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It appears, for example, that the connections
between black people in the U.S.
differ to some extent compared to the
connections among white people in the
sense that there are more disassortative
relationships, or relationships between
people with different risk factors. There’s
more of a tendency for African Americans
to have relationships with people who
have much greater risk for HIV than they
themselves do. There’s also the issue of
partnerships that overlap in time, or sexual
concurrency. In addition, they tend to find
partners within their communities, which
are often segregated. Sexual concurrency
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has been found to put people
at greater risk for HIV than
serial monogamy, even if
people in both groups have
had the same number of
partners over the same
period of time.
THE THIng THaT
is really, really
important is the
observation that
it is the social context of
life in the United States that
really contributes to those
partnership patterns. It’s
pretty clear that black people
as a whole tend to live under
very different circumstances
in the United States than
white people do. And some
of these characteristics that
we have been studying, like
incarceration for example,
not only contribute to HIV,
but they’re also emblematic
of the oppression that
minority populations are
living under in the United
States. A history of incarceration,
for example, which is
experienced by black men
more than any other group,
primarily as a result of the war on drugs,
lowers the possibility of employment and
increases the risk of poverty, while at the
same time disrupting the stability of longterm
partnerships. Incarceration and death
due to violence and disease in black men
lead more black women to enter into relationships
with men who have greater risk
factors for HIV than they do.
This doesn’t mean that each and
every minority, each and every African
American, in the United States is poor and
oppressed. But as a whole, it is these types
of factors that contribute to the spread
of HIV, STDs, and in fact different rates of
other diseases, such as diabetes and heart
disease. Black people are at greater risk
of acquiring HIV infection independent of
their own low-risk behavior compared to
other groups.
I
woULD aLSo EmPHaSIzE THaT
we do have personal responsibility for
our behavior. However, I think some
people tend to look at this work and
say, “Oh, they’re just blaming the environment,
blaming the majority population.”
That’s really not exactly it. While we do
have personal responsibility for our behavior,
I think it’s very critically important to
realize that black people have substantially
increased risks than other populations,
even with the same behavior. And this has
been demonstrated. This is true for black
gay men as well as for black heterosexual
men and women.
I would say to black women living with
HIV, keep the faith. Teach your sons and
daughters all the lessons you’ve learned.
You have a wealth of experience, and certainly
resiliency.
We need to work in whatever ways we
can to change the social and economic
factors that are putting our people at risk,
and putting our children at risk.
It would help if everyone in the United
States had health care. It’s astonishing to
me that, apparently, health care is not a
right. It remains an open question in the
United States that people should have
health coverage, even though it’s clearly
most cost effective for the nation as a
whole. This is a civil rights issue. That’s
what I mean by working to change the
economic factors that put people at risk.
Health care availability, affordability for
all, would make a huge difference in terms
of transmission of HIV, and also in terms
of the personal health of people who are
living with HIV.
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