September 17th 06, 01:21 PM
Moishe Lippschitz, M.D. wrote:
> 'Down Low' Lifestyle Causing AIDS Epidemic Among Blacks
> News; Posted on: 2004-04-08 19:18:02 [ Printer friendly / Instant
> flyer ]
> Black men on the "down low," while not calling themselves gay or
> bisexual, have sex with other men, behind the backs of their wives and
> African-American women are 23 times as likely to be infected with the
> Aids virus as white women and account for 71.8% of new HIV cases among women
> in 29 US states, government research shows.
> The Kaiser Family Foundation has found that in 2001 roughly 67% of
> black women with Aids had contracted the virus through heterosexual sex - up
> from 58% four years earlier.
> Government studies in 29 states found that black women comprised
> roughly half of all HIV infections acquired through heterosexual sex, in men
> and women, from 1999 to 2002.
> "Yes, the risk of contracting HIV is highest in the African-American
> community and there's no question black women are at higher risk compared to
> other women," Robert Janssen, the director of HIV/Aids prevention at the
> Centres for Disease Control (CDC), told the New York Times.
> The principal theory as to why this affects women so acutely is that
> many black men live on "the down-low" - meaning they have public
> relationships with women and secret sex with men.
> Once a week, the five friends, all members of the Abundant Life
> Cathedral here, get together to eat sushi, sip wine and talk. But one recent
> afternoon, the women chose a different activity: They went to see "Not a Day
> Goes By," a musical about black men on the "down low" who, while not calling
> themselves gay or bisexual, have sex with other men, often behind the backs
> of their wives and girlfriends.
> To these women, it was a subject of increasing urgency.
> "Once I found out how prevalent the down low was in our community, I
> was very afraid," said one of the women, Tracy Scott, a 37-year-old
> government relations consultant.
> Her friend Misha King, 35, said she needed to get as much information
> as she could, as quickly as she could.
> "I've been on field trips to the gay bars and have seen guys that look
> like men you would date," Ms. King said. "I treat every man as a bisexual
> because I don't want to end up as the sister with H.I.V."
> Researchers say a black woman has a greater chance of coming into
> contact with the virus when she has sex with another black person because,
> compared with the population at large, there is more HIV in the smaller
> population of black Americans.
> Researchers say it comes down to a numbers game: Blacks make up about
> 12 percent of the nation's population but in 2002 accounted for 42 percent
> of people living with AIDS and more than half of all new HIV infections.
> Blacks generally have sexual relations with other blacks, experts say,
> which works to confine the virus within the black "sexual network."
> "A high prevalence of infection in the pool of potential partners can
> spread sexually transmitted infections rapidly within the ethnic group and
> keep it there," said Adaora Adimora, an infectious disease physician and
> associate professor at the University of North Carolina School of Medicine
> in Chapel Hill.
> She and others cite several other factors. But perhaps the most
> troubling is the shortage of black men as potential partners and husbands.
> "Large numbers of black men are in prison, or unemployed, or dead, so
> there is simply a smaller pool of available partners to choose from," said
> Gail Wyatt, a psychiatry professor and an associate director of the UCLA
> AIDS Institute.
> In 2002, according to the census, 37.7 percent of black men 15 or
> older were married and living with their spouses, compared with 58.5 percent
> of white men. Among women 15 or older, 29.2 percent of blacks were married
> and living with their spouses, compared with 54.3 percent of whites.
Perhaps this will keep the population in check!
September 17th 06, 05:30 PM
> > What kind of comment is that?
> > Think it demonstrates more the sosial and economic problems in the us...
> If you respond to racist spam you will see more of it.
What was racist about it? It's true.
HIV/AIDS and African Americans: A 'State of Emergency'
by John-Manuel Andriote
(March 2005) More African Americans are living with HIV or already dead
from AIDS than any other single racial or ethnic group in the United
States-a crisis one black AIDS activist calls "a state of emergency"
for the African American community.1
Over 40 percent of Americans who have been diagnosed with HIV since
1981 have been African American.2 And although AIDS diagnoses and
deaths have declined substantially in the United States since the
mid-1990s with the advent of highly active antiretroviral therapy
(HAART), African Americans have continued to be diagnosed with HIV/AIDS
in numbers disproportionate to their percentage of the population.
