Simply Black & White?

Ongoing racial disparities in the nation's HIV infection rate are an "indictment" of the U.S. response to the epidemic, according to a study published in the November 2009 issue of the American Journal of Preventive Medicine. "Continuing racial disparities in HIV infection more than two decades after the identification of the virus and availability of an accurate test are an indictment of the U.S. response to the epidemic," says study lead author Adaora A. Adimora, MD, MPH, a professor of infectious diseases in the University of North Carolina at Chapel Hill School of Medicine. "Existing interventions have failed to control the epidemic in African-Americans in part because critical features of [socioeconomics] promote behaviors that transmit HIV and increase the risk of HIV infection, even among those who do not have high-risk behaviors." Adimora and her fellow researchers decided to examine the factors responsible for the stark racial disparities in HIV infection in the United States and the now-concentrated epidemic among black Americans. HIV prevalence among African-Americans is 10 times greater than the prevalence among their white counterparts, according to collected data. This racial disparity in HIV prevalence has persisted, Adimora points out, in the face of both governmental and private actions, involving many billions of dollars, to combat HIV. The Centers for Disease Control and Prevention estimates that 45% of new HIV infections in the United States in 2006 occurred among non-Hispanic blacks. Among the 13,184 adolescents and young adults in the National Longitudinal Study of Adolescent Health, a nationally representative study, HIV seroprevalence was almost 0.5% among black Americans -- a rate 20 times that of white Americans in the study. While individuals' sexual behaviors can contribute to the disparity in HIV prevalence, according to Adimora, these differences in individual behaviors do not fully explain the marked racial differences in HIV infection prevalence. Even when comparisons are broken down by education, poverty level, marital status, age at first sexual intercourse, lifetime number of sex partners, history of male homosexual activity, illicit drug use, injection-drug use, and herpes simplex virus-2 antibody positivity, HIV prevalence among African-Americans exceeds that of whites, and it does so typically substantially. According to the team, the overall impact of these factors constitutes "structural violence," a social system characterized by inequalities in power and life of sufficient magnitude to restrict a group of people from realizing their full potential and "put them in harm's way." "There is a need for research and interventions that are informed by expertise in public health, medicine, basic science, and social sciences," Adimora states, "along with expertise in economics, business and finance, education, criminal justice, political science, and other disciplines. Governments should be held accountable for progress -- or lack thereof -- in eliminating inequities."