism, etc. If you are unsure of certain terms, a glossary has been added at the end of this article to help you navigate these concepts. All these systemic barriers can immensely contribute to new HIV infections among specific demographics. An intersectional lens is crucial to understand the high rates of HIV transmission in the Black community.
Although the two are not always interconnected, poverty correlates with HIV diagnosis. Where could this intersect? When access to quality healthcare has an income limit. Let’s break it down. In 2019, a report mentioned that “Blacks represented 23.8% of the poverty population” while “Hispanics [represented] 28.1%”. One thing remains unclear: if some people categorized as Hispanics may have been Black, but identified as Hispanic. Given this data, poverty and low income are tied to access to healthcare. Healthcare can be very expensive in a country like the USA – people go into debt with medical bills. A 2022 study explains that Black people are 1.5 times more likely to be uninsured than White people. For Hispanics, the rate is 2.5. If you are uninsured, a visit to the doctor’s office, a couple of tests and perhaps medication can become pricey; especially if you are trying to make ends meet. This can represent a barrier to access to adequate healthcare, sexual health screening and medication to render the virus undetectable. Even when healthcare is accessible, medical mistrust can be a barrier.
How do you feel at your doctor’s appointment? Do you feel heard and well taken care of? Or do you often feel unheard and anxious? This is what some people call: medical mistrust. Racial biases in the medical field contribute to this sentiment. If you want to learn more about this, we recommend checking out Joel Bervell. Statistics show that, in the past 12 months of 2020, 20% of Black adults reported being treated unfairly, as opposed to 5% of the White community. This data is also supported by a national survey from Undefeated and the Kaiser Family Foundation (KFF). The results show that Black adults under the age of 50 years old express being less likely to trust “doctors and the health care system to do what is right for them and their communities''. What does this mean overall? Black people are more likely to mistrust due to medical biases, discrimination, bad experiences and communal trauma. A study compiling various research indicated that: “a lack of cultural diversity and competence among physicians is a major contributor to African American distrust of physicians. Ethnic minority patients receive less information, empathy, and attention from their physicians regarding their medical care than their White counterparts”. This can impact sexual health screenings, adherence to your medication regimen to render the virus undetectable and potential HIV conspiracies.
Let’s talk about the elephant in the room: homophobia. Homophobia is present in the Black community, whether in social, communal or family settings. According to this article, the National Black Survey conducted in 2008 found that "72% of black adults said that homosexuality was “always wrong”—a rate that has changed little since the onset of the survey." Unfortunately, many Black adults from the LGBT community have reported “experiencing victimization including verbal insults or abuse (79%), being threatened with violence (60%), and being physically or sexually assaulted (44%)”. It is important to acknowledge these facts, while also highlighting that supportive friends, family members and supportive youth centers make a big difference in people’s lives. Where does this intersect HIV? Let’s dive into it.
To understand how this can contribute to HIV transmission, we need to talk about stigma. Let’s think about COVID-19 and how it was portrayed. Do you remember the surge of Asian hatred following COVID-19? Some people were calling it the Chinese virus, implying that every Chinese person had COVID-19. This association has also been made with HIV. For a long time, HIV was referred to as a “Gay Disease”. And just like COVID-19, this is a false narrative. The truth is this: the first reported cases of COVID-19 infections were in Wuhan. Similarly in the Western hemisphere, the first documented cases of first AIDS and then HIV were in the gay community. See the difference? A virus does not have an identity, society gives it one.
Now that we understand the stigma, the “HIV is a gay disease” misleading association has remained. If a male presenting person expresses their positive HIV diagnosis, their sexual orientation may be questioned. The assumption of queerness, voluntary or forced coming out frequently faces negative backlash. This can lead to social isolation, being ostracized by communities like family and church, dropping out of school, violent reprisals and homelessness. The lack of knowledge and education about HIV can contribute to these outcomes. Among other factors, one barrier to PrEP use as a prevention method for Black heterosexual men may be due to the societal connection between HIV and homosexuality.
The Black/African population is disproportionately affected by new HIV diagnosis. In fact, “[they] accounted for 42% (15,305) of the 36,801 new HIV diagnoses in the US and dependent areas in 2019" Here’s what to know about new HIV diagnosis, according to CDC reports.
When we are looking at the data, Black women and other minorities are disproportionately affected by HIV. How can we mitigate that you may ask? By tackling issues of the homonegative stigma and lack of education around HIV. Community-based organizing to educate and spread awareness is crucial. Also, safe spaces queer youth can assuredly make a difference in addressing these issues.
Firstly, we would recommend asking questions and informing yourself about HIV and its transmission. This may cause a bit of stress, especially when you are unsure of where to go and what to ask. Luckily, your fingers are one Internet search away from knowing where your nearest Youth Centre is located. Make it a fun date night with friends! They usually have cool games and Youth Center staff equipped to answer all of your questions, including those about sexuality. Sometimes talking to a neutral person about this helps. There are also organizations like Black Coalition for AIDS Prevention that provide valuable information and phone lines available
Luckily, you have the choice to choose what is best for you! If you are concerned about getting a sexual health screening, a few options are available to you:
Conversation about STI screenings with your partner(s) before engaging in sexual activities are important and limits your risks of contracting an STI. If you feel ready to have sex with a first/new partner, a prompt like this one can ease the nervousness you may have around that conversation: “before anything goes further, I would love it if we can go get tested together. Sexual health is important to me and I want to make sure that we can have a risk-free sexual experience”. P.S.: we highly recommend the use of condoms.
PrEP is a prevention medication for HIV exposure. If you had unprotected sex and fear of getting HIV there is also PEP, a post-exposure prophylaxis. Of course, prevention is always suggested in this case. Condoms, when used properly, can be an effective prevention tool for sexually transmitted infections.
If you are HIV positive, it may feel overwhelming and difficult to navigate this journey. We want you to know that there are organizations, educators and even influencers that are there to support you. There might be a feeling that your life is over after a positive diagnosis, though we want you to remember that it’s not! The virus can become undetectable and untransmittable to your partners. For sexually active folks, the possibility of having a fulfilling relationship and exploring their sexuality is still on the table. The road can be bumpy, and there are people who care about you, who love you and who are there to support you regardless of your status.