Why Race Matters: Women and HIV
April 18, 2016
Table of Contents
- What Are Health Disparities?
- What Is Race?
- What Is Privilege?
- What Is Intersectionality?
- HIV Among U.S. Women of Different Races/Ethnicities
- Let's Get Intersectional! Taking Action, Making Change
Race matters when it comes to HIV -- and not just for women of color.
Around the world, the "female face of HIV" is, overwhelmingly, the face of a Black or Brown woman. This is the case worldwide, where roughly half of all people living with HIV are women. The vast majority of these women live in sub-Saharan Africa and Asia, where the percentage of women with HIV is rising. Further, transgender women around the globe are nearly 50 times more likely to be living with HIV than the general adult population.
In the U.S. (where this fact sheet will mainly focus), about one in four people living with HIV (HIV+) is a woman. However, African-American women and Latinas make up nearly 80 percent of these women, even though they account for less than 30 percent of the U.S. female population. (For more information, view our fact sheet, Women and HIV.) One study also showed that the HIV rate is more than three times higher among Black transgender women than among white or Latina transwomen.
Though not often talked about, in part due to their small numbers in the population overall, American Indian/Alaskan Native communities experience the third-highest HIV rate of any racial group in the U.S. And while Asian/Pacific Islander communities may not be as heavily impacted by HIV, cultural factors may leave women in these communities vulnerable to becoming HIV+, or make it harder for them to connect to HIV care.
While the number of women being diagnosed with HIV each year in the U.S. overall has gone down by 40 percent in the last decade or so, that number is still high among women of color. Differences in HIV rates by race get talked about a lot in the HIV community. HIV is not the only health condition that affects different races differently due to social factors -- as we've seen with diabetes and heart disease among communities of color -- as opposed to inheritance (passing a health condition down through a family over generations through genes). However, the root of why these differences exist is often misrepresented (and steeped in bias and myths), rarely well explained, and even less often addressed.
Global HIV activist and medical anthropologist Paul Farmer has called HIV-related health disparities "the biological expression of social inequalities" (unequal or unjust social conditions).
A health disparity (a difference in health that is linked to unequal or unjust social conditions) can be a higher rate of a disease among certain groups than others, even with ongoing prevention efforts. These disparities may exist according to gender, race, education or income level, disability, sexual orientation, region, and more.
Social determinants of health (the social realities that have an impact on a person's physical health), like poverty, lack of education, and racism, are linked to health disparities.
We usually think of a person's "race" as being tied to the color of their skin, the shape of their eyes, or other physical traits, as well as the part of the world from which their ancestors originated. But those factors don't explain why people in the same country, or even the same city, can have such different levels of health based on their race. Human beings just aren't that physically different from one another.
Race is as much a social category as a biological one. It is a way of explaining differences in the way people live in society, including how healthy they are, based on differences in how they look and how they are treated accordingly. In reality, the social conditions that people live under affect their health, not how they look.
Race is a powerful idea that has been used to separate people and make opportunities available to some people based on their race, while keeping the same opportunities out of reach for people of other races. Usually, this process of racial separation has occurred over many generations, and become deeply embedded in the structure of society.
Racism is the system in which people are valued differently because of their race. This system:
- Unfairly disadvantages some individuals and communities
- Provides unearned advantage to other individuals and communities
- Damages the whole society, because human resources get wasted when all people are not treated as valuable and supported in fully contributing to society
For example: Many key reasons why a person of a certain race may be more likely to acquire HIV have less to do with their body being different from someone else's than with the factors that structure how they live -- factors that also structure how people in their social group live, and may have lived over multiple generations of unequal treatment.
Aryah Lester, a blogger on The Well Project's A Girl Like Me blog, writes about living "in the basement: the lowest floor of the social systems we have here in America" as a woman who has experienced being devalued by racism, sexism, classism, as well as transphobia, and recognized these inequalities since childhood. [Trigger warning: The blog entry linked above contains descriptions of sexual violence and discrimination.]
"I ... first learn[ed] about the perceived differences in skin color, notwithstanding our commonality or upbringing," Aryah writes. "I empathized with my father when he was refused well-deserved promotions because he was of color."
Aryah goes on to describe seeing how women are deemed less valuable than men in our society, and often experience outright violence as a result: "Women all around me were delegated to the floor below in their homes, at their jobs, and in the public. Women in our history books were often just sidekicks of 'greater' heroes, who all happened to be male."
When she began transitioning from male to female in her late teens, she says, "the basement door became sealed. I found myself pounding on the door for employment, searching for the keys to a healthy relationship, and trying to break the windows of public opposition."
When Aryah became the victim of a terrible act of violence, she didn't scream, or tell anyone -- because of her fragile economic state, and the fact that people who look like her are often not valued or believed: "I could only think of my stay in the basement. ... 'I might be kicked out, not being on the lease.' 'Who's going to believe me?' 'Just take it, you've been raped plenty of times before.'" She tested HIV positive a few months later.
Racism and other forms of inequity have been proven to cause stress on people's minds and bodies, and stress has a negative effect on health. Racism has even been shown to be a form of trauma. Women living with HIV experience trauma at much higher rates than the general population of women, both before and after their diagnosis. Trauma also has a negative impact on health. For more information about this connection, read The Well Project's fact sheet on Trauma, Women and HIV.
Racism is not just a way to describe how individual people see or treat one another. A white person may have many friends of different races and have never harmed another person on purpose because of their race. However, that person still benefits from a system that has, for many generations and in many ways, put a higher value on the lives of white people than people of color.
Being antiracist (against racism) does not just mean that white people must treat individual people of color with respect. Being antiracist means disagreeing with the ways systems in our society have shut out or been biased against people of other races for many generations. It also means recognizing the ways we may benefit from systems that are biased against others (privilege).
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