In fact, between 1999 and 2003, AIDS diagnoses among African Americans
increased by 7 percent, compared with a 3 percent decline among whites.
Even as AIDS deaths declined by 18 percent among whites over this
period, African Americans continued to die at the same rate as before
effective treatment became available, according to the Kaiser Family
Foundation.3 Black women, youth, and men who have sex with men (MSM)
have proven particularly vulnerable to HIV infection.
What accounts for these high infection and mortality rates? Experts say
that a mix of factors-including socioeconomic factors, limited access
to health care, late HIV testing, high rates of sexually transmitted
infections, and limited knowledge of treatment and prevention
options-have contributed to the HIV/AIDS crisis among blacks.
Analysts add that the best approaches to treatment and prevention will
take these factors into account.
Sobering Numbers and Disproportionate Burdens
Although blacks make up 12.3 percent of the U.S. population, they have
accounted for 40 percent of the nearly 930,000 AIDS cases diagnosed in
the country since the epidemic began here in 1981. And that proportion
appears to be growing. In 2003, 50 percent of the estimated 32,000 new
HIV/AIDS diagnoses in the 32 states with confidential name-based HIV
reporting were among African Americans.4
And HIV/AIDS is now the leading cause of death among African Americans
ages 25 to 44-ahead of heart disease, accidents, cancer, and
homicide.5 "It's a state of emergency," says longtime AIDS activist
Phill Wilson, executive director of the Los Angeles-based Black AIDS
Institute and himself HIV-positive for many years.6
The rate of AIDS diagnoses for blacks in 2003 was almost 10 times the
rate for whites and almost three times the rate for Hispanics. Between
2000 and 2003, African American females had 19 times the rate of
HIV/AIDS as white females and five times the rate for Hispanic females.
The rate of HIV/AIDS among African American males during the same
period was seven times the rate for white males and three times the
rate for Hispanic males.7
"In America in 2005," Wilson said recently, "AIDS is overwhelmingly a
black and brown disease."8
At Greatest Risk: Black Women, Youth, and Men Having Sex with Men
The epidemic has most greatly affected certain subgroups of African
Americans, particularly women, youth, and men who have sex with men
The Kaiser Family Foundation says that black women accounted for 36
percent of new AIDS cases among African Americans in 2003, compared
with a 14 percent proportion of women among all new AIDS cases for
whites (14 percent). Black women accounted for two-thirds of new AIDS
cases among all U.S. women with AIDS in 2003, compared with white women
(15 percent) and Latinas (16 percent).9 African American teens (ages 13
to 19) accounted for 65 percent of new AIDS cases reported among teens
in 2002, although they only account for 15 percent of American
African American MSM have been especially affected by the epidemic. A
study of six major U.S. cities found that nearly one-third (32 percent)
of black MSM between ages 23-29 were already infected with HIV,
compared with 7 percent of white MSM in the same age group.11
Risk Factors and Obstacles to Prevention
Although African Americans are most commonly infected by HIV through
sex and drug-using behaviors, the proportions of African Americans
infected with HIV from particular risk behaviors vary from other
populations. Additional socioeconomic and cultural factors-such as
inadequate access to health care, denial about HIV, and conspiracy
theories about the virus-also make African Americans particularly
vulnerable to infection.
