By Maryse Isma, MSWSpecial to CSMS Magazine In the United States, the HIV/AIDS epidemic is a health crisis for African Americans. According to the Center for Diseases Control in 2002, HIV/AIDS was among the top three causes of death for African American males aged from twenty-five to fifty-four and among the top four causes of death for African American women aged from twenty-five to thirty-four. While information on recent HIV infection is limited, data reported by the Center for Disease Control (CDC) in 2004 suggest that the leading cause of HIV infection among African American men is sexual contact with other men followed by the use of drug injection and heterosexual contact.      According to the 2000 census, African Americans make up 12.3% of the US population. However, African Americans accounted for 19,206 (50%) of the estimated 38,730 new HIV/AIDS diagnoses in the United States in the 35 areas with long-term, confidential name-based HIV reporting. During 2001–2004, the rate of HIV/AIDS diagnoses for African Americans decreased, although the rate for African Americans was still the highest among all racial and ethnic groups.     At a time when black women are being diagnosed with HIV at a rate 20 times higher than that of white women, five CDC studies will be among the first to try to learn how many White, Black, Asian and Latino men fit the down-low profile; identify how, if at all, being on the down low differs from being “in the closet,” and determine whether down-low men have a role in infecting women with HIV.  Most black women with HIV say they were infected through heterosexual contact, but it isn’t known how their male partners were infected—by sex with other men? or by using contaminated needles to inject drugs?      The term of down-low mean men who have a double life. The definition of down low depends on who does the defining. The term comes from the world of hip-hop and R&B music, where it means an illicit relationship. As adapted by a subculture of black men, being on the down-low describes men who have sex with other men but appear straight, have relationships with women, and do not acknowledge being gay or even bisexual. These men are putting the African American women at high risk in the very fast pace for HIV/AIDS. Many down-low men find it difficult to see them as gay because of the stigma attached to homosexuality in the black community, said Phil Wilson, executive director of the Black AIDS Institute in Los Angeles. Being gay risks rejection by family and friends.      Many black men who have a double life do not see themselves hurting their community and their family by spraying virus; rather, they see themselves as good husband, boyfriend, and father. Some of them think they might be positive because of their behaviors, but chose not to test. Many have wives, or are living with women, and see themselves as being straight. But they will do anything to get the next rock. Scott calls it “survival sex.”  Black men who have double lives are not the only cause of HIV/AIDS. Substance abuse is another leading factors of HIV/AIDS among the Black Community.      Injection drug use is the second leading cause of HIV infection for African American women and the third leading cause of HIV infection for African American men. In addition to being at risk from sharing needles, casual and chronic substance users are more likely to engage in high-risk behaviors, such as unprotected sex, when they are under the influence of drugs or alcohol. Drug use can also affect treatment success. A recent study of HIV-infected women found that women who used drugs, compared with women who did not, were less likely to take their antiretroviral medicines exactly as prescribed.Risk factor among African American Women: African American women are most likely to be infected with HIV as a result of sex with men. They may not be aware of their male partners’ possible risks for HIV infection, such as unprotected sex with multiple partners, bisexuality, or injection drug use. In a study of HIV-infected persons, 34% of African American men who have sex with men (MSM) reported having had sex with women, even though only 6% of African American women reported having had sex with a bisexual man. Most of the time they are afraid of asking their potential partners the most important questions before having an intimate relationship such as: when is the last time you test for HIV. Do you ever have sex with another men? Are you substance user? Do you use and share needle to inject drug? Experts agree that by asking questions before intimacy can decrease the risk of HIV/AIDS.Sexually Transmitted Diseases According to the Center of Sexual Transmitted Diseases, the highest rates of sexually transmitted diseases (STDs) are those for African Americans. In 2003, African Americans were about 19 times as likely as Whites to have gonorrhea and about 6 times as likely to have syphilis. Partly because of physical changes caused by STDs, including genital lesions that can serve as an entry point for HIV. The presence of certain STDs can increase one’s chances of contracting HIV 3- to 5-fold. Similarly, a person who has both HIV and certain STDs has a greater chance of spreading HIV to others.

Denial

 Most of African Americans are in deep denial about HIV/AIDS. Some of them think that the virus is a disease for homosexual and drug addicts. It is not meant for straight people. Therefore, they think they can fool around and have a deviant behavior; nothing would happen to them. Studies show that a significant number of African American men, who have sex with men (MSM), identify themselves as heterosexuals. As a result, they may not relate to prevention messages crafted for men who identify themselves as homosexual. African American women have a tendency that I am a one hundred percent woman. My husband or my partner would never be attractive to another male. My husband or my boyfriend is a very though guy, muscular and family oriented. That could not be. Not my husband or my boyfriend.        

