Policy Perspective

HIV/AIDS Among People of Color
Think Local, Not Just Global

by Megan Comfort and Celeste Watkins

Fall 2005, Volume 27, Number 1

In tracking the spread of HIV/AIDS, American media attention has rightly focused on the global epidemic, which in 2004 encompassed 40 million people living with HIV and 3.1 million lives lost to AIDS. The media particularly emphasize the devastating rates of HIV infection in regions such as sub-Saharan Africa, where 60 percent of all people infected with HIV reside. Not surprisingly, this has led many Americans to associate HIV and AIDS with people in distant lands. Yet a crisis of epidemic proportions is brewing right here at home.

According to the Centers for Disease Control and Prevention, African Americans represent 12 percent of the total U.S. population, but were estimated to account for 50 percent of the HIV and AIDS cases diagnosed among adults in 2003. In the U.S., the AIDS diagnosis rate is 23 times higher for black women and five times higher for Hispanic women than their white counterparts. Black men are diagnosed at nine times and Hispanic men at three times the rate of AIDS for white men. African Americans, followed by Hispanics, also have the poorest survival rates among people diagnosed with AIDS.

It is time to sound the alarm.

If HIV infection and AIDS mortality continue at the current rates, many of America’s communities of color will face a public health threat more akin to that of an impoverished country than a prosperous and technologically advanced nation.

Were upper-class white heterosexual Americans at risk—or even perceived to be at risk—for HIV/AIDS at the same rates as low-income people of color, our country’s top-ranking officials would presumably take notice. They would fully engage the country in rigorous proposals for the design, funding, and implementation of a massive prevention and treatment campaign. Instead, the issue goes largely unnoticed by the general public and our national leaders.

Case in point: In response to a question about rising HIV rates among Americans of color in the vice-presidential debates in fall 2004, John Edwards talked broadly about access to health care, and Dick Cheney admitted he was not aware that HIV/AIDS was reaching epidemic proportions among African American women.

Underlying the muted national reaction to the HIV/AIDS crisis among African Americans and Hispanics is a culture of blame. Fixation on the mode of infection shapes a distancing response to the disease, as HIV is cast as the consequence of imprudent, reckless, or dissolute behavior. Compounding the perception that HIV infection happens to the irresponsible or immoral are persistent racial attitudes that tend to blame people of color almost exclusively for the social, economic, and political disadvantages they suffer.

While race and ethnicity are not inherently risk factors for HIV infection, African Americans and Hispanics are disproportionately afflicted by poverty, lack of access to medical information and care, incarceration, and other hazardous health experiences that result in increased vulnerability to HIV exposure. HIV infection is not simply about who does what, but rather ways in which destitution, racism, and extreme social marginalization jeopardize people’s physical and emotional health. These social conditions increase the likelihood that people will engage in unprotected acts with those in whom HIV is undiagnosed or untreated.

Our country’s senior officials cannot be allowed to plead continued ignorance to a preventable epidemic. Medical providers, research centers, and community organizations must be resourced and empowered to continue making important headway—not hindered by ideological debates that undermine their prevention and treatment measures.

Education and public awareness about the serious threat posed by HIV and AIDS to America’s communities of color must begin at the highest levels of political leadership so that the nation can act collectively to protect the health and well-being of all of its people.

Megan Comfort is a research specialist at the Center for AIDS Prevention Studies, University of California, San Francisco.

Celeste Watkins is an assistant professor of sociology and African American studies and a faculty fellow at the Institute for Policy Research at Northwestern University.