CommunityPam's House Blend

Jon Cohen as a superb piece on Slate about why there is such a high percentage of HIV and AIDS among black women. This was a question both Cheney and Edwards blew in their debate. They were clueless.

When Gwen Ifill asked a pressing question about AIDS during the vice-presidential debate, both candidates were utterly lost. “I want to talk to you about AIDS, and not about AIDS in China or Africa, but AIDS right here in this country, where black women between the ages of 25 and 44 are 13 times more likely to die of the disease than their counterparts,” said Ifill. “What should the government’s role be in helping to end the growth of this epidemic?”

Cheney did not bother trying to hide his ignorance. “I have not heard those numbers with respect to African-American women. I was not aware that it was—that they’re in epidemic there [sic],” he said. Edwards resorted to dodge ball, spending his 90 seconds on AIDS in Africa, the genocide in Sudan, uninsured Americans, and John Kerry. “OK, we’ll move on,” said Ifill, who somehow restrained herself from rolling her eyes à la Jon Stewart.

…Coming up with a sophisticated answer to Ifill’s question is a tall order. AIDS researchers don’t have a solid explanation for why black women in America have such a shockingly high prevalence of HIV infection and AIDS, which makes it difficult to spell out precisely how the government should respond to the problem—other than to reach out to these women more aggressively and to conduct more studies.

Many theories abound, the most interesting of which is the DL or down-low phenomenon, where self-identified “straight” black men who sleep with men and also sleep with (and have relationships with) women.

Some men on the DL are becoming infected by anal intercourse with men and then spreading the infection to their female partners, a transmission route that became widely discussed earlier this year with the publication of J.L. King’s On the Down Low: A Journey Into the Lives of “Straight” Black Men Who Sleep With Men. But the great unknown is how frequently this occurs, and whether it’s truly different in blacks versus whites or Hispanics.

…A fascinating CDC study published last year specifically looked at men who have sex with men and do not disclose their sexual orientation versus those who do disclose. The study recruited participants from only six gay bars (which already tilts the results away from DL men who may not go to gay bars), but the findings were startling. More black men were nondisclosers (18 percent)—that is, on the DL—than white men (8 percent), and all nondisclosures reported having more sex with women than with men. But nondisclosers of all races were also less likely to be infected with HIV than disclosers, and black nondisclosers in particular reported significantly less unprotected anal intercourse with men than did black disclosers. Several other recent studies have found higher proportions of bisexual black men than white men, but it’s unclear whether how much of an HIV “bridge” they are to black women.

It’s clear, however, that the biggest and most easily identifiable factor in HIV transmission is the high incarceration rate of black men (where high-risk same-sex activity is assumed). Women on the outside are infected by these men upon release. And the sad truth is that good men are sparse, and there is a lot of non-monogamous activity that increases the likelihood of the spread of HIV.

They mix with new partners when their men leave and often reunite with them when they are released. Incarceration also exposes many men to anal sex, whether by coercion or choice, and injection-drug use, the two most efficient ways to spread HIV. And if the locked-up man was the main wage earner, poverty can be a factor, too.

One superb study of concurrency in African Americans in rural North Carolina found that 53 percent of the men and 31 percent of the women reported concurrent partners during the preceding five years. Interestingly, 80 percent of the men in the study who said they had been incarcerated for more than 24 hours reported having had concurrent partners within five years; that percentage plummeted to 43 percent if a man had not been locked up for a day or longer.

Equally important, black women have a small pool of black men to choose from at any given time. “African American women are the only group in the United States where there are fewer men than women,” says Gail Wyatt, an associate director of the AIDS Institute at the University of California, Los Angeles. “The availability of a partner who shares the same values is much less likely. The women are more likely to be educated than their partners. They’re more likely to be employed.” As a result of the shortage of black men, black women are vulnerable to becoming involved with men who are engaging in risky behaviors that they don’t know about, whether it be having unprotected sex with other partners, female or male; visiting sex workers; or injecting drugs.

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Pam Spaulding

Pam Spaulding