High Rates of Sexually Transmitted Infections
African Americans have the highest rates of sexually transmitted
infections of any racial or ethnic group in the United States. In 2003,
blacks were 20 times more likely than whites to have gonorrhea and 5.2
times as likely to have syphilis.12 Genital lesions, such as those
caused by herpes, increase one's chance of contracting HIV three- to
five-fold. And a person who is co-infected with HIV and another STI is
more likely to spread HIV to others.13
Sexual Behavior and Injection Drug Use
Among black men, 49 percent of new HIV diagnoses in 32 states from 2000
to 2003 were attributed to unprotected sexual contact with another
man-compared with 72 percent of the estimated diagnoses among white
men. Injecting drug use accounted for another 18.3 percent of
diagnoses.14 Injecting drug use carries both the risk of infection from
sharing needles and other paraphernalia and from users who are more
likely to engage in high-risk behavior, such as unprotected sex, while
under the influence of drugs or alcohol.15
Most African American women are infected with HIV through heterosexual
contact (80 percent between 2000-2003), followed by injecting drug use
(16.7 percent). African American women also are at heightened risk from
male partners who are injecting drug users or engage in unprotected sex
with other men.
In two studies of African American MSM, 20 percent and 34 percent of
these men reported having a female sexual partner within the previous
12 months-even though only 6 percent of African American women
reported having had sex with a bisexual male.17
Nearly one in every four African Americans lives in poverty, and
studies have found a connection between higher AIDS incidence and lower
income.18 For instance, a study of African American women in North
Carolina found that those with HIV infection were more likely than
noninfected women to be unemployed; receive public assistance; have had
20 or more lifetime sexual partners; have a lifetime history of genital
herpes infection; have used crack or cocaine; or have traded sex for
drugs, money or shelter.19
With blacks accounting for 39.2 percent of all people incarcerated in
prisons and local jails in the United States as of mid-2003,20 the
nation's prisons have also played an important role in vectoring HIV
into the black community. The Los Angeles-based Black AIDS Institute
points out in its 2005 report The Time Is Now that the "astronomically
high incarceration rates in black neighborhoods" demand sensible HIV
prevention policies in prisons. But the report notes that, despite the
evidence of widespread drug use, tattooing, and sex in the nation's
prisons, "the tools proven to be most effective at stopping HIV's
spread-condoms, clean needles, fresh tattoo ink-are banned in most
Limited Access to Health Care
African Americans are more likely to be uninsured than whites-a
disparity that also holds for blacks and whites with HIV/AIDS,
according to the Kaiser Family Foundation. The HIV Cost and Services
Utilization Study found that African Americans with HIV/AIDS were more
likely to be publicly insured or uninsured than their white
counterparts. More than one-half (59 percent) of African Americans with
HIV/AIDS rely on Medicaid, compared with 32 percent of whites.22
Another study found that African Americans also were more likely to
postpone medical care because they lacked transportation, were too sick
to go to the doctor, or had other competing needs.23
Limited Treatment, Knowledge, and Access
While more African Americans report being tested for HIV than whites,
they tend to have less knowledge about the availability of HIV
treatment.24 And blacks also seem to have less access to HAART,
according to a study of 10 primary HIV care sites in the United States.
Even though the overall prevalence of HAART has increased since the
mid-1990s, women, African Americans, and injection drug users are less
likely to receive the treatment.25
One cause for this disparity may be the racial gap that seems to exist
between patients and their providers. A study of 1,241 HIV-positive
adults receiving care from 287 different providers in the United States
found that African Americans with white physicians tended to receive
HAART later in their illness than did African Americans with African
American physicians. And both these groups received HAART later on
average than white patients with white physicians.26
Not learning one is infected with HIV until the virus has already
damaged the immune system represents missed opportunities for
preventing and treating HIV infection. Centers for Disease Control
(CDC) data indicate that, between 2000 and 2003, 56 percent of late
testers-defined as those who were diagnosed with full-blown AIDS
within one year after learning they were HIV-positive-were African
African Americans with HIV have tended to delay being tested because of
psychological or social factors discussed below-which means they
frequently are diagnosed with full-blown AIDS soon after learning they
are infected with HIV. For this reason, African Americans with AIDS do
not live as long as people with HIV/AIDS from other racial/ethnic
Dr. Daniel Kuritzkes, director of AIDS research at Boston's Brigham and
Women's Hospital and associate professor of medicine at Harvard Medical
School, describes two unequal tracks of HIV treatment and care in the
United States. In what Kuritzkes calls the "ideal track," a person
discovers she or he is HIV-infected, seeks medical care, has regular
follow-ups, and follows a HAART regimen without complications. "There
is every expectation that this person will lead a normal life,"
But some individuals follow a second, more-dangerous track. These
individuals, Kuritzkes says, "come to the hospital with full-blown AIDS
as their initial diagnosis. They may have limited access to care
because of finances or because other social or medical problems
"By and large," he adds, "the deaths [from HIV/AIDS] are among this
group, which tends to be African Americans."29
The denial of personal risk has played a large role in preventing
particularly African American MSM as well as black women from
adequately protecting themselves and their partners. There has been a
strong tendency to blame ostensibly heterosexual African American men
who secretly have sex with other men-the so-called "down-low"-for
the high rates of HIV infection in African American women.
