Hello, my name is Kelly Chong. Today, I will be presenting AIDS in the Black communities of North Carolina. Wangari Maathai, the first African women Nobel Peace Prize winner, once claimed that HIV is a biological weapon deliberately created to wipe out the Black population. She argued, “others say AIDS was a curse from God, but I say it cannot be that. Us black people are dying more than any other people in this planet” (African American Registry, 2004). I am interested in learning about the factors that contribute to the higher HIV transmission rate in Black communities compared to White communities in North Carolina. In North Carolina, the number of Black people living with AIDS is approximately three times the number of white people as of 2018, according to AIDSVu (n.d.). Health disparity in HIV is a social injustice issue. We need to look beyond the biomedical lens and focus on the social, political, and economic aspects of this decades-long issue to identify its root causes that can later lead us to potential solutions.
Acquired immunodeficiency syndrome (AIDS) is a condition caused by the infection of the human immunodeficiency virus (HIV) which cure still remains unknown. According to Mayo Clinic (2020), within a few weeks after HIV infection, the infected person typically exhibits flu-like symptoms. Once the HIV infection progress to AIDS, symptoms such as unexplained weight loss and chronic diarrhea start to manifest themselves. AIDS symptoms are indistinguishable from many other illnesses, making it nearly impossible for people to detect the disease without testing. In fact, one in five people are not aware that they are infected (CDC, 2011).
We can only expect the number to be higher in Black communities due to the low HIV testing frequency. While the Black people account for the majority of the HIV cases, only 40 percent of the Black population nation-wide are reported being tested (Mathews et al., 2020, p.1). A study done by Dr. Allison Mathews and her research team investigated the barriers and motivators for Black people in urban and rural areas of North Carolina to do HIV testing. The study showed that the HIV stigma revolving around Black people is the main discouragement that refrained them from performing HIV testing. For example, many young Black people are anxious to go to the healthcare facilities or buy self-testing HIV kits to screen for HIV because they are terrified of being found out (Mathews et al., 2020, p. 4). This shows that HIV-related stigma not only created an unsafe environment in the public but also at home for the Black people.
Besides, stigmatization and discriminated treatment from the healthcare workers also discourage Black people to go in for HIV testing. One of the participants stated in utter disappointment that she received many shaming in the clinic and was encouraged self-stigmatization by the healthcare workers when she received her positive HIV result back (Mathews et al., 2020, p. 4). In short, as long as this stigma persists, Black people will continue to be shied away from HIV testing. Without HIV testing, Black people living with HIV will not be able to detect the virus and thus lead to them spreading the virus more unconsciously and unintentionally.
The social and structural determinants of health contribute to the increasing gap of HIV transmission rate between the Black communities and the White communities in North Carolina. As of 2014, Black communities in the Southern United States account for 54 percent of the newly diagnosed HIV cases in these areas. It was reported that the southern Black people suffer from higher HIV-related morbidity and mortality compared to the White counterparts (Sutton et al., 2017, p. 2). Dr. Madeline Sutton and her research team discovered that the southern United States counties with a higher rate of HIV cases associated with a larger Black population, higher poverty, higher unemployment, fewer owner-occupied housing unit, and more female head of household.
The high unemployment rate, which gives rise to the high poverty, within the Black communities discourages Black people with HIV seek treatment due to the unaffordable cost. According to the North Carolina Justice Center, the unemployment gap between Black people and White people persists for more than forty years, and the unemployment rate of Black people is 2.3 times of White people (Sirota, 2018). Oftentimes, unemployment goes hand in hand with the loss of healthcare insurance, rendered the uninsured Black people living with HIV vulnerable in facing the financial burden of HIV treatment which cost approximately $20,000 per year (CDC, 2019).
Moreover, racial disparities in criminal justice indirectly led to a higher HIV rate in North Carolina Black communities. In North Carolina, Black males accounted for 21.5 percent of the state’s adult population, yet they made up 52.9 percent of the 2016 prison population (ACLU of North Carolina, 2018). The disproportionally high incarceration in Black communities causes a low Black male to Black heterosexual female ratio and thus results in more female head of household and higher concurrent sexual partnership, which ultimately leads to higher HIV transmission rate in the Black communities (Sutton et al., 2017, p. 7).
To reiterate, all of the factors that cause a higher HIV/ AIDS rate in Black communities of North Carolina mentioned earlier boil down to HIV-related stigma and racial inequalities. Stopping HIV stigma starts with friends, family members, and community members being more accepting and supportive of the person living with HIV and understanding that HIV infection is not a representation of a person’s personality or lifestyle. In order to overcome racial inequalities, on the other hand, conscious actions are required from all parties—no matter it is as small as spreading awareness to colleagues during small talks or as big as challenging the authorities in regards to their discriminatory decisions—to support our Black communities.
Although it may seem like AIDS is only prevalent in the Black community, let us not forget that HIV can infect everyone. They say prevention is better than cure. Since we have yet to formulate a cure for AIDS, we need to take even more serious steps in prevention collectively to protect everyone from all racial groups and progress towards the goal of the U.S. Department of Health and Human Services (HHS) of reducing new HIV infection in the US by at least 90 percent by 2030. Lastly, living with HIV can be challenging; please show love and support to the person living with HIV as they go through this journey. Thank you.
ACLU of North Carolina. (2018, September 5). ACLU OF N.C. RELEASES ROADMAP FOR CUTTING INCARCERATION BY 50 PERCENT. https://www.acluofnorthcarolina.org/en/press-releases/aclu-nc-releases-roadmap-cutting-incarceration-50-percent.
African American Registry. (2004, October 9). Nobel winner: “AIDS is biological warfare on Blacks.”. https://aaregistry.org/story/nobel-winner-says-aids-is-biological-warfare-on-blacks/.
AIDSVu. (n.d.). North Carolina. https://aidsvu.org/local-data/united-states/south/north-carolina/.
Centers for Disease Control and Prevention. (2011, December). New hope for stopping HIV. https://www.cdc.gov/vitalsigns/hivtesting/index.html.
Central Disease Control. (2019, October 31). Hiv Cost-effectiveness. https://www.cdc.gov/hiv/programresources/guidance/costeffectiveness/index.html.
Mathews, A., Farley, S., Conserve, D. F., Knight, K., Le’Marus, A., Blumberg, M., Rennie, S., & Tucker, J. (2020). “Meet people where they are”: A qualitative study of community barriers and facilitators to HIV testing and HIV self-testing among African Americans in urban and rural areas in North Carolina. BMC Public Health, 20(1), 494. https://doi.org/10.1186/s12889-020-08582-z.
Mayo Clinic. (2020, February 13). HIV/AIDS. https://www.mayoclinic.org/diseases-conditions/hiv-aids/symptoms-causes/syc-20373524.
Sirota, A. F. (2018, January 15). Unemployment levels for Black workers two times that for whites in NC. North Carolina Justice Center. https://www.ncjustice.org/publications/unemployment-levels-for-black-workers-two-times-that-for-whites-in-nc/
Sutton, M. Y., Gray, S. C., Elmore, K., & Gaul, Z. (2017). Social determinants of hiv disparities in the southern united states and in counties with historically black colleges and universities (Hbcus), 2013–2014. PLOS ONE, 12(1), e0170714. https://doi.org/10.1371/journal.pone.0170714.
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