The first cases of AIDS among African Americans were identified in the early 1980s. Initially HIV and AIDS mainly affected gay men and intravenous drug users (IDUs) within the black community, much as it did in the rest of the population.
The first cases of AIDS among African Americans were identified in the early 1980s. Initially HIV and AIDS mainly affected gay men and intravenous drug users (IDUs) within the black community, much as it did in the rest of the population. However in 1983 the US Centers for Disease Control and Prevention (CDC) documented the first two cases of AIDS in women. Both women had acquired HIV through sex with an intravenous drug user. One of these women was Latina; the other was black.
From this point on, the AIDS epidemic began spreading rapidly amongst the African American population. Women were particularly affected and by 1988, African Americans accounted for half of all AIDS cases identified in females in the US.6 Today, 60 percent of women living with an AIDS diagnosis are black.7
Much of the problem in the early years was the American media's portrayal of AIDS as a disease of white gay men. Black Americans were given few reasons to believe that AIDS could affect them, even though black men made up a large proportion of the early cases of AIDS in the gay and bisexual community, and from the outset, black heterosexual adults and children were significantly more likely to be infected than white heterosexuals.8
One of the first groups to address this lack of awareness, and the general problems created by the AIDS epidemic among African Americans was the San Franciscan gay community group, Black and White Men Together (BWMT). BWMT was significant not only for giving rise to America’s first official black AIDS organisation, the National Task Force on AIDS Prevention, but for counting Reggie Williams as one of its members. Williams was one of the first gay black AIDS activists, and worked for many years to document deaths and raise awareness of AIDS in the black homosexual community. It was his successful lobbying that eventually led the CDC to issue its first ever grant for HIV prevention targeted at black gay men in 1988.9
The seriousness of the AIDS epidemic among African Americans in the 1980s and 1990s was also highlighted by a number of well known African Americans who became infected with HIV or died of AIDS. Max Robinson, the first black US news anchorman, was one of the first African American celebrities to openly admit his status shortly before he died in 1988. His death was followed by that of tennis star Arthur Ashe, who died from AIDS in 1993, and the rapper Eazy-E, who died in 1995.
Perhaps the most famous HIV-positive black American still alive today is former basketball player Earvin “Magic” Johnson, who announced he had HIV in 1991. Magic Johnson’s assertion that HIV “can happen to anyone” represented a greater understanding that AIDS was not just a ‘gay’ disease.
Others who have helped raise the profile of HIV in the black community include the Reverend Jesse Jackson, who in 2000 joined a number of other well-known African Americans in taking an oral HIV test to demonstrate the importance of HIV testing.
Though action is being taken, Rev Jackson is likely one of many who believe that current efforts to combat HIV in the black community are still not enough:
“AIDS has been allowed to stalk and murder Black America like a serial killer because we have been a compliant victim, submitting through inaction. It is now time for us to fight AIDS like the major civil rights issue it is...” Reverend Jesse Jackson, 2006 10
Main risk factors among African Americans
For both black men and women, having unprotected sex with a man is the leading cause of HIV infection. Among black/African American men living with HIV in 2008, just over half were infected through male-to-male sexual contact.11 One study cited in the National HIV/AIDS Strategy revealed half of black gay and bisexual men in five major US cities were HIV positive.12 13 A larger study (conducted in 21 cities) concluded that almost a third of black MSM were infected with HIV.14 Among this group, the young are particularly affected. In 2006, more black men who have sex with men (MSM) between 13 and 29 were infected with HIV than any other age group, including of other races.15 Furthermore, the HIV epidemic among this group has grown rapidly; between 2001 and 2006 annual HIV diagnoses among black MSM aged 13-24 grew by 93 percent compared to 12 percent among black MSM of all ages.16
There are several theories as to why young black men are so vulnerable to becoming infected through homosexual activity, though none are decisive. One reason is the already high HIV prevalence within this community. The risk is heightened for young men who partner with older men because older MSM tend to have had more sexual encounters and therefore greater exposure to HIV.17
“In the black gay community, very young black men tend to have their first sexual experiences and relationships with older black MSM...It’s a very resource-driven situation. For young black MSM from urban areas, their peers don’t have the resources that they need—a place to stay, food on the table, pay my cell phone bill."18
Young black MSM are also the least likely to be aware that they are infected19 which means they may be less likely to take steps to prevent transmission of HIV. However, other research has shown young, black MSM do not engage in risky behaviour to a greater extent than young white or Latino men, making reasons behind why they are disproportionately affected largely unknown.20
Among women living with HIV, black women are disproportionately affected, with the most likely transmission route being heterosexual sex. Three out of four African American women living with HIV were infected this way and account for over half of the country's entire female epidemic. Of black men living with HIV, 20 percent were infected through heterosexual contact.21
There are a myriad of social and economic factors that result in higher levels of sexual HIV transmission among black Americans. However, higher levels of STDs among African Americans, also shaped by social and economic factors, in turn facilitate sexual transmission of HIV. Black Americans have 8 times the level of chlamydia, and 18 times the level of gonorrhea compared to white Americans.22 An analysis by the U.S Centers for Disease Control and Prevention (CDC) found that 48 percent of black women and 39 percent of black men were infected by genital herpes in the U.S compared to 21 percent of women and 11.5 percent of men overall.23
Injecting drug use is the second most likely HIV transmission route for African Americans and in 2008 accounted for 18 percent of all AIDS diagnoses among African Americans. More black males and females living with AIDS were infected by injecting drug use compared to males and females of any other racial or ethnic group. African American injecting drug users (IDUs) have a high risk of acquiring HIV and of not surviving long after an AIDS diagnosis.24
A direct risk of transmission occurs when IDUs share needles with people of a different HIV status. Indirectly, drug users may also become involved in crime or prostitution to fund their habit. Sex workers who are desperate for a fix, or are high on drugs are less likely to insist their clients use a condom. Crack cocaine, along with drugs such as crystal methamphetamine, can also lower inhibitions and increase the likelihood that users will engage in high-risk sexual behaviour.