I’ve been a human services provider since 1998, working with the underserved in marginalized communities throughout New York State. There is very little that separates me from the clients I have the privilege of serving, who are facing some of life’s biggest obstacles—from HIV diagnoses to behavioral health challenges. In them I see my family, my neighbors and myself. I’m committed to seeing an end to the AIDS epidemic, and it can’t happen unless the needs of the Black community are met.
Nearly 500,000 African-Americans in the U.S. are living with HIV, and only 29 percent are virally suppressed. This National Black HIV/AIDS Awareness Day (Feb. 7) and Black History Month, let’s talk about the epidemic facing Black Americans and what can be done to end it.
The Black community is facing a disproportionate burden of the HIV epidemic. Despite comprising just 12 percent of the population, 44 percent (19,540) of estimated new HIV diagnoses in the U.S. in 2014 were among African-Americans. Black women comprise 62 percent of all women currently living with HIV. Young men who have sex with men, or MSM for short, are most at risk, with Black men accounting for 39 percent of all MSM diagnosed with HIV in 2013. Young Black MSM are twice as likely to be infected with HIV as young MSM of any other ethnic group.
If current diagnosis rates persist, approximately one in 20 Black men, one in 48 Black women and one in two Black MSM will be diagnosed with HIV during their lifetimes, according to the Centers for Disease Control and Prevention. We have the power to prevent this prediction from becoming a reality and to end the AIDS epidemic in New York State and across the country. The first step is to ensure that Black communities receive the culturally competent, quality health care they deserve.
These health disparities are caused by multiple issues that result in barriers to health care. Social and economic factors, such as poverty and discrimination, contribute to high rates of HIV. Lack of access to food, housing, education and employment, and high rates of incarceration make it difficult for people of color to seek medical care.
In addition to socioeconomic factors, there are several systemic influences driving the HIV crisis. Pervasive stigma around sexuality and HIV creates a culture of silence, making people reluctant to disclose risky behavior and sexual orientation, which could prevent them from learning about prevention tools such as pre-exposure prophylaxis, delay the diagnosis of HIV or discourage them from seeking treatment. Beyond stigma, the long history of racism and exploitation of Black Americans, such as in the Tuskegee syphilis study, leads to fear and care avoidance. In addition, many young MSM of color see health care as a privilege, instead of being necessary and within their reach.
The cycle that creates barriers to health care must end now. Training and hiring more people of color as doctors and therapists is one very important way to address this issue, because individuals who are already wary of receiving care could better relate to care providers from the same community. More health care providers and insurers must focus their efforts on engaging Black Americans in care. This engagement includes improving access to pre-exposure prophylaxis to prevent new cases of HIV, expanding access to HIV testing and diagnosing and comprehensively treating African-Americans with HIV.
At Amida Care, 67 percent of our members are people of color, and by making high-quality, coordinated care for all communities a priority, we’ve achieved a 75 percent viral suppression rate among our HIV-positive members. We provide Integrated Care Teams to help our members stay in care and receive health services customized to their specific needs, keeping members at the center of the treatment plan. Behavioral health services are an important part of this package of offerings. Mental health counseling and care helps our members overcome challenges, such as early life trauma and substance use issues, which keeps them on the path of achieving viral suppression and maintaining good health.
Workforce development programs also empower people to take ownership of their health and the health of others. Training programs for jobs in health navigation and outreach, such Amida Care’s Workforce Initiative Network program, prepare many young MSM of color to use their life experience to help people living with HIV become virally suppressed and to help those most at risk of HIV infection remain HIV negative. Amida Care also employs Community Health Outreach Workers who meet members where they are and reach out to them in the communities where they live. CHOWs and Health Navigators form personal relationships with members and become a critical support system to help them stay engaged in care.
To confront the growing HIV crisis among African-Americans, we must improve access to comprehensive, culturally competent care for the Black community. It’s also imperative that we address everything from stable housing and food security to fair wages, educational opportunities and access to health insurance.
More than 35 years after the AIDS epidemic began, it is unacceptable that any population is bearing this undue burden. We must act to ensure the African-American community has access to the HIV care they need to survive and thrive—for their health and the health of our nation.