But some observers argue that the fact of men who have secret sex with
other men does not absolve either these men's male or female partners
of the need to protect themselves. "The down low is not responsible for
the AIDS epidemic," argues Keith Boykin, an African American
commentator on race and sexuality, in his 2005 book Beyond the Down
Low: Sex, Lies and Denial in Black America. "HIV is spread by behavior,
The down-low phenomenon was discussed at the March 2005 National
Conference on African Americans and AIDS in Philadelphia. At the
conference, Phill Wilson said there is no research to quantify how such
behavior contributes to the incidence of HIV/AIDS among African
Americans. He also argued that emphasizing the down low as a risk for
women portrays women as powerless victims, unable to protect themselves
against HIV-infected men.
And Celia Maxwell, assistant vice president for health affairs at
Howard University in Washington, D.C., said at the conference that
women need to be proactive in protecting their health by asking their
partners about HIV and other STIs. "You need to keep the lights on,"
she said, emphasizing the importance of such awareness.31
There has also been a widespread belief among African Americans that
HIV/AIDS was purposely developed by government scientists to
exterminate blacks. Though without scientific credence, such views are
unsurprising given the troubled relationship between African Americans
and scientists harkening to the infamous Tuskegee experiments. In that
mid-20th century U.S. government-supported study, scientists observed
the effects of untreated syphilis in poor black men over several
decades while deceiving the men about the alleged "treatment" they were
Conspiracy beliefs like these are widely held and can present a barrier
to HIV prevention among African Americans. Researchers have reported
that men in particular who hold strong conspiracy beliefs are likely to
also hold negative attitudes toward condom use as a preventive
Prevention Strategies That Can Work
The Black AIDS Institute sees preventing the spread of HIV among
African Americans as part of the broader effort to address the
disparities in health and health care between blacks and other racial
and ethnic groups in the United States. The institute has called upon
African American individuals, political, religious, and cultural
leaders to engage in a coordinated campaign of advocacy on behalf of
the HIV/AIDS needs of African Americans, including:
* Funding for domestic care and treatment programs;
* Lowering the cost of HIV medications;
* Supporting needle exchange programs;
* Rejecting the scapegoating of so-called "down-low" men;
* Demanding comprehensive sex education that includes credible
information on condoms and other protection; and
* Adopting sensible HIV prevention policies in prisons.33
Targeted interventions are important for those at particular risk of
acquiring or spreading HIV. Heterosexual African American men surveyed
for one study recommended that interventions targeting them should
address condom use; condom availability; skills for using condoms;
eroticizing condoms; and substance abuse prevention (because of the
high correlation between substance use and unprotected sex).34
The development of prevention methods that women can control themselves
(such as vaginal microbicides) will greatly increase the ability of
women to protect themselves against HIV even if a male partner refuses
to use a condom-which is frequently the case in relationships with
men prone to violence.35
Researchers and analysts also point out that to be effective,
prevention efforts must address the contextual factors of people's real
lives-such as poverty, discrimination, illicit drug use in the
community, the ratio of men to women in a given population,
incarceration rates, and racial segregation-and their influences on
But perhaps the single most important preventive measure is for people
to know their own HIV status. If they are uninfected, this knowledge
helps them protect themselves; if they are infected, the information
helps them to protect their partners.
