She Links HIV Rates, Social Factors

Twenty years ago, Adaora Adimora was puzzled and frustrated by what she saw.

It was the mid-1980s, and she was starting her medical career in New York City. Conventional wisdom about why black people seemed more susceptible to HIV and AIDS didn’t make sense to her.

“The number of black people that I saw with HIV was just overwhelming,” she said. “The question was—even back then—why are so many black people HIV-positive?”

The question followed her as Adimora moved to North Carolina, joined the faculty at UNC-Chapel Hill’s medical school and became a distinguished researcher in the field.

Last week, Adimora went to Capitol Hill to tell a congressional committee her best answer to that question. It surprised committee members.

People are still responsible for their behavior, she told Congress, but if the U.S. wants to slow the rates of HIV infection among African Americans—which are as much as 10 times as high as in whites—then long-standing issues of inequality will have to be addressed.

Social forces such as poverty, discrimination, residential segregation by race, and incarceration disparities, she said, all conspire to increase the risk of disease among African-Americans, even among those who don’t engage in high-risk behavior.

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The research of Adimora and her colleagues is different from most of the other research into why and how the disease spreads. It focuses not on how the disease works but on how social conditions affect the way people live.

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To curb the spread of HIV, researchers and activists traditionally think in terms of individual risk factors. Does a person use injection drugs? Does a person have sexual contact with men who have sex with men?

Beyond risk factors

But looking simply at those risk factors does not explain why African-Americans are infected at such a high rate. According to 2006 data released this month by the state Division of Public Health, whites in North Carolina were infected with HIV at a rate of 11 cases per 100,000 people. The rate for blacks was 102 cases per 100,000 people. The rate is only slightly lower for African-Americans nationally.

Risk factors—not using a condom, sex with multiple partners, drug use—aren’t enough to explain those numbers.

Adimora and colleagues began studying the problem in the mid-1990s. After several studies, particularly ones in Eastern North Carolina, the researchers have concluded that social forces contribute mightily to a black person’s risk of infection.

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Adimora acknowledges the wide-ranging implications of her findings. But she says it’s not impossible to change long-standing social trends. {snip} After all, she said, how would the nation react if white men in their 40s were 10 times as likely to be infected with HIV as blacks?

“There has been a tendency for people to throw up their hands and say, ‘We can’t do anything about poverty and racism,’ ” she said. “I don’t believe that people cannot find a solution to some of these problems.”