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HIV/AIDS Resource Center for African Americans
Kai Chandler Lois Crenshaw Gary Paul Wright Fortunata Kasege Keith Green Lois Bates Greg Braxton Vanessa Austin Bernard Jackson

Is AIDS in Black America More About Behavior or Institutional Factors?

February 28, 2013

Kellee Terrell

Kellee Terrell

It's not a secret that African Americans are the racial/ethnic group most impacted by HIV/AIDS. While we account for a mere 14 percent of the U.S. population, we account for 44 percent of all new HIV infections. And yet when it comes to what we need to do to end this epidemic, we are very much at odds: with ourselves, with those who fund our work and with a general society that doesn't really get it.

One crucial issue we can't get right with is what's to blame for the AIDS crisis in Black communities. What makes us more vulnerable: risky behaviors or institutional oppression? And better yet: Does AIDS Inc. place too much emphasis on behavioral interventions (short-term goals) and not enough on fixing the fissures in our community (long-term goals)?

Now no one is denying that AIDS is 100 percent preventable. More of us need to use condoms more often -- and not just with casual or at-risk partners, but in long-term relationships. And more of us need to get tested more often, so that if we test positive, we can get on treatment sooner, before the virus has had a chance to progress. And there isn't a damn thing wrong with encouraging folks to make some changes in how they view risk. And there isn't anything wrong with wanting to lower our community viral load by getting more HIV-positive people on effective treatment.

But solely focusing on what we do in the bedroom sends dangerous messages about Black sexuality. By not complicating behavior's role in this epidemic, or voicing those complexities loudly enough, we are co-signing on the message that there is something pathologically and inherently wrong with Black sexuality. We're giving validation to the belief that this epidemic is our own fault and if we could just get our sexuality together like the good white folks, this wouldn't be our problem.


Just read the comments section on any article posted online about AIDS in Black America and you'll see ample examples of this narrow thinking. Hell, I've even seen journalists share this same belief. Last summer at the XIX International AIDS Conference in Washington, D.C., last summer, during a panel on HIV and Black men who have sex with men (MSM), a white journalist from an LGBT newspaper asked the panel: "Why don't Black MSM use condoms if they know HIV is a serious problem? How can we get them to take safer sex seriously?"

Thankfully, the panel took him to task by reminding him about the existing data: Black folks actually report fewer or as many risk factors compared to white folks. Not to mention that condom use alone, even when it's at its highest, may not be enough to protect us given how saturated our communities are with untreated HIV and sexually transmitted diseases (STDs).

This is the primary problem with relying on behavior alone: It doesn't explain Why us? Why can other races and ethnicities have unprotected sex and use IV drugs and their HIV rates are much lower? Why do Black folks have to use condoms more than anyone else?

That answer lies in structural factors like poverty and economic instability. Institutionalized racism. Lack of quality health care, poor access to health care in general and mistrust in the medical system. Gender-based inequality and violence. Homophobia. Higher consequences of IV drug use. Lack of access to needle-exchange programs. Low health literacy. High rates of incarceration. Untreated STDs, such as herpes and gonorrhea, which make people more vulnerable to contracting HIV.

Granted, linking AIDS to oppression is a hard sell for mainstream America. It goes against the "personal responsibility" and "there's no oppression in this country" rhetoric that gets stuffed down our throats. It's frustrating, because an AIDS-free Black America without a groundbreaking (and readily available) biomedical intervention like a cure or vaccine would mean that somehow we dismantled oppression and created a world free of all forms of stigma, with equal education, financial stability and opportunity.

And let's keep it real: That ain't happening anytime soon.

That's the downfall when solely focusing on oppression: It's not something that individuals can reverse tomorrow, or maybe even in a lifetime. And if that's truly the case, it's easy to feel completely hopeless about this epidemic.

I hate to feel this way, because I truly believe that we are more than our oppression. That in many ways, we do have agency to change our lives and communities. That we don't have to wait on the government to save us. But what can we do?

