“I’ve really been irritated with all the so-called surprise around the racial disparities,” says Tony Christon-Walker, director of prevention and community partnerships for AIDS Alabama. “This is not new.”
You may think he’s talking about well-documented disparities between white and Black people when it comes to HIV/AIDS, such as dramatically higher rates of new HIV infections among young Black men who have sex with men compared to their white counterparts, or starkly lower levels of PrEP (the HIV prevention pill) uptake or adherence among Black gay men. These disparities are well known to many who work in the HIV field and inform a lot of current national and regional efforts to end the HIV epidemic across racial communities.
But no. Christon-Walker, who is Black and gay, is actually talking about what has emerged in the past week or so as dramatically higher rates of COVID-19 illness and death among Black Americans than other groups—something documented everywhere from Illinois, Michigan, and Louisiana to the Carolinas, Vegas, Connecticut, and Minnesota.
The disparities are not all in Black people. In New York City, the U.S. epicenter of the COVID-19 pandemic, Latinx people have had the highest percentage of COVID-19 deaths—34%, while making up about 29% of the city’s population—followed by Black, whites, and Asians. Undocumented immigrant workers of any race, already often without sick leave, are also ineligible for unemployment or cash payments, even if they pay taxes or their kids are U.S. citizens.
Still, like many Black Americans, especially those who’ve long worked in the health sector, Christon-Walker says he could only shake his head to hear President Trump wonder aloud at an April 7 press briefing, with typical mangled syntax, “Why is it that the African-American community is so much, numerous times more than everybody else?”
It was even irritating to hear the government’s Anthony Fauci, M.D., the nation’s longtime top expert on pandemics—and someone who has long been familiar with racial disparities around HIV/AIDS—say that same day that racial disparities in COVID-19 death rates were “shin[ing] a very bright light on some of the real weaknesses and foibles in our society.”
“Well, guess what?” asks Christon-Walker. “Everything bad we’ve got in society disproportionately affects Black people. Think about who our essential workers are right now. The nurses, the EMTs, even the janitors. They’re disproportionately Black and Brown. In health care settings, the higher up you go, the more white people you see—the directors and administrators, who can work from home. I’m very fortunate that I can work from home, too, but I know a lot of people who don’t have that privilege and luxury. A lot of them are still flipping burgers right now.”
He’s not alone in his thoughts. Around the country, from the Deep South to Chicago to Detroit, Black HIV and health service providers say the fact that COVID-19 appears to be hitting Black Americans harder comes as no surprise. Not only, they say, have African Americans long had higher rates of underlying conditions that increase chances of severe COVID-19 illness, such as diabetes and high blood pressure, they are also less likely to be able to work from home and may have less access to health care.
Plus, they say, many people of African descent have a longstanding mistrust of government information about health matters—something that goes back at least as far as the notorious Tuskegee Syphilis Study, when government researchers secretly withheld syphilis treatment from Black male patients in order to study the disease’s natural progression.
“It’s a perfect storm of factors,” says Christon-Walker. “When this first came out, a lot of Black people were saying that they wouldn’t be affected, because this was only going to hit people, richer white people, who’d traveled back from foreign countries recently. It was the same with AIDS, where at first we thought it was only happening to gay white dudes,” he adds, when in fact it was clear by the late 1990s and early 2000s that the HIV epidemic had made deep inroads into Black communities, including among heterosexual Black women.
According to Maya Green, M.D., M.P.H., a provider at the South Side site of Chicago’s LGBTQ-serving Howard Brown clinic, the fact that, several weeks ago, Black people who said they hadn’t recently traveled internationally were turned away from COVID-19 testing was a form of implicit bias, in which a certain group is medically undertreated due to assumptions or stereotypes about them (such as the well-documented, pernicious, medical-provider bias that Black people experience less physical pain than other groups).
“I know an elderly African-American gentleman like that who’d been turned away for COVID-19 testing elsewhere,” she says. “I ended up calling the EMTs for him, and he was taken to the hospital and ended up in the ICU.” (He’s better now, she says.)
Unsurprising, yet Still Shocking
Many folks say they saw this coming. “When we started to learn about COVID, I was concerned about the South because of the tremendous barriers to health care here,” says Charles Stephens, who heads Atlanta’s The Counter Narrative Project, a community mobilization group for gay Black men. “There’s already a very thin social safety net available to us.” (The majority of the 14 states that have not expanded Medicaid eligibility since 2014 are all in the South.)
Then there are economic disparities, he continues. “A lot of the folks in our advocacy network were part of the gig economy, driving for Lyft or Uber or working individual events, so they’ve lost jobs. And many more work in retail or health care, so they’re right out on the front lines of the pandemic.” He pointed to Albany, Georgia, a majority-Black town a few hours south of Atlanta that has the country’s fourth-largest COVID-19 breakout relative to its size.
“The rate there is catastrophic,” he says. “This is such a reminder of what it means to be vulnerable in this country.”