Socioeconomic Issues

 Today 2006, nearly 1 in 4 African Americans are living in poverty. Studies have found an association between higher AIDS incidence and lower income. The socioeconomic problems associated with poverty, including limited access to high-quality health care and HIV prevention education, directly or indirectly increase HIV risk. Social economic is one of the major impacts leading HIV/AIDS among African American women. Because of their economic status, women are afraid to confront their partners about their sexual orientations.  Most women knew or suspected they partners have or might have sex with other male or abuse substance. They chose not to talk about or play dam in order to survive. These women are afraid that their husbands or partners might leave them if they bring the subject up because they are the main source of income for the family. Therefore, these women risk their lives in order to survive economically. Some of the women have children, with no education or little education, no job skills, or never hold a job they think the best thing for them is to stay and not talk about it even if it is true they have to sacrifice their heaths.

What puts African American women at Risk?

 Unemployment and poverty are significant co-factors, which may have led to high rates of addiction and high rates of risk behaviors such as sharing needles. In fact, the HIV and drug use epidemic among African-Americans is focused in a small number of inner-city urban neighborhoods of color, an indication that the epidemic may have more to do with geography and poverty than race.      While attitudes in the African-American community are slowly changing, homophobia and negative attitudes toward gay men still exist. For young African-American men who have sex with men (MSM), these negative attitudes may cause low self-esteem and community and psychological distress; all of which contribute to risk-taking behaviors      Many African-American women, especially adolescent women, are at high risk for heterosexually acquired HIV. African-American women may not want to or may not be able to negotiate condom use because they may think it would interfere with physical and emotional intimacy, imply infidelity by themselves or their partner or result in physical abuse. Some women may also be in denial or be unaware of their own risk. According to Center for Diseases Control over one-third (35%) of AIDS cases among African-American women reported in 2004 were classified as “risk not reported or identified.” It is thought that a majority of these women are infected through heterosexual sex with Injection Drug Users (IDU) and/or gay or bisexual partners.

Who are African-Americans at risk?

 African-Americans, like many ethnic/racial groups, represent a diverse population. Their diversity is evident in their immigrant status, religion, socioeconomic status, geographic locales and the languages they speak. For example, African-Americans are white-collar and working class, Christians and Muslims. They reside in inner city and rural neighborhoods, are the descendants of slaves and recent Caribbean immigrants. HIV transmission in African-American communities is primarily viewed as a problem among heterosexual IDUs and their sexual partners. Among African-American men, however, the cumulative proportion of AIDS cases attributed to homosexual/bisexual activity (38%) is greater than that attributed to injection drug use (35%).      African-American adolescents have, with few exceptions, markedly higher seroprevalence rates compared to White adolescents. Some sexually active young African-American women are at especially high risk for HIV infection, especially those from poorer neighborhoods. A study of disadvantaged out-of-school youth in the US Job Corps found that young African-American women had the highest rate of HIV infection in the study. Women 16-18 years old had 50% higher rates of infection than young men. Said the Center for Disease Control (CDC).

What are obstacles to prevention?

 Communities of color in this country, including African-Americans and immigrants, have experienced persistent inequalities in social benefits, health care, education and job opportunities. Economic disparities continue to exacerbate the health status of African-Americans and other communities of color in the US. As a result, African-Americans report high rates of diseases and mortality. In addition, many African-Americans hold a distrust of government programs and health institutions. Some African-Americans believe that the effects of AIDS on the community are the results of deliberate efforts and omission of responsibility by the US government. Effective community-based prevention programs must address these concerns.      AIDS has been seen as a primarily gay issue in the African-American community. In addition, homophobia exists in the African-American family, church and community on both a personal and institutional level. Many homosexually active African-American men may have been reluctant to respond to the AIDS epidemic for fear of alienation.

What specific needs to be done?

 The Public officials, the Researchers and Community Base Service providers need a better understanding of the role of cultural and socioeconomic factors in the transmission of HIV, as well as the effect of racial inequality on public health. In addition, public health officials should consider changing epidemiological surveillance to include other demographic information such as social, economic and cultural factors. These efforts need to influence the design of HIV prevention messages, services and programs.       In the second decade of the AIDS epidemic, homophobia and AIDS denial have yet to be fully countered. Public health institutions should seek out partnerships with African-American faith-based communities, African American Celebrities, and incorporate spiritual teachings on compassion to ignite a community response. HIV prevention for African-Americans must occur at the community level. Comprehensive programs should link with other health services, such as substance abuse programs, family planning services and STD clinics.Note: Maryse Isma is a MSW and executive director of Community Support For Youth and Family (CSYF), a subdivision of the Center For Strategic And Multicultural Studies (CSMS). Also see: https://csmsmagazine.org/news.php?pg=20060811I216