The HIV/AIDS epidemic in the U.S. is increasingly and disproportionately impacting African American women, men who have sex with men (MSM) and the incarcerated. Strategies for confronting HIV/AIDS among African Americans must account for the HIV prevention, care and treatment needs of these specific populations.

African American Women

Much attention has been focused on the impact of HIV/AIDS on women abroad. Although the female burden of this pandemic clearly falls on other parts of the world such as Sub-Saharan Africa, the impact of HIV/AIDS on women (especially young African American women) in the U.S. cannot be ignored. At the end of 2003, over 66 percent (58,319) of the estimated 87,940 women living with HIV/AIDS were African American.¹⁰

As HIV prevalence and incidence rates in the African American community increase, so does the risk for HIV transmission among African American women, as they are more likely to establish sexual relationships within their racial or ethnic group. Higher rates of sexually transmitted disease (STD) among young African American women is another issue of grave concern given that the presence of an STD can greatly increase the likelihood of acquiring or transmitting HIV infection according to the CDC. African Americans now represent the largest group of young people affected by HIV¹¹ and for young African American women (aged 20-24), HIV infection has been cited as one of the four leading causes of death.¹²

Poverty, abuse, a paucity of female-controlled HIV prevention methods, disparities in access to care, and imbalances of power are all factors that may place women at a disproportionate risk for HIV. For example poverty and the despair that is linked to poverty are believed to increase risky behavior. African American women at high risk for HIV are more often caught at the intersection of poverty and gender discrimination, and many report feeling powerless in protecting themselves against HIV. There must be dialogue and commitment among stakeholders to end the unacceptable impact of HIV/AIDS on African American women. The challenge lies in deconstructing the myriad of factors, often complex, that place African American women at an even greater risk for HIV.

"Prevailing negative views towards people of African descent and HIV stigma have created a context in which being Black and living with HIV is a double-edged sword. Of particular concern is the pervasive and unconscionable racism experienced by African American men who have sex with men (MSM), coupled with additional discrimination based on actual or perceived HIV status. We must engage ourselves in cultivating innovative research and community empowerment initiatives that address the specific racial, cultural, sexual and social dynamics that influence the health behaviors of Black MSM." Dr. David Malebranche Emory University's Division of General Medicine

African American Men Who Have Sex With Men (MSM)

Regardless of gender or race/ethnicity, HIV/AIDS is stigmatizing. The intersection of HIV/AIDS with issues of sexuality, particularly among African American men, creates a powerful dynamic. African American MSM must navigate many cultural, social, spiritual, sexual, racial, and economic issues that alone may appear to be similar to issues affecting other populations. However, when combined, these issues pose a unique set of challenges that include:

1. The powerful role of the Black church in establishing sexual norms
2. The connection between African American masculinity and the expression of sexuality
3. External and internal prejudice
4. The impact of violence and substance abuse
5. High rates of incarceration among young African American men
6. The lack of culturally competent providers and access to quality health care, treatment and information.

Data released by the CDC at the 2005 National HIV Prevention Conference in Atlanta, GA confirmed the HIV epidemic's disproportionate impact on Black MSM. A study of MSM conducted in five U.S. cities (Baltimore, Los Angeles, Miami, New York City and San Francisco) from June 2004 to April 2005, showed that 46 percent of Black MSM tested were HIV-positive, and 67 percent of these men were unaware of their status.¹³ These results follow several previous studies documenting high rates of HIV prevalence among Black MSM.

An August 2005 CDC Black MSM Consultation convened health care providers, policymakers, scientists, researchers, and community leaders to discuss current HIV prevention programs and research activities targeted at Black MSM. Recommendations from this consultation, as well as those developed by a unified national coalition of Black gay men, should guide CDC and other HHS agencies in developing a comprehensive response. Resources, both financial and human, must be used in the most effective ways to reduce the alarming rate of HIV infection among Black MSM.

More than one in ten African American men in their twenties and thirties are incarcerated in U.S. prisons and jails,14 where inmates are at high risk for HIV infection.

The Incarcerated

More than one in ten African American men in their twenties and thirties are incarcerated in U.S. prisons and jails,¹⁴ where inmates are at high risk for HIV infection. According to the U.S. Department of Justice, among male inmates, Blacks were nearly twice as likely as whites to be HIV positive and the rate of HIV infection among white female inmates was nearly half that of Black female inmates. Additionally, Black inmates were twice as likely as Hispanics and 2.5 times as likely as whites to die from AIDS-related causes. In 2002, AIDS-related deaths among Black inmates accounted for two-thirds of all AIDS-related deaths.¹⁵ HIV/HCV co-infection, another issue of concern which has been well-documented among high-risk populations such as African American injection drug users (IDUs) and the incarcerated, makes addressing HIV/AIDS in African American communities even more complex.

Policies and programs addressing HIV infection within African American communities must consider the profound impact of incarceration on the health of African Americans. Organizations such as the Association of State and Territorial Health Officials (ASTHO) work with state public health officials and corrections officials to encourage collaboration, influence sound HIV prevention policy in correctional facilities, and promote transitional planning programs for HIV positive inmates re-entering the community. Collaboration among a variety of stakeholders is critical to meeting the HIV prevention, care, and treatment needs of the incarcerated.