Perhaps if anything, behavioral interventions offer some hope in reminding folks that on an individual level, we can control our destiny and change our lives. But is that power I am dreaming of only for those who have health insurance, sexual autonomy, steady income and housing?

When it comes to behavior vs. structural factors fueling the epidemic, we need to understand that there are no either-or answers. We have to simultaneously address both in hopes to get somewhere until a cure or vaccine comes. But even if that miraculous day does come and AIDS is cured in Black America, without fixing these structural fissures that rendered us vulnerable in the first place, Black folks will just be the victims of the next deadly health epidemic that rears its ugly head.

Kellee Terrell is the former news editor for and She is currently the health reporter for

Copyright © 2013 Remedy Health Media, LLC. All rights reserved.

More From This Resource Center

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This article was provided by TheBody.

See Also
More Views on HIV/AIDS in the African-American Community

Reader Comments:

Comment by: Kelly (Lampeter, PA) Tue., Apr. 26, 2016 at 9:11 pm UTC
Mistrust of the medical community? Why is it that black people are leary of the very people white people grow up calling "heros?". Maybe change needs to happen in the home where instead of fear and mistrust, respect and admiration are taught for professionals who heal us, protect us, rescue us and serve us. My kids learn of the heroics of policemen, firemen, doctors etc right from preschool and it carries thru to elementary school. Why not black kids?
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Comment by: Keith Lawrie (Livingston MT ) Fri., Apr. 8, 2016 at 12:36 pm UTC
I am white . I had no idea things are so serious in your communities.
That alone points a finger at the media.
But back to the epidemic.
Poverty, poor education, single parent families, needles.
All of these factors exist in disenfranchised communities of all races.
The common factor is. If a person grows up in one of these communities, he or she is destined to take more risk than someone who grows up under better economic circumstances.
This is not meant as a solution, I wouldn't begin to think I have a solution to such a complex problem. The heroine problem in the mid west comes to mind.
I just hope my comment will help to to see things a little more clearly than before.
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Comment by: Osmosis Jones (Cleveland,Ohio) Wed., Apr. 6, 2016 at 10:51 am UTC
I don't know what to believe with this aids epidemic. It's sad yet true that we do make up a lot of the general public that has aids. However has anyone ever thought that we may be the ones getting tested the most? I mean how else would people know that we make up the majority?
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Comment by: Dark Knight (Birmingham) Wed., Feb. 17, 2016 at 5:10 am UTC
We do what we do. Can't nobody make you do you no different. Sex is all black folk always had that white america didn't take.
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Comment by: Concerned Educator/American (North Carolina ) Mon., Feb. 8, 2016 at 6:42 pm UTC
As an educator, I feel the author hasn't been around black teens very often. The majority of my students are either talking about weed, or sex. Who can blame them? Listened to a hip hop/rap song lately? Smoking up and having sex could be the title for 99% of the songs. They spend over half the day (like all teens), with ear buds in. Hard to compete with the music when they are getting very little education on the topic at home. Speaking of home, how many black teens go home to a "set" of parents? Makes you wonder their prospective on relationships. Yes, limiting your number of partners is a start with lowering STDS, I know...shocker. Just like others have mentioned, it's all about personal responsibility. The answer to her problem is easy, applying it is the difficult problem. In Conclusion, I'm not saying other teens don't have sex. What I will say is look at how early black kids (yes as a teacher I have seen 1st-5th graders talking about and acting out fu*?ing.) but not with any other race. Also, give stats on black teen pregnancies compared to others. Health care, screening, any other thing mentioned to be denied b/c of race wouldn't solve the problem of AIDS. Personal Responsibility, and good parenting.
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Comment by: Hidaya (NC) Fri., May. 27, 2016 at 6:14 pm UTC
I couldn't agree with you more! Kudos! I am a social worker and have had 3 male relatives die from AIDS (and a cousin who I suspect of having had it). One of those had a 'baby mama' who also died from AIDS.

