It is no secret that African Americans live shorter lives, fall ill earlier in life, have sicker children and are more susceptible to both chronic and acute diseases than others in our country. In fact, we as a society have to come to expect a greater burden of disease among Black Americans than among people of other races.
It used to be expected that African Americans would submit to unjust laws and open, legal discrimination. While Jim Crow laws have been wiped from the books, the health disparities the Black community faces remain a painful symptom of structural racism. The AIDS epidemic is the noose in a Jim Crow health environment.
According to the Kaiser Family Foundation, of the 1.2 million people in the U.S. living with HIV/AIDS, nearly half — 500,000 — are Black. A staggering 2 percent of Blacks are HIV positive. African Americans have been disproportionately affected since the epidemic’s beginning and the trend has only become worse. Blacks have a higher share of new HIV/AIDS cases, people living with HIV/AIDS, and HIV-related deaths than any other U.S. racial group.
AIDS is caused by the human immunodeficiency virus (HIV). The virus invades human cells and hijacks the cellular “machinery” to produce millions more copies of the virus that can infect other human cells. HIV attacks helper T cells, critical in coordinating the body’s defenses against viruses and bacteria.
HIV-positive individuals develop AIDS when the number of helper T cells in the blood becomes so low they can no longer fight off other infections. Death is usually caused by an opportunistic infection that takes hold when HIV has greatly weakened the body.
Representing only 12 percent of the U.S. population, African Americans account for over half the AIDS cases diagnosed in 2005 — a dramatic increase from 1985, when Blacks accounted for 25 percent of new diagnoses. The AIDS case rate (number of cases per 100,000 people) was 10 times higher among Black adults and adolescents than among whites. Black men had the highest AIDS case rate of any group, 95.1, followed by Black women, 45.5. White men had an AIDS case rate of 12.1.
Distribution of HIV is not geographically even. The burden is higher on the East Coast, with Washington, D.C., having the highest case rate among Blacks in the country, 237. However, the South sees the greatest concentration of AIDS cases among Black Americans. Fifty-one percent of Blacks living with HIV live in the South, and 56 percent of new AIDS diagnoses among Blacks occur there. It is clear that the AIDS epidemic is most rampant in Jim Crow’s old strongholds.
A full examination of the factors driving the racial disparities in HIV is outside the scope of this article. Lack of access to affordable, quality health care is a central cause of poorer health and greater HIV among Black communities. Furthermore, Black people have historically been victimized and discriminated against by the health care system, resulting in a profound distrust that translates into delayed diagnoses and missed opportunities for prevention.
Solving the disproportionate burden of disease faced by African Americans can only fully occur as the struggle against racism and other forms of oppression advances. Key goals, however, must be achieved to address the pressing crisis of HIV/AIDS in Black communities today.
First, we need a system that can provide everyone in our country with access to affordable, quality health care.
Second, it is critical to expand the number of skilled health professionals, especially nurses and physicians, who come from and will serve African American communities. Black health professionals will reduce distrust in health care settings and allow people to see doctors who understand the context of their lives and illness.
It is only by understanding poor health as a symptom of systematic and historic oppression that we can implement policies and programs that can fundamentally address health disparities in the African American community.
Flávio Casoy works on universal health care with the American Medical Student Association.
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