A Racial Paradox

Although African-American young adults on the whole take fewer sexual risks than their white counterparts, they have higher rates of sexually transmitted diseases and HIV infection, so researchers who studied this paradox have recommended that health officials accordingly retool prevention strategies for black Americans. The study of over 8,700 non'Hispanic black and white men and women between 18 and 26--reported in the January issue of the American Journal of Public Health--was conducted by the Pacific Institute for Research and Evaluation. Researchers sorted data about their population-representative sample according to their sexual risk-taking behavior and other cofactors, such as drug, alcohol, or tobacco use. They found that young black men and women who abstained from sex for the prior year and engaged in little or no alcohol or drug use were almost 25 times more likely to be infected with an STD, including HIV, than white individuals in the same category. Young African-Americans who had a few sexual partners and low use of alcohol or drugs were seven times more likely to be infected. 'If you think it's only the very risky groups that you need to target for intervention, then you're missing the boat completely among African-Americans,' warns study leader Denise Dion Hallfors. She explains that prevention tactics that focus on an individual's behavior may work for certain white populations, but risk of infection among black young adults is high even if they engage in supposedly low-risk behavior. Therefore, she has recommended a new public-health media campaign geared toward African-Americans in which free screenings and treatment are widely available in traditional as well as nontraditional settings, such as beauty shops or church functions. Teasing apart the precise reasons for these skewed rates is difficult, according to Hallfors. One factor contributing to the disparity is that people are more likely to engage in sex with members of their own race. Since the rate of infection is generally higher within black 'sexual networks,' there is a greater risk of exposure to HIV and other STDs. The rates might have begun to rise in the first place because HIV infection is less likely to be diagnosed and treated in black populations. Gregorio Millet, a behavioral scientist at the Centers for Disease Control and Prevention, wrote a paper in 2006 that similarly found that the rate of HIV infection is high among black men who have sex with men for reasons outside of taking sexual risks. He said epidemiologists should pull away from studying the sexual behavior of black men and look toward structural factors that contribute to the spread of STDs. These include the effects of incarceration on black inmates and their communities, and access to health care. 'Reducing the toll among African-Americans will require a comprehensive and sustained response,' Millet says. 'There are complex factors that we have to deal with: stigma, racism, denial, poverty. This requires a comprehensive approach where we have to have sustained partnerships between the government, community, community leaders, health care providers, and families.'