Long story short, if more Blacks got tested for HIV, treatment and open dialogue could REALLY begin! Until then, everyone is wearing rose colored glasses when in fact, they could be HIV positive themselves and not know it! Get tested! Know YOUR Status!

Comment by: Danny Johnson (Raleigh, NC) Mon., Feb. 8, 2016 at 6:39 pm UTC
Interesting view by the author.
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Comment by: Kevin (Savannah) Thu., Feb. 4, 2016 at 4:47 pm UTC
I do believe the writer is sincere but let's race over ride her critical thinking. If not behavior, how does the virus get from party to party? It sure does not get transmitted from reading a book or attending church! It is transmitted by sexual contact with an infected person. That is behavior. The man did not make the two parties do anything they did not want to do. The writer and the group that she wrote about need to take the chip off their shoulders and look in the mirror. At that point, they will see the issue.
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Comment by: Winston (Seattle) Mon., Jan. 25, 2016 at 4:47 pm UTC
Your article is awful. If you want to educate the black community on aids or persuade some one to consider this problem more seriously then, follow the MLA and APA standards. Don't try and come down to the level that anyone can understand using profanity and trigger words like "black sexuality" as if we are all going to understand your because you went from professional to sister girl in just one paragraph. And back to professional the next. It's a serious subject and if you want our black community and others to listen then, get serious and use what you learned in college English. And on that note for not explaining "black sexuality" or including the fact that BET and other black media outlets did little to nothing to help change the views on sex as sexuality. Or even create a lasting Conversation on culture vs race. Or promote a cohesive non- polarizing black community. I say this is a c+ at best.
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Comment by: Wayne (Loveland Co) Wed., Mar. 9, 2016 at 10:29 am UTC
Well said.

Comment by: John (Simsbury, CT) Sat., Jan. 23, 2016 at 6:38 am UTC
I want to thank Ms. Terrell for this article. As a Caucasian-American and a physician, it has been easy for me to overlook the root cause of this problem. As with many of our social issues in this country, the underlying causes are multifactorial. There is no simple explanation and there is no simple solution. Only by bringing light to these issues can we hope to overcome them.
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Comment by: David (Dumfries, Va) Wed., Oct. 14, 2015 at 3:23 am UTC
How can the disease be 100% preventable but you don't want to take responsibility for the diseases continued spread in the black community and it all be someone's else fault because your "oppressed?" Use condoms, get tested regularly or face the consequences, HIV/AIDS is color blind.
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Comment by: John (Simsbury, CT) Sat., Jan. 23, 2016 at 6:41 am UTC
It seems that you have missed the point of this article. Reread it, and then tell me if you have been 100% compliant with the advice given here. Also consider whether or not your particular ethnic or socioeconomic group has always been provided for in the same way as that of America in general. I also feel that taking personal responsibility is paramount, but it is not always as easy as that.

Comment by: D (NYC) Thu., Oct. 1, 2015 at 3:12 am UTC
Oh boy. Really.......a lot of interesting theories about the epidemic of HIV/AIDS in the black community. You forgot to mention the CIA infecting black people to cull the community! Ignorance about the disease and a lack of personal accountability, are the primary reason this disease spreads in any community.
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Comment by: Anonymous Mon., Jan. 25, 2016 at 4:53 pm UTC
Ok let's say the CIA did infect the black community,
Would they have been so blind to think that it would only stay in the black community?

If so then your saying the CIA also wanted to kill non-black Americans who had sex with black Americans as some form of punishment to them. Well that's a hell of a act against the American people if I did say my self.

Comment by: J Ludwig (Philadelphia Pa) Mon., Sep. 28, 2015 at 10:38 am UTC
rationalizations that obscure the merit of personal responsibility are becoming increasingly twisted and incoherent. It is frightening that such "wisdom" is perceived as the solution rather than the problem.
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Comment by: Will (Las vegas ,nv) Tue., Apr. 12, 2016 at 3:34 pm UTC
Thank you. I am black and from philadelphia i left the east coast because of i wanted a chance.

