Black Women's Burden: An Epidemic of HIV

Janice was 27 years old and eight weeks pregnant with her son when she was diagnosed with HIV in 1991. The Queens, N.Y., resident believes that the father of her older child—a daughter, now 24—gave her the infection. She's far from alone in acquiring the virus from a man she thought she could trust. "Some people have the attitude that it can't happen to them," says Janice, who asked that her real name not be used. "If you're not practicing safe sex, you're at risk, because you don't know if your partner is monogamous or not."

With her diagnosis, Janice joined the ranks of thousands of black women in the United States who are living with HIV/AIDS. Those ranks have swelled in the years since her son's birth, and black women continue to be struck particularly hard by the virus, new research shows. As of 2005, that group accounted for 64 percent of the more than 126,000 women who were living with HIV/AIDS in the United States, according to the Centers for Disease Control and Prevention. The rate in 2006 of new infections in black women, moreover, was nearly 15 times that in white women—55.7 infections versus 3.8 infections per 100,000 women, respectively—according to the latest data, which appear in the September 12 issue of the CDC's Morbidity and Mortality Weekly Report.

That study comes on the heels of a dramatic upward revision of the agency's assessment of how rapidly HIV is spreading. In August, the CDC estimated that about 56,300 new infections occurred nationwide in 2006, up from earlier estimates of about 40,000. This week's report breaks down the new infections by race, gender, age, and other demographic measures.

Many assume that HIV primarily affects homosexual men, who are, in fact, heavily afflicted. Nevertheless, high-risk heterosexual contact was the source of 80 percent of newly diagnosed infections in women in 2006, the CDC reports. Yet many black women may not realize when they're having sex with a high-risk partner. In black communities, discussion of homosexuality is largely taboo, and some women report being infected with HIV/AIDS by boy friends or husbands who they later find out were sleeping with men. The so-called down-low phenomenon first garnered widespread attention in 2004 when J. L. King wrote the book On the Down Low: A Journey Into the Lives of 'Straight' Black Men Who Sleep With Men, about his own experiences as a married man who slept with other men but considered himself to be heterosexual.

Unprotected sex between infected men may play a role in the increasing number of black women being infected, says C. Virginia Fields, president and CEO of the National Black Leadership Commission on AIDS. Black men had an HIV incidence rate that was six times that of white men in 2006, according to the new CDC report. Gay and bisexual men accounted for about 63 percent of all infections in black men that year.

Another concern, Fields says, is the number of black men who return home from prison or jail and have sex with wives or girlfriends without first getting tested for sexually transmitted diseases. The CDC estimates that HIV prevalence among those who are incarcerated is nearly five times higher than that of the general U.S. population. About 9 percent of those infections were found to occur during incarceration in an April 2006 CDC study of inmates in the Georgia Department of Corrections' system. One in 15 black men ages 18 and older is incarcerated, compared with 1 in 106 white men, according to a Pew Center on the States analysis of U.S. Department of Justice statistics.

Neither the down-low theory nor incarceration theory has been linked by scientific research to HIV/AIDS infections in black women, but "because of how this [disease] is spreading through heterosexual black women, both of those discussions are plausible," Fields says.