And yet, says Stephens, the scale of the current crisis has shocked even some cynical types like himself. “Many of us in the Black community have experienced sudden trauma, where it feels like the bottom falls out, but this still feels like a shocking new world—like living in an Octavia Butler novel.” (The late Butler was an African-American science fiction novelist whose work often depicted Black people living in dystopian futuristic worlds.)
The disparities around the crisis show up in different ways. In Chicago, Ariq Cabbler, who heads Brothers Health Collective, notes that while drive-up COVID-19 testing is available at Roseland Community Hospital on the heavily Black South Side, a potentially useful community tool, it still costs between $75 and $200 for the uninsured—a big sum for the financially struggling. (One study found that Illinois ranked 19th nationwide for breadth of insurance coverage, with Blacks uninsured at twice the rate of whites.)
In Detroit, an 80%-Black city that is the epicenter of Michigan’s COVID crisis, carrying 40% of deaths in the state so far, Black folks are carrying the burden, says Michael Gipson, founder and head of the national Black gay men’s group Black Bear Brotherhood (BBB). (“Bear” is gay slang for chunky or chubby men.)
“And that applies even to Black folks in towns outside Detroit, where we are not the majority,” he adds. In the crisis’ early days, he says, “there were a lot of memes floating around that Black people can’t get this, but I already knew, based on health disparities that are already common, that we were going to be disproportionately impacted. But a lot of us don’t believe what we read, and we have a long history of not trusting or believing medical authorities.”
He, too, uses the phrase “perfect storm,” saying, “Our BBB membership is very blue-collar, guys who are still required to go to work as bus drivers, factory workers, Amazon plant workers, Instacart delivery people, security guards. They’re terrified, because they still have to be out there. Quite a few have sent me pics from the factory or plant where their jobs don’t allow them to practice six-foot social distancing.”
Plus, he adds, “We’re a bear group, so we’re a heightened microcosm of risk, with lots of hypertension and diabetes among us. A lot of members have been sick.”
Where to Go From Here
Just how to close racial health disparities is a huge and multilayered question to ask at any time, let alone in the middle of a health emergency, but advocates still have ready answers.
“These disparities have been built into the very fabric of our society,” says Green. “We’re born into it, and the only way to address it is to build equity into a person’s experience from birth—in education, food, housing.” In the short-term, she says, organizations and entities, such as state governments, must be collaborating and coordinating their response, rather than competing with one another and creating redundancies. “Whether it’s sheltering the homeless right now or delivering food to them there,” she says, “people have to work as one unit right now.”
Of course, one might say, the situation is as bad as it is precisely because of a lack of a coordinated, coherent response flowing from the federal government down into the states. Rather, Trump has actually come right out and said that states should compete against one another, as well as against the federal government, for lifesaving supplies, as though handling a health crisis were just another bidding war on The Apprentice.
“We need to create a time machine to go back in time and get rid of this president,” says Christon-Walker. “We’re playing two- to three-month catch-up because of the ineptitude of this non-science-believing administration that we have, which played down the crisis early on as an example of Democrats trying to make them look bad.”
Christon-Walker says he has no time for Americans of any race who aren’t willing to unite around the Democratic presidential ticket come November. “As a 53-year-old Black person, I’ve always had to vote for the lesser of two evils, except for Obama.” Now, he says, it’s time for everyone else to do the same.
Meanwhile, others urge an even bigger vision. “What this epidemic has demonstrated is that some of what the Democratic Socialists have argued for has been right,” says Gipson. “Health care should be a right, not a commodity. When you think about how many Southern states have declined Medicaid expansion ... what is that going to do to African Americans in the rural South who are going to be hit really hard in the next month, once the epidemic in the cities is on the decline?”
But for now, with the state of the November elections very much up in the air at the moment, Black service providers and advocates say that they’re addressing disparities in their communities the way they often have—with their own enterprise and altruism, not waiting around for governments to rescue them. Gipson’s BBB has started Bears Care, delivering food and meds to sick members. (That’s also being done, he says, by Detroit groups including the Trans Sistas of Color Project and the LGBTQ youth-serving Ruth Ellis Center.)
In Little Rock, Arkansas, Cornelius Mabin, who heads the LGBTQ youth of color drop-in center Arkansas RAPPS, says that, although his office is largely closed, he’s still been driving clients to doctor appointments who have no other way of getting there. “I have a minivan, so I make them sit way in the back with their mouths covered,” he says, adding that “these disparities have always been the reality—this is nothing new. I know people who already make only the $10 an hour state minimum wage whose hours have been reduced. They don’t even have $1,000 in an emergency fund.”
In Atlanta, Stephens says that his organization is not only trying to provide members with up-to-date information and analysis, but to keep community together—and morale up—through digital convenings.
“The virtual happy hour is gonna become even more important than ever,” he says, “but we have to maintain our advocacy agenda at the same time. We have to keep our political imaginations alive.”