Testing also provides the entry point to appropriate treatment and care
for individuals who test positive. At the March 2005 conference on
HIV/AIDS among African Americans in Philadelphia, Rev. Jesse Jackson
urged well-known African American men to make a "public stand" for HIV
testing to break the stigma associated with the virus.37
Phill Wilson crystallizes these points when he says: "It is time for us
to reject the paralyzing denial, stigma, and homophobia promoted by a
few lone voices. We must confront the socioeconomic conditions that
cause people to do drugs and exchange needles; challenge the lack of
affordable medicine and treatment options available to many of us;
dispel the myths and misinformation circulating in our communities; and
alleviate the myriad of issues that contribute to the spread of AIDS in
black communities today."38
John-Manuel Andriote, author of Victory Deferred: How AIDS Changed Gay
Life in America, is founder and president of Washington, DC-based
Health & Science Reporting.
1. Centers for Disease Control and Prevention (CDC), National Center
for STD, HIV and TB Prevention, HIV/ AIDS Among African Americans (fact
sheet) (February 2005), accessed online at
www.cdc.gov/hiv/pubs/facts/afam.htm, on March 1, 2005; Phill Wilson,
quoted in The Drumbeat (newsletter of the Black AIDS Institute), Los
Angeles: Black AIDS Institute, accessed online at
www.blackaids.org/pub/drumbeat1.pdf, on March 1, 2005.
2. CDC, HIV/ AIDS Among African Americans.
3. HIV/AIDS Surveillance Report: Cases of HIV Infection and AIDS in
the United States, 2003, as cited in Kaiser Family Foundation, "African
Americans and HIV/AIDS" (fact sheet, Feb. 2005), accessed online at
www.kff.org/hivaids/6089-02.cfm on March 9, 2005.
4. CDC, HIV/ AIDS Among African Americans.
5. Robert N. Anderson and Betty L. Smith, "Deaths: Leading Causes
for 2001," National Vital Statistics Reports 52, vol. 9 (2002): 27-33,
accessed online at www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_09.pdf, on
March 1, 2005.
6. Wilson, quoted in The Drumbeat.
7. CDC, HIV/ AIDS Among African Americans.
8. Quoted in Ethan Jacobs, "Soaring Rates: Local AIDS Advocates Talk
About HIV in the Black Community," Bay Windows, Feb. 10, 2005.
9. CDC, HIV/AIDS Surveillance Report.
10. CDC, HIV/AIDS Surveillance in Adolescents, L265 Slide Series
(through 2002), as cited in Kaiser Family Foundation, "African
Americans and HIV/AIDS" (fact sheet, Feb. 2005), accessed online at
www.kff.org/hivaids/6089-02.cfm on March 9, 2005.
11. CDC, No Turning Back: Addressing the HIV Crisis Among Men Who
Have Sex with Men( November 2001), accessed online at
www.thebody.com/cdc/msm/msm.html#contents, on March 1, 2005.
12. CDC, Sexually Transmitted Disease Surveillance, 2003, accessed
online at www.cdc.gov/std/stats/default.htm, on March 1, 2005.
13. D.T. Fleming and J.N. Wasserheit, "From Epidemiological Synergy
to Public Health Policy and Practice: the Contribution of Other
Sexually Transmitted Diseases to Sexual Transmission of HIV Infection,"
Sexually Transmitted Infections 75 (1999): 3-17.
14. CDC, HIV/AIDS Among African Americans.
15. B. Leigh and R. Stall, "Substance Use and Risky Sexual Behavior
for Exposure to HIV: Issues in Methodology, Interpretation and
Prevention," American Psychologist 48 (1993): 1035-45.
16. CDC, HIV/AIDS Among African Americans .
17. CDC, "HIV Transmission Among Black College Student and
Non-Student Men Who Have Sex With Men-North Carolina, 2003,"
Morbidity and Mortality Weekly Report 53 (2004): 731-34; J.P.
Montgomery et al., "The extent of bisexual behaviour in HIV-infected
men and implications for transmission to their female sex partners,"
AIDS Care 15 (2003): 829-37.
