By: Tyler Cochran, JD
Due to incredible, cutting edge advancements in antiretroviral therapies that treat HIV, and pre-exposure prophylactics that reduce transmission rates, people living with HIV have never been so able to exercise their sexual agency, bodily autonomy, and freedom to love. With each passing day, we endeavor to move towards the visions for our collective future imagined by visionaries such as Marsha P. Johnson and her contemporaries at organizations such as ACT UP— visions of liberation for all people living with HIV, and of a world that fully values the dignity, brilliance, and worth of those living with HIV who are most marginalized by racism, transphobia and homophobia, and poverty.
Unfortunately, we have yet to create the world Marsha P. Johnson and her contemporaries envisioned. Bias, stigma, and discrimination against people living with HIV still exist, both structurally and interpersonally. These systems of violence and oppression place people living with HIV and those most vulnerable to HIV infection at risk.
This post, the first in a series, will briefly examine how structural, Anti-Black racism threatens the well-being of both Black people living with HIV and Black people most vulnerable to HIV infection in the US, and end with a brief discussion of the intersections of HIV and other disabilities from a health justice framework. Future posts in this series will examine topics including the impacts of the criminalization and stigmatization of sex work on the HIV/AIDS pandemic and racial/gender justice, and the impact of the “Truvada whore” stereotype on queer people’s ability to access crucial sexual and reproductive healthcare.
The Intersection of Anti-Black Racism and HIV in the US
Kali Villarosa, of the Black AIDS Institute, wrote
“While scientific advancements, such as improved medications, have led to lower rates of HIV infection and transmission as well as fewer deaths worldwide, it has become increasingly clear that true eradication of the [HIV] virus can only be achieved by shifting from a strategy of pinpointing the virus as the primary issue to one that targets the intersectional systemic inequalities that have allowed the virus to continue to spread… This means that HIV/AIDS is not only a medical epidemic but also a social and cultural Rorschach test that pushes our views about overlapping and complex inequalities to center stage.”
Although Black Americans comprise about 14% of the US population, a staggering 40.3% of all people living with HIV in the US in 2019 were Black and/or African American, according to HIV.gov. From the period of 2015-2019, the rate of newly reported HIV infections of Black women in the US was 11 times higher than that of white women over the same period. Queer and trans Black people are especially vulnerable. Twenty-six percent of all newly reported HIV infections in 2019 occurred within the category of Black men who have sex with men. A 2021 report from the CDC found that almost two-thirds (65%) of Black transgender women surveyed across several large US cities are living with HIV. Cumulatively, these disparities result in Black people accounting for a 44% of deaths amongst people living HIV in the US—more than any other racial group.
Most stunning, however, is that no innate biological differences explain the disparity in these statistics— the HIV virus does not biologically interact with Black bodies differently than white or Asian bodies. Rather, concurrent systems of marginalization overlap, creating structural barriers to accessing treatment and preventative care. According to the Center for Disease Control, “Racism, HIV stigma, homophobia, poverty, and barriers to health care continue to drive [racial] disparities [in HIV infection rates].” Because of these barriers, Black Americans, “have been disproportionately affected by HIV/AIDS since the epidemic’s beginning, and that disparity has deepened over time.”
To begin to address these disparities, the Black AIDS Institute, suggests that federal, state, and local policymakers embrace a, hyper-intersectional approach [to pandemic response] that prioritizes the eradication of racism [and] could lead to positive results for Black people in many areas, including poverty, LGBTQIA+ discrimination, police violence, incarceration, and houselessness. This means redefining racism as a public health issue and an epidemic in itself. To do that, policymakers must strategically address destructive socio-economic and political circumstances that lead to health conditions that disproportionately affect Black populations.
In order to make health justice a reality for both Black Americans living with HIV and Black Americans vulnerable to HIV infection, addressing structural racism, lack of access to quality affordable healthcare, and violence against Black queer and trans people need to be priorities in and of themselves.
The Intersection of HIV/AIDS and Other Disabilities
As activists urge policymakers to adopt a “hyper-intersectional” approach in order to pursue health justice for Black Americans living with HIV and other groups especially impacted by the HIV/AIDS pandemic, it is vital that the lived experiences of people living with HIV and other disabilities concurrently are sought out, valued, and centered. UNAIDS reports in aggregated data from Sub-Saharan Africa that there is an elevated risk of HIV infection for both disabled men and women, when compared to men without disabilities. This disparity is especially large for women with disabilities, who are 2.21 times more likely to become HIV positive when compared to non-disabled men in their communities.
One cause of this disparity is likely that people with disabilities experience barriers to accessing sexual and reproductive healthcare and education. For instance, many disabled people are unable to easily access comprehensive, culturally competent sexual education that encourages them to “exercise full autonomy over their bodies and live life on their own terms.” Further, many OB-GYN practices fail to make their provision of reproductive health care fully accessible, and providers receive “little to no education or training on how to provide care to patients with disabilities.” One study conducted in 2019 in the US found that these barriers may result in an increased likelihood of participation in sex without condoms as well as an increased likelihood of participation in survival sex work, both of which are associated with increased risk of HIV infection. People living with disabilities are also often more likely to experience sexual violence and abuse, which is a key driver of HIV infection—for example, people with intellectual disabilities are seven times more likely to experience sexual violence than people without disabilities.
As policymakers and activists develop their “hyper-intersectional approaches” to pursuing health justice for people living with HIV, as well as those most vulnerable to HIV infection, people with disabilities must be active members in the conversation. Ultimately, health justice can only be achieved when the rights of all disabled people to their own sexual and bodily autonomy are ensured.
