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.
That's why, experts say, it's important not to assume that your partner or past partners are not infected. "AIDS does not discriminate. Unsafe sexual practices and unsafe drug behaviors with someone who is infected can and will lead to HIV infection," says SharenDuke, executive director of the New York City-based AIDS Service Center, a community organization that provides HIV testing, mental health services, medical care, support groups, and other services. "It has crossed all racial, cultural, and class backgrounds."
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.
Both Janice and her 16-year-old son, who was born with HIV, are in good health. She takes three medications daily, exercises three times a week, eats healthily, and sees a therapist to discuss any issues that bother her.
Brown, who takes seven pills per day, is also doing well. The diagnosis has even helped her in dating, she says. "You can tell a lot about a man's character when you tell him that you have HIV," Brown says. "I used to date a guy for years before I found out that he was no good. Now I find out in the first 10 minutes."