18. U.S. Census Bureau, "Poverty Status of the Population in 1999 by
Age, Sex, and Race and Hispanic Origin," (March 2000), accessed online
at www.census.gov/population/socdemo/race/black/ppl-142/tab16.txt, on
Mar. 1, 2005; T. Diaz et al., "Socioeconomic differences among people
with AIDS: Results from a multi-state surveillance project," American
Journal of Preventive Medicine 10 (1994): 217-22.
19. CDC, "HIV Transmission Among Black Women3North Carolina, 2004,"
Morbidity and Mortality Weekly Report 54 (2005): 89-93.
20. P.M. Harison and J.C. Karberg, Bureau of Justice Statistics
Bulletin: Prison and Jail Inmates at Midyear 2003 (2004): 11, tables
13, 14, accessed online at www.ojp.usdoj.gov/bjs/pub/pdf/pjim03/pdf, on
March 1, 2005.
21. Black AIDS Institute, The Time Is Now (2005), accessed online at
www.blackaids.org/stateofaidsreport.htm, on March 1, 2005.
22. M.F. Shapiro et al., "Variations in the Care of HIV-Infected
Adults in the United States," JAMA 281, vol. 24 (1999): 2305-15, as
cited in Kaiser Family Foundation, "African Americans and HIV/AIDS"
(fact sheet, Feb. 2005), accessed online at
www.kff.org/hivaids/6089-02.cfm on March 9, 2005.
23. W.E. Cunningham et al., "The Impact of Competing Subsistence
Needs and Barriers to Access to Medical Care for Persons With Human
Immunodeficiency Virus Receiving Care in the United States," Medical
Care 37, vol. 12 (1999): 1270-81.
24. S.H. Ebrahim et al., "Race/Ethnic Disparities in HIV Testing and
Treatment for HIV/AIDS: United States, 2001," AIDS Patient Care STDS 1,
no. 1 (2004): 27-33.
25. K.A. Gebo et al., "Racial and Gender Disparities in Receipt of
Highly Active Antiretroviral Therapy Persist in a Multistate Sample of
HIV Patients in 2001," Journal of Acquired Immune Deficiency Syndromes
38, vol. 1 (2005): 96-103.
26. W.D. King et al., "Does Racial Concordance Between HIV-Positive
Patients and Their Physicians Affect the time of Receipt of Protease
Inhibitors?" Journal of General Internal Medicine 19, no. 11 (2004):
27. CDC, "Late versus early testing of HIV-16 sites, United States,
2000-2003," Morbidity and Mortality Weekly Report 52 (2003): 581-86.
28. CDC, HIV/AIDS Surveillance Report.
29. Linda Villarosa, "Patients With HIV Seen as Separated by a Racial
Divide," New York Times, Aug. 7, 2004.
30. Keith Boykin, Beyond the Down Low: Sex, Lies and Denial in Black
America ( New York: Carroll & Graf, 2005).
31. Susan FitzGerald, "African Americans Should Take More
Responsibility in Fight Against HIV/AIDS, National Conference Speakers
Say," Philadelphia Inquirer, March 2, 2005.
32. Laura M. Bogart and Sheryl Thorburn, "Are HIV/AIDS Conspiracy
Beliefs a Barrier to HIV Prevention Among African Americans?" Journal
of Acquired Immune Deficiency Syndromes 38, no. 2 (2005): 213-18.
33. Black AIDS Institute, The Time Is Now.
34. E.J. Essien et al., "Strategies to Prevent HIV Transmission Among
Heterosexual African American Men," BMC Public Health 5, no. 1 (2005):
35. J. Saul et al., "Relationship Violence and Women's Reactions to
Male-Female-Controlled HIV Prevention Methods," AIDS Behavior 8, no. 2
36. A.A. Adimora and V.J. Schoenbach, "Social Context, Sexual
Networks and Racial Disparities in Rates of Sexually Transmitted
Infections," Journal of Infectious Disease 191 (Suppl 1, 2005):
37. FitzGerald, "African Americans Should Take More Responsibility in
Fight Against HIV/AIDS."
38. Wilson, quoted in The Drumbeat.
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