How Does Poverty Fuel the African-American HIV Epidemic?
The U.S. Centers for Disease Control and Prevention (CDC) released results of a study in July 2010 discussing the HIV epidemic in impoverished urban areas of the United States. The results of the study show that those who live in poverty, African American or not, had an HIV prevalence of 2.4 percent compared to those who live above the poverty line, with a prevalence of 1.2 percent. African Americans experience a 2.1 percent HIV prevalence if living in poverty, compared to a 1.7 percent overall rate for African Americans. 46 percent of African Americans live in poverty compared to 10 percent of whites. This highlights the disparities of just being African American in the United States.
People who live in poverty are more concerned with food and housing than condom negotiation and safe sex behaviors. Mothers are concerned about how to feed their kids tonight and maintain a roof over their heads instead of adherence to medications. Many persons who live in poverty have unstable housing, which for women can be defined as living with a man who provides for them and their kids. Therefore, the woman is less likely to negotiate safe sex in order to satisfy the person providing for her than if she had her own stable housing.
Persons who live in poverty often live in areas where there are fewer resources available such as HIV education and testing. Poverty also leads to illegal behaviors such as drug use, as a coping skill; or drug trade, to provide income. Both lead to increased risk of HIV as it has been shown that drug trade increases incarceration, which removes African-American men from the community and therefore increases sharing of partners by women due to lack of available male partners. And let's not start to speak about recidivism in African-American communities and the impact on relationships. Drug use diminishes judgment and the ability to negotiate safe sex or the sensibility to practice safe sex or reduce needle sharing or other harmful behaviors.
Poverty fuels the epidemic due to its impact on all aspects of life including income, housing, education, nutrition, access to health care and the list goes on. In the African-American communities where poverty rates are even higher there exists a greater gap in all of these areas that fuel the inability to negotiate, feel empowered, get educated on HIV and get tested.
Let's be real, if I can't afford my next meal or next month's rent, do you think I'm going to make a big deal about using condoms? Because the man that's taking care of me is taking care of her too. No, I have too much else to deal with.
But there is hope. Many community organizations are now targeting these communities to conduct HIV testing and connect those who test positive, or are lost to care, to medical treatment. Even though we cannot always directly impact the poverty levels in these communities, we can impact the availability of testing and education resources.
Ingrid Floyd is the executive director of Iris House in New York City.
View the full feature, "What Really Fuels the HIV/AIDS Epidemic in Black America?"