African-Americans comprise 12% of the US population, but, as of 2016, accounted for 44% of the estimated 40,000 new HIV diagnoses. 58% of the African-Americans diagnosed with HIV were black MSM. Statistics such as these, drawn from the 2016 CDC HIV Surveillance Report, are the basis of a recent ‘Decade Call to Action’ (Laurencin & Christensen). They are set against the background of data from the 2005 Surveillance Report, itself the basis of an earlier ‘Call to Action’ in 2008.
It is true that over the period 2005-2014 yearly incidence of HIV diagnosis has declined in both African-American (A-A) women and men. Nevertheless, this still leaves an enormous disproportion between incidence in African-Americans and other ethic groups: A-A males are 2.1 times more likely to be HIV positive than Hispanics, and 7.8 times more likely than whites; while the equivalent ratios for females are 4.9 and 16.4.
But the greatest concern is the black MSM population, which, unlike the black population as a whole, has seen an increase (22%) in incidence over the period from 2005-2014. As for young black MSM (aged 13-24), they have seen a 30% increase over just the period from 2011-2015. Add to this that the South contains 21 of the 25 metropolitan areas with the highest HIV prevalence among gay and bisexual men – and one begins to appreciate the truly explosive nature of the epidemic in certain local key populations.
But the larger part of this paper consists in an analysis of potential causes of this extreme disparity between African-Americans and other elements of the population. The authors enumerate some of the more frequent candidates, including: the high levels of ulcerative STIs (9 times the likelihood of diagnosis with gonorrhoea; 5 times the likelihood of syphilis) and disappointingly low levels of consistent HIV healthcare treatment for HIV- infected African-Americans (38% from 2011-2013), and of effective viral suppression for gay and bisexual HIV-infected African-Americans (48% as of 2017). But they also include interesting discussion of how segregation serves to augment ‘community viral load’, especially when compounded by strong racial identification within these communities. Nor do they evade the sensitive issue of stigmatization, which they attribute in part to ‘homo-negativity’ within African-American Church, citing the low level of activities to serve persons living with HIV. It is interesting in this regard that their recommendations for action include: ‘adapting Church-based prevention strategies developed for other A-A sub-groups; considering how Scripture supports prevention efforts; emphasizing the tenets of liberaton theology.’
Qualitative research undertaken in other cultural settings has demonstrated how low community resistance to HIV-related stigma can jeopardize stigma-reduction strategies (Bonnington & Wringe/STI), and how bio-medical strategies can themselves lead to new forms of stigmatization (Roura & Zaba/STI). The question of how to involve senior faith leaders in health interventions is an interesting and no doubt important one. Willms & Macondesa/STI offer an interesting example of such an intervention in Malawi – though probably not one that would be generalizable to the context of African-Americans. The brief discussion by L&C of stigmatization in the context of the A-A church is respectful and constructive, and points to important areas for future research.