Sunday, March 22, 2009

AIDS and Racism

As many are aware, new numbers came out in the Washington Post, revealing that Washington, D.C. now has a 3% HIV+ rate - and that the disease is spreading rampantly throughout the African American community. Only two days ago The Dallas Voice/Pegasus News published new numbers for Dallas, TX - which indicates 50% of all new HIV/AIDS cases in Dallas County are in the African American community. This matches nationwide numbers as reported by Anthony Fauci of NIAID - where he points out that African Americans make up 12% of the population but account for 50% of all new HIV/AIDS cases.

Since the turn of the century, the "on the down low" phenomenon has continually been cited as a leading reason for this trend in the African American community. Whether you're watching Oprah Winfrey, Tyra Banks, Law and Order - or reading countless blogs and news stories - you will get told that many, many black men hide their true sexuality - and thus have sex with other men, catch HIV, then turn around and give it to their wives and girlfriends. You will be told that these men do not wear condoms when having sex with men, because to plan for sex by bringing a condom would mean to admit their intent to have homosexual sex - and that somehow by not wearing a condom, they psychologically avoid their own sexual identity. You may also read reports that indicate there are larger numbers of bisexual black men than in other races.

The Dallas Voice article article continues to perpetuate the notion that the transmission of HIV from black men to black women is largely due to "on the down low" behavior.

Nobles also noted that HIV/AIDS has increased dramatically in recent years among black women, many of whom contract the disease from men who have gay sex on “the down low.” In 2007, for example, 81 percent of all new HIV/AIDS cases were in males, but 32 percent of new cases among blacks were in females.

“They have a gay lifestyle but in the public they have a wife or a girlfriend, and so the disease is crossing over rather rapidly in this particular population,” Nobles said.

It is extremely important to note that in scientific literature, this has been discounted - or at least viewed as highly suspect. And what floors me is that a very important study reported in the Annals of Epidemiology in 2006, addressed the issue head on. Here are a few excerpts from Reuters reporting in 2007:

This assumption was mistaken in many ways, they explain. First of all, the practice of straight men secretly having sex with men is seen across all ethnic groups.

Also, Ford notes, while black men and women have higher rates of HIV infection than other ethnic groups, they also report fewer risk behaviors, suggesting researchers should look elsewhere to understand the disparity.


Research has refuted the claim that black men living the down low lifestyle are driving the spread of HIV, Ford said, but the perception that this is the case remains, even in the epidemiology community. She points to a dean at a colleague's school who urged researchers to study "the down low" after seeing a TV segment on it.

The view of black sexuality as deviant and diseased has deep roots, Ford noted, pointing to the way the public and the medical community viewed syphilis in the early 20th century as a disease of the black community.

The careless use of such claims to explain the disproportionate infection rate among black women is based on anecdotal evidence and is not scientific in the least. It serves to demoralize the black community and may even hurt - as the Reuters article suggests - research efforts to discover the true reasons behind the trends.

And what about these trends? The recent "3%" number of infected Washington residents has been all over the news and has been the subject of myriad press conferences by health officials - but in January of 2008, American Medical News reported that 5% (or 1 in 20) of D.C. Residents were HIV+. Not 3% - but 5%.

This is a 40% drop. So is there actually reason to celebrate in D.C.? A 40% drop in HIV infections in a single year is significant, yes? Sarcasm aside, the better question is: how is this data being gathered? And the biggest question is: why are journalists so quick to report numbers and never check previous statistics and studies?

I have been looking at comments on many blogs where the D.C. numbers - and now Dallas numbers - have been reported. There's this general acceptance that African Americans are simply "different", "more promiscuous", "more homophobic" - etc., etc. - and when I'm teaching inner city at-risk youth and they are shown posters for Black HIV Testing Day - and they say things like: "Why is our community too stupid to not get AIDS" - my heart sinks. This is a dangerous sort of racism. The reasons given by the media are oversimplified in an attempt to explain disproportionate numbers that make no epidemiological sense.

I ask all journalists and bloggers to consider these issues and make sure that great care is given when hurling accusations at minority communities. Ironically, in an effort to "help" - I fear health care practitioners may be missing the actual causation of this trend among African Americans - and in the process, are promoting racial stereotypes. Does it truly add up - just using common sense - that "black homophobia" can account for 50% of all HIV cases in the US - but African Americans only make up 12% of the population? That's an absolutely staggering number - and I think harder questions and better research must be conducted to truly understand what is going on.

As I have said in previous posts...don't be so quick to accept what they say - because who are they and how did they get their information? When dealing with issues as important as infectious disease...when using words like "epidemic"...when using phrases like "national health crisis"...when using tax payer money to fund research and understand trends...a critical mind must be employed. It is far too easy to simply accept and go along with statistics and gross generalizations - especially if it isn't affecting 88% of the population that is YOU.

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