Comment by: Anon (Atlanta) Tue., Sep. 15, 2015 at 3:14 pm UTC
I feel that the main contributions to this epidemic is ignorance, poverty, and unfortunate happenstance.
No one infected wants to risk infections, but let's be real condoms aren't always readily available, nor 100% trustworthy. Hundreds if not thousands of unplanned children are born regularly, much like unplanned exposure. I don't know how many outreach preventable organizations are present elsewhere, but here in Atlanta there are several that do decent jobs with education and distributing free barrier contraceptives. They're usually in the city or areas with decent economics.
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Comment by: Bee (Norfolk) Mon., Sep. 14, 2015 at 11:51 pm UTC
Focusing on one thing only isn't the answer but behavior can and should be in the eqaution. Black people have the power to change their destiny. There are certian truths that must be acknowelge AIDS is one leading stds in N orfolk, VA. Black People are still having sex because they want to not because of oppression. It ferls good and consequense is not apart of the agenda.
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Comment by: kay (mo.) Thu., Sep. 10, 2015 at 1:45 pm UTC
Why black get accuse of everything bad yet the white people wants to be black. I don't understand.
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Comment by: L'Dtrelle (Mobile) Fri., Aug. 28, 2015 at 6:15 pm UTC
It's definitely anyone's fault but our own. I believe that when crack did not destroy us, the CIA invented AIDS to destroy the African-American people!
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Comment by: Anon (Atlanta) Tue., Sep. 15, 2015 at 3:29 pm UTC
Sarcastically speaken right? I hope. Most of us have risked exposure, because we're human. Not saying its right, but it happens. No form of government would spread a disease like this to its people, especially one with no cure. Reality is this is something that has probably been around thousands of years, hundreds at the very least. Since people HIV or Aids die from other causes that their immune system can't fight, HIV/Aids probably existed long before the discovery and isolation of the antibodies produced in response to the infection, which is today still the only way to detect the virus.

Comment by: colorless Human (nyc) Sat., Aug. 22, 2015 at 8:40 pm UTC
you can lead a horse to water but you can't force him to drink it.
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Comment by: Adam Schatten (Boston, MA) Fri., Aug. 21, 2015 at 9:40 am UTC
As the reality of vaccine and cure arrives, where will society be on its understanding of and access to knowing what being Black in America, means? When will people again really talk about, care about, or know about Black Gay or Black sexuality anything? Race as an issue certainly won't be evaporating like an epidemic cured.

My point is that while there has always been a dueling history of what HIV/AIDS is as a transmissible health concern, vs. what it means to us in our battles with hippocracy, and how they do many times overlap, AIDS will soon leave us with having to ask deeper questions of ourselves and forge our resolve without it's spectre. So who are we?

Why do we fail to know each other to the point where such distance has resulted that in any county in America where a third of people identify as Black, not mixed, death rates are 4x above the national average for all losses? We know why.

Because we fail to make the vitality of all of America what unites us and we still live as strangers to each other, that is the only denial, and is one of consciousness.

AIDS may help those outside of understanding to get woken up, and spurred to thought or action, but neutrality, and silence is endemic to what an America already filled with inequalities and tragic losses, certainly for Black Americans has and will have as a remaining constant.

It comes down to this. What are YOU willing to do to fight for what brings vitality to others?

Would you trade aspects of your current thinking into collectivity to ensure such vitality for all? and be moved yourself?

That must be what attracts and binds us to such a goal that already includes the end of AIDS.
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Replies to this comment:
Comment by: Anon (Atlanta) Tue., Sep. 15, 2015 at 5:01 pm UTC
I couldn't agree more. There are some many issues that contribute to infection, but we like to play politics and focus on things like multiple partners, introvienous drug users, without attacking choice and more thorough education of the spreading. We can't devalue any attack on this epidemic, and expect it to be effective without doing so on multiple fronts. Also, it has been proven that blacks and Hispanics are more likely to use condoms than others, so why are they affected disproportionately? Another issue that I am having is some people take all precautions including monogomy, testing before sexual intercorse, and don't use needles and still become infected. Since we detect the virus by antibodies, is it possible to test negative and pass the virus?

