They Don’t Want Us to Talk About Race. But It’s the Only Way We’ll End HIV

Last month, HIV advocates, clinicians, and researchers convened for the biennial International AIDS Conference (AIDS 2026) in Rio de Janeiro. For many Americans, Brazil means beaches, bikinis, and bars; it can also be a magical place known for majestic views, from Sugar Loaf Mountain to the towering Cristo Redentor statue overseeing the city.

But for many others—especially Black Americans—it is a window showing the parallel experiences of other people from the African Diaspora.

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Nearly half of the Africans forced into bondage via chattel slavery crossed the Atlantic Ocean. Approximately 5 million stolen bodies came to present-day Brazil from West, Central, and Southern Africa between the 1500s and the 1800s. Any time spent in the Rio museums teaches firsthand about the frequent rebellions of resilient Africans and the numerous communities of African peoples who resisted their Portuguese abusers.

Notably, Brazil was the last country in the Americas to abolish slavery, in 1888—over 20 years after the United States ratified the 13th Amendment. But similar to the U.S., abolition has been followed by a centuries-long effort toward justice for the descendants of the original Africans who landed on those shores. We are still advocating, battling, and yearning for true social equality.

Why is this history lesson vital to our work in the HIV field? Because anti-Black racism remains one of the greatest barriers—if not the greatest barrier—to ending the HIV epidemic. Black people bear the disproportionate brunt of HIV in the Americas, especially in Brazil and the United States: Black and mixed-race Black people account for over 60% of HIV cases in Brazil, while approximately 40% of HIV cases in the U.S. are Black-identified people.

Oni Blackstock Lends Her Voice

It is impossible to talk about the disproportionate impact of HIV across North and South America without talking about race and racism. And that’s why nearly every social justice-minded attendee of this year’s International AIDS Conference who I spoke with shared that they planned to attend or watch a session called “Racism as a Driver of HIV: From Lived Experience to Structural Design.” The speakers in that session included Oni Blackstock, M.D., M.H.S. (she/her), the globally known and respected founder of the consulting firm Health Justice. She is a leading voice on the roles that directly mitigating anti-Black racism while addressing health equity can play to realize more equitable HIV-related health outcomes across the United States.

For Blackstock, coming to AIDS 2026 in Rio was, in a sense, a homecoming. “I came here almost four decades ago when I was 10 years old as part of a group of Black educators and students from New York City called Roots Revisited,” she recalled to me. “Each summer, we would travel to the Motherland and to other countries that are part of the African Diaspora, such as Brazil. I have wonderful memories from that time and am grateful to be [in Brazil] again to take in the history, music, and culture of Rio, much of it Afro-inspired.”

As anyone who has worked with Blackstock will tell you, she does not water down discussions on race and HIV. When I asked her why this is an important topic for a conference like AIDS 2026, which has a strong scientific focus, she did not hold back.

“There needs to be a reckoning,” Blackstock replied. “The [HIV] field must interrogate itself about what redistribution of resources, decision-making, and power actually looks like. People who have built their careers in HIV need to understand that the same systems causing Black and Latine communities in the U.S. and communities across the Global South to be disproportionately impacted by the HIV epidemic are the very same systems producing the lack of representation from those communities in HIV research and policy leadership.”

Appreciating History and Its Place in the Here and Now

The session attracted many thought and implementation leaders in HIV, both local and global. Many were sitting in the front row. I asked Jeffrey Crowley (he/him), former director of the Office of National AIDS Policy under President Barack Obama, why he was there; he said, “There is no other place that I’d rather be. I’ve been looking forward to this session since I saw it in the program. I always learn so much every time that I listen to [Blackstock].”

Birgit Poniatowski (she/her), the executive director of the International AIDS Society, which convenes the International AIDS Conference, was seated front and center to take in the session. “This is one of the most important topics being discussed at this year’s conference,” she told me. “It is very important to our success [to end the HIV epidemic] that we address racism directly. I must be here.”

When Blackstock took the microphone during the session, she walked attendees through the story of a white boy named Ryan White and the challenges he faced, including HIV-related stigma and exclusion from school even though the world already knew by that point how HIV could and could not be passed. White’s story caught the attention and empathy of the nation, and would eventually lead to a major federal HIV benefits program named after him.

She then reminded some (and newly educated others) that one of the first known cases of HIV occurred long before Ryan White. A teenage Black boy from my hometown of St. Louis, Missouri, named Robert Rayford died of HIV-related complications when he was 16 years old in 1969—14 years before HIV was even isolated and identified.

Blackstock noted that Black boys had never received the same level of empathetic support as boys like Ryan White, even once it became clear that Black boys and men were shouldering an outsized proportion of the epidemic. She detailed how systemic racism produced a world where Rayford likely acquired HIV through survival activities, even though he had never traveled outside of the St. Louis metropolitan area in his short lifetime. She showed how redlining and the remnants of Jim Crow not only reduced access to land and capital among Black people in St. Louis, but also reduced their access to life itself: Life expectancies were nearly 20 years lower for Black St. Louisans in the 1960s compared to their white peers.

While I’m focusing on Blackstock’s talk in this article, she credits her co-panelists at the session for giving her much to think about as well. She reflected on how Brazilian queer activist and session organizer Thiago Cruz “traced racism as the foundation under which both the HIV epidemic in Brazil and the war on drugs, which has disproportionately harmed Black Brazilians, sit,” highlighting a systemic anti-Black racist structure of legally allowable over-policing of Black bodies that is all too familiar to many in the room. And she described how E. Roberto Orellana, Ph.D., M.Phil., M.P.H., M.S.W., from the University of Washington, “highlighted the persistent erasure of Indigenous people across the Americas, and how that erasure blocks any real understanding of the [HIV] epidemic's impact on Indigenous peoples.”

United and Strengthened by Our Common Bonds

The session takeaways for Blackstock appeared to be in line with those held by many of the audience members, judging by the Q&A session that followed her talk. In particular, she highlighted “how many similarities there are between the U.S. and Brazil in how Black people are treated and how Black people live. So part of the answer is bridging and amplifying, naming the common threads, sharing what has worked, and what can be done better. It’s important that we recognize knowledge exchange can happen in both directions.”

From my perspective—after being born and bred in St. Louis and then spending half of my HIV career domestically and half internationally—this could not be more true. A true understanding of best practices comes from numerous communities, across continents and across oceans. It is vital to recognize that, as different as localities and regions may be, they also share similarities; sometimes, what works in rural Malawi will also work in downtown Los Angeles. People are people.

After this impressive session, I asked Blackstock what should be done to mitigate racism within the HIV response. “This is going to be a transgenerational effort,” she replied. “It has taken centuries to get here and will take us just as long to dismantle racism—and we will need to use all of the tools that are at our disposal.”

Blackstock previously served as the assistant commissioner for the Bureau of HIV at the New York City Department of Health & Mental Hygiene (NYCDOH). She said that her mentor in that role, the former NYCDOH commissioner Mary T. Bassett, M.D., M.P.H., set the stage for actualizing anti-racism efforts by mandating discussions on the impact of racism within the public health response. “I was inspired by her leadership when I created a Racial Equity and Social Justice Initiatives program at the Bureau to embed an antiracist lens across all of our programmatic and administrative activities to the fullest extent we could,” she said.

Dismantling racism and its supportive structures may take a herculean effort, but it is far from impossible. Attending AIDS 2026 reminded Blackstock that “The energy and the sense of Community are unmatched. In HIV, many of us have found a home, a communal home, a social justice home, an intellectual home. I am grateful to be part of this Community.”

Onward. Together.

TheBody is proud to be an official media partner of AIDS 2026.