February 28, 2013
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 TheBody.com and TheBodyPRO.com. She is currently the health reporter for BET.com.