Revolutionizing HIV Prevention in Black Communities

Since the discovery of the Human Immunodeficiency Virus (HIV) around the mid-20th century, scientists have proposed several ways of preventing the spread of the virus while studies are still ongoing to find a definitive cure. However, since the discovery of the virus, it continues to affect the Black community disproportionately.

In the United States, for example, the Black community has the largest number of people estimated to be living with HIV (42%), has a larger share of HIV diagnoses (43%), and records the most deaths among people with HIV (44%) compared to any other racial or ethnic group according to CDC and KFF studies.

Black women, cis- and transgender men who have sex with men, bisexual men, and youths, have been hit the hardest. What is the cause of this disproportionate impact of HIV on Black communities and what are the new preventatives and medications they can leverage to turn the tide?

Factors influencing high HIV epidemic in Black communities

In 2018, the rate of new HIV diagnoses per 100,000 people was 47.5 in Black adults and adolescents. That number was 8 times more than the 5.6 recorded in whites and almost three times the United States average (13.6). Black women also had the highest rate compared to women of other nationalities. Asked why HIV prevalence is still high in Black communities, Dr. Joyell Arscott Ph.D., B.S.N., R.N., ACRN, Health Science Liaison with Elevate Black Health said, “I think it is a combination of things.”

“In the beginning, the focus was on gay White men, with not much attention focused on communities of color or women. As time went on that shifted, with an emphasis on Black same-gender loving men. Then Black women. These initial efforts focused on behaviors and not structural or institutional factors. Now research and community programming focuses on the social determinants of health. So, in a sense, the work historically lagged behind the actual epidemic.”

Recent studies suggest a decline in the rate of new HIV diagnoses in Black communities—which is something to cheer about. However, it is still the highest compared to other races. Black adult deaths from HIV continue to be higher than other racial groups. Social inequalities birthed by centuries of racial oppression tend to favor this trend as highlighted below.

1. Incarceration epidemic

The Black community has been at the receiving end of police brutality with many ending up being incarcerated unjustly. The latest report by the Prison Policy Initiative shows that every state in the United States incarcerates Black residents in state prisons at a higher rate than white residents. The low male-to-female ratio in prisons increases the risk of HIV transmission. Likewise, smaller sexual networks raise the risk of those who are not incarcerated.

“A smaller sexual network is not the same as having less partners,” explained Dr Arscott. “It just means having a smaller network or “pool” of sexual partners to choose from. If all of your sexual partners and their partners (and so on) all come from the same zip code, the risk of acquiring and transmitting HIV is much higher. But if your sexual network (and their network) is spread out over an entire city or state(s), you have a wider pool to choose from, which decreases your chances of acquiring HIV.”

2. Living in disorderly neighborhoods

People living in low socioeconomic areas with neighborhood disorders (neighborhoods with physical and social features suggesting reduced quality of life and lack of social control) and greater income inequality have been identified to have a higher HIV risk. Unfortunately, that defines many Black communities scattered all across the globe. This socioeconomic inequality is tied to racism and systemic under- or unemployment that Black adults face in the job market.

‘We have to look at the distribution of HIV resources for historically marginalized communities. What are the options for transportation to community clinics? Do the bus and train lines run frequently, is there public transport to the clinics? Outside of the city centers, where are the HIV resources located? Are they easily accessible?” Dr Arscott explained further.

“We also have to look at public health funding. How have budget cuts affected community clinics and HIV programing? If people can’t get to a health resource or that resource is taken away, how can they keep themselves safe? Especially if the person is living paycheck to paycheck or has a job that has limited or unpaid leave? It is difficult to navigate the healthcare system with these odds.”

3. Limited access to screening

The limited availability of screening services and preventive techniques means many Black HIV-positive patients who are unaware of their status will go around transmitting the virus. People in Black communities are more likely to be underinsured or uninsured and are often not properly informed about treatment options and free resources available to them.

4. Mistrust of the healthcare system

There is still mistrust between Black patients and white healthcare providers. It doesn’t help that only a small percentage of healthcare providers are Black. We previously highlighted how to earn the trust of Black patients. We asked Dr Arscott if scientists will ever come up with a definite cure for HIV. She said, “This is a hard one!”

“There has been a lot of research done searching for a vaccine for HIV. I really hope in the next ten years we have a breakthrough. Right now, we have U=U or Undetectable = Untransmittable. If we can pair that with a vaccine or cure, we will be in a better place!”

Undetectable is when the viral load in the body is too small that it cannot be detected by regular HIV tests. At that stage, the patient cannot transmit the virus to another person.

5. Stigma

Publicly disclosing your HIV-positive status comes with a level of stigma in Black communities. The idea that being HIV-positive is a result of personal irresponsibility and immorality is still pervasive. This is because the mode of transmission of the virus is still not properly understood. This stigma often holds back positive patients from seeking help—hence the higher number of HIV-related deaths in Black communities. We asked Dr Arscott the one action that can stamp out HIV stigma.

“It’s not ONE thing, but it would take a shift in how the healthcare system addresses HIV,” she said. “Having access to providers who will ask the right questions (feel comfortable asking about sexual history and health), test early, and refer patients to HIV treatment and prevention (PrEP and PEP) resources early.”

HIV prevention technologies Black communities should exploit

To date, the only HIV prevention method that many people in Black communities know is the use of condoms, antiretroviral drugs (ARVs) for the prevention of perinatal transmission, and post-exposure prophylaxis (PEP) for preventing possible transmission when someone without HIV has been exposed to the virus. However, there are so many more options that people in Black communities are not fully exploiting. They include:

Voluntary medical male circumcision (VMMC): used in men without HIV to lower the risk of heterosexual transmission
Dapivirine Vaginal Ring: a ring containing ARVs that is placed in the vagina to lower the risk of HIV transmission among women
Lenacapavir: the medication which is a pre-exposure prophylaxis (medication used to lower the risk of getting HIV) was recently approved for use for HIV treatment by the FDA and will be administered twice yearly which is more convenient than ARVs which are taken daily.

Elevate Black Health recommends regular testing among sexually active partners for HIV and other STIs. The presence of some STIs can increase your chances of contacting HIV during sex. Also, government and non-profit organizations should step up advocacy to combat HIV stigma. It will be hard to curb the spread of HIV without dealing with the underlying conditions that facilitate its spread.

For more reading:

https://www.hiv.gov/blog/working-together-to-end-hiv-in-black-communities

https://www.cdc.gov/nchhstp/atlas/index.htm

https://www.verywellhealth.com/hiv-in-black-men-increased-risk-facts-testing-resources-5207397