Comment by: Kimberly white (grand. rapids Michigan ) Sun., Jul. 19, 2015 at 3:28 pm UTC
Iam so glad to hear that someone is. Taken notes this is something that we should be aware of. Thanks to ms Terrell for the awesome work.
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Comment by: Peter Parker (New York City) Fri., Jul. 10, 2015 at 1:30 pm UTC
I've never read anything that was so long that said nothibg. U want the time I wasted reading the this article back.

It's clear, the author wants to minimize personal responsibility and assign blame somewhere else. Anywhere else. How unique and refreshing..
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Comment by: Joe Hetero (Detroit ) Thu., Jul. 9, 2015 at 9:50 am UTC
Much easier to blame "institutional racism" and ANYTHING but personal responsibility.
One look @ the photo of the author told me why she espouses such empty ideas. Imagine a young Black female writer for "The Body" calling on fellow African Americans to take responsibility for NOT spreading the DEADLY virus they may carry. Never happen.
Get it together, Kellee.
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Comment by: John Owen (Denver CO) Wed., Jul. 8, 2015 at 8:36 am UTC
I respectfully disagree with everything Keller said. It does come down to responsibility and nothing more.
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Comment by: Amanda McDowell (Farmerville, LA) Fri., Jul. 3, 2015 at 7:28 am UTC
"Like the good white folk?" Really? I'm done. I can't believe this went to print like this. And, no, I won't subscribe.
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Comment by: Father 29 (Culpeper va) Tue., Jun. 23, 2015 at 7:05 am UTC

You don't make a compelling case here at all. How can the virus itself act as a discriminator against individuals within the black community? The virus is ignorant to this sort of demographic.

The opposite of what you say here is true. There is a significant problem with behavior. if you like, continue to keep your head buried in the sand like much of the rest of the black community ... and ultimately affect no change.
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Comment by: realhonor (NYC) Sat., Feb. 8, 2014 at 1:44 pm UTC
Frank communication about a taboo subject like sex is a must in the black communities. Preferably, the discussion should begin with families and friends. I have talked with black people from different countries, and there are big nuances of attitudes, hypocrisy, fears, cultural and moral beliefs. Make people feel safe and look for the opportunity to present healthy and positive viewpoints on the topic must be taught. That is so lacking in any black communities. In the Haitian community in NYC, those in charge use their radio air times to assassinate and devalue the characters of a woman with HIV, instead of learning from the woman's mistakes. This is a big weakness in black communities. One can learn from other people's mistakes as well as their successes. A black woman with economic wealth is not necessarily sexually autonomous because the cultural values of male dominance are much stronger in black communities. My remarks also apply to other cultures, but I am talking about the black communities.
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Comment by: DeeDee (Austin, TX ) Tue., Dec. 17, 2013 at 12:55 pm UTC
I really appreciate this article and perspective. I currently work for the state health department in Texas and this concept is perhaps the most difficult to get folks to understand, especially those who are not directly impacted by racial and/or gender-based oppression. For example, I struggle greatly with trying to get the 'powers that be' at the state health department, to understand how racial and gender-based oppression affect Black women and increase their/our vulnerability to HIV. Articles like yours, absolutely help in that fight. Thank you.
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Comment by: Jennifer Beadle (Granite City, IL) Wed., May. 1, 2013 at 10:43 am UTC
This is a great article. The biggest issue I have seen in corporate America is their choice of solving everything today with no concern about tomorrow. Profits are now never in the next quarter. I believe that since the whole country seems to be using the corporate model that this may be the crux to many if not all our social issues as well.
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Comment by: Tony Eason (San Francisco, CA) Tue., Mar. 12, 2013 at 5:12 pm UTC
Thank you Kellee Terrell for providing such important information. Being an African American Gay Male living in San Francisco, I appreciate your article.
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