Bill Scanlon, Rocky Mountain News, Dec. 2, 2006
A quarter-century after AIDS burst into public awareness, the scourge is a minor footnote in the non-gay white community in Colorado, but a growing threat in the black and Hispanic communities.
The Colorado Department of Public Health and Environment typically does not categorize AIDS exposure by ethnic group or gender, but, at the request of the Rocky Mountain News, the department’s Health Statistics section broke down the numbers.
Black women here are 31 times more likely to acquire the AIDS virus than white women, according to the health department.
Among men who say they are not gay, black men have a 35 times greater risk than white men.
About one in six Coloradans is Hispanic, but Hispanics comprise one-fourth of all people living with AIDS. The risk factor for Hispanic women is five times greater than for non-Hispanic white women.
While certain men in all ethnic groups engage in that high-risk behavior, it is a greater problem in the Hispanic and black communities because of greater cultural taboos against homosexuality, says Deirdre Maloney, executive director of the Colorado AIDS Project.
“When the state gathers information about people’s risk factors, it’s always self-reported,” Maloney said. “A black male may be having sex with other men but may not identify as gay. In communities of color, there is a lot less discussion about gay culture.”
Cultural differences make it harder for black women in Colorado to ask the hard questions and negotiate about condom use and safe sex, she said.
Adding to the risk in the black community is the disproportionate number of black men in Colorado prisons, where AIDS is often transmitted, Maloney said.
By contrast, sex between a man and a woman in the white community has a quite low risk for AIDS.
Of the 1.5 million or so white women in Colorado older than 18, just seven acquired AIDS over the past 12 months through sex.
Blacks make up just 3.8 percent of the state’s population, but during the prior 12 months, 16 black women acquired AIDS through sex.
About 6,000 Coloradans have the AIDS virus; another 4,500 have died of AIDS.
Virtually all Coloradans living with HIV or AIDS are on protease inhibitors and other medications that represent the state-of-the-art in treatment.
Over the past year, 318 Coloradans were newly diagnosed with AIDS.
Heterosexual contact is the fastest growing exposure category, with 55 new AIDS cases the past year.
In Colorado, no child under 12 acquired AIDS the past 12 months, and just one teenager did. No one acquired it via blood products and no mother passed it along to her newborn.
HIV in Colorado
New HIV/AIDS cases, October 2005 through September 2006*
o GAY CONTACT
White gay men 114
Black gay men 15
Hispanic gay men 35
Asian gay men 6
o HETEROSEXUAL CONTACT
White men 4
Black men 10
Hispanic men 7
Asian men 2
White women 7
Black women 16
Hispanic women 9
Asian women 0
Coloradans living with AIDS
Gay or bisexual men 3,871
Gay and drug user 543
Injecting drug user 516
Heterosexual contact 423
No specified cause 639
Mother with risk 28
Blood transfusion 24
*Source: Colorado Department Of Public Health And Environment Note: Gay-Men Category Refers To New Hiv Cases; Heterosexual Contact Refers To New A . . .
By now, most Americans know the drill: Practice safer sex, and HIV should leave you and your community alone.
Except that it’s not really working out that way for America’s blacks. Study after study shows that HIV infections continue to escalate among this community — especially among gay and bisexual black men — even though they practice safe sex at rates that equal or exceed those of whites.
For example, a study published in time for World AIDS Day on Friday in the American Journal of Public Health found that young black adults who had engaged in no sex over the past year, didn’t drink, and didn’t abuse drugs were still 25 times more likely to test positive for a sexually transmitted disease or HIV than whites who practiced similar behaviors.
According to the U.S. Centers for Disease Control and Prevention, fully half of the nation’s new HIV infections occur among blacks, who make up just 13 percent of the population. That rate continues to soar, despite the fact that condom use among blacks now tops 50 percent, compared to just one-third for young whites. According to the CDC, black women have 21 times the risk of white women of contracting HIV, while black males are eight times as likely to become infected as white men.
And, according to a recent five-city study conducted by the CDC, a staggering 46 percent of young gay black men in America now carry HIV — a rate that equals or exceeds that of most nations in sub-Saharan Africa. By comparison, the infection rate among gay American white men hovers around 21 percent.
“However, black men who have sex with men (MSM) do not engage in higher rates of unsafe sexual behaviors compared to other MSM — we found that in about 30 studies,” said CDC HIV/AIDS investigator Gregorio Millet. He spoke at a Foundation for AIDS Research (amfAR) summit on the issue held earlier this week in New York City.
Millet noted that studies also show that gay and bisexual black men use illicit drugs at roughly the same rate as their white peers.
So, if black Americans are doing so much that is right, what is going wrong? Twenty-five years into the AIDS epidemic, no one really knows for sure.
Denise Hallfors, the author of the American Journal of Public Health paper, said that for too long, the CDC and other public health entities have looked upon HIV/AIDS from a solidly white perspective.
Since the beginning of the AIDS epidemic, most infections among whites were largely contained within specific groups, such as gay men and intravenous drug users. “The thinking was, you have to go after those very high-risk populations,” said Hallfors, who is senior research scientist at the Pacific Institute for Research and Evaluation in Chapel Hill, N.C.
But the black community appears to work differently, with the borders between low- and high-risk groups much more blurred. “High-risk individuals can and often do cross over into low-risk groups,” Hallfors said. “Once they cross over into the low-risk group, then they spread infection to the much larger community.”
Because of the higher death and incarceration rate of black men, black women — who tend to partner with black men — have a smaller pool of potential mates to pick from compared to whites, Hallfors added.
There could be many other reasons for the virulent spread of HIV among gay black men, but the data just isn’t out there, he said. Gay black men may be at higher risk because of their genetics, their lower rate of circumcision (circumcision reduces infectivity), reduced access to health care, their pattern of sexual partners, and their higher rates of incarceration — one in four black men will serve jail time vs. one in 24 whites. “Unfortunately, there are all these hypotheses where we just don’t have sufficient data,” Millet said.
There are signs of a real turnaround at the CDC. Late in 2005, the agency’s head, Dr. Julie Gerberding, met with black activists who had pasted signs reading 46% is Unacceptable to the front of their desks. As reported by The Advocate at the time, Gerberding told them that, “Whatever we are doing right now, it is not enough.”
Since then, the agency has launched a flotilla of HIV/AIDS education and prevention programs aimed at specific black communities — many with proven track records in turning attitudes and behaviors around.
And, on Thursday, Gerderding issued a statement noting that the CDC has “recently issued new recommendations to make HIV screening a routine part of medical care for all patients between the ages of 13 and 64.” Most experts who deal with minority communities say getting individuals acquainted with their HIV status is key to helping them get treated, protect their partners, and slow the epidemic.
CDC investigator Millet said he believes the situation “is getting better, in that we are now asking the right questions — there are more people from these affected populations who are doing the needed research.”
Hallfors agreed. She said that papers like hers, and new data coming out of the CDC and elsewhere, “is really important, because policymakers can start to think differently. Whites and blacks are different, the dynamics are different, and you can’t just treat these diseases the same for both groups.”