Yet many women make the mistake of having unprotected sex with an unsafe partner. Some, like 24-year-old Marvelyn Brown, a Tennessee native who now lives in New York City, say they didn't ask their sexual partners to wear condoms because it made them feel special that the men involved trusted them enough to forgo protection. In her recent autobiography, The Naked Truth: Young, Beautiful, and (HIV) Positive, Brown says that when she contracted HIV at age 19, she didn't care enough about herself to require that her boyfriend consistently use condoms. "If you love yourself, you can protect yourself," she says, "and that eliminates HIV from the beginning." Yvonne Gooden also believes she contracted HIV through unprotected heterosexual sex. The Yonkers, N.Y., mother of two was diagnosed with HIV in 1993 and AIDS in 1995. And like many others, she thinks that low self-esteem played a role in her not protecting herself during sex.
Women should feel "empowered to make sure that their partner uses a condom," says Raymond Martins, medical director of the Whitman-Walker Clinic in Washington, D.C., a nonprofit organization focused on HIV/AIDS treatment. "Especially in the black community, that doesn't seem to always be the case."
Gooden's disease has left her feeling fatigued much of the time. Although medical strides have been made in making HIV/AIDS manageable, black women like Gooden still bear a tremendous burden of associated death and disability. In recent years, HIV/AIDS has been among the top three causes of death for African-American females ages 25 to 34. Some of those deaths might be preventable if HIV-positive people were consistently diagnosed early in the course of their infections, before AIDS arises. To improve HIV detection, the CDC recommended in 2006 that everyone ages 13 to 64 get tested at least once. For years, experts have been advocating routine HIV testing in people who seek treatment for other sexually transmitted diseases. Michelle, 44, a busy New York City mother of three who once refereed basketball games in her spare time, was diagnosed with HIV at age 33 when she sought treatment for chlamydia. She'd contracted both infections from her fiancé. "I was infected because of love," says Michelle, who asked that her real name be omitted to protect her children's privacy.
While the CDC recently upped its estimate of new HIV infections occurring annually nationwide, Washington and New York City have been dealing with the issue for years—with minority groups and men who have sex with men especially hard hit. African-Americans comprise 57 percent of Washington's population but account for 81 percent of new HIV infections. And 90 percent of new HIV infections in women occur in black women, according to the District of Columbia Department of Health.
In New York City, residents are contracting HIV at three times the national rate, according to a recently released estimate from the New York City Department of Health and Mental Hygiene. The new figures suggest that 72 of every 100,000 Big Apple residents was newly infected with HIV during 2006, compared with a national rate of 23 per 100,000 residents. Blacks comprised nearly half of the city's new HIV infections that year.
A woman's background can also affect her HIV risk, experts say. "Many of the women that we work with have a history of childhood sexual abuse and trauma," Duke says. This type of history can impact a woman's decisions—including whether or not she chooses to have safe sex. In some cases, women may be forced to have unprotected sex by an abusive partner, Fields says.
Michelle and Janice are both in committed relationships now: Each has a man her life who is HIV negative, and both say they practice safe sex to help keep their partners from becoming infected. Gooden says that her HIV-negative boyfriend of 12 years gets routine HIV tests. "I chose not to have sex [after being diagnosed with HIV] until I met someone who understood that putting on a condom was important to me," she says.