The forgotten epidemic

The numbers are staggering. According to the CDC, in 2016, African Americans accounted for 44 percent of all HIV diagnoses, even though they comprise only 12 percent of the U.S. population. More than half (58 percent) of those diagnosed with HIV were gay or bisexual men, and 39 percent of those were aged 25 to 34.

I should note here that it is not just African-American gay and bisexual men who are disproportionally affected by HIV. African-American women also have considerably higher rates of HIV infection compared with women of other races/ethnicities. In 2015 (the last year for which figures are available), of the total number of women diagnosed with HIV, 60 percent were African American, 17 percent were white, and 17 percent were Hispanic/Latina.

Although Mazzoni Center primarily provides care and support services to the LGBT community, we see a significant number of heterosexual and bisexual women as well as homosexual and bisexual trans men, all of whom are at risk for HIV through vaginal intercourse. Though rarely discussed, trans men who have sex with men are at increased risk for HIV.

Before we can look at ways to combat the disparity in HIV-infection rates between African Americans and other races/ethnicities, we must first examine the underlying factors that are driving these disparities.

We know that homophobia and discrimination play a role in creating barriers to gay and bisexual men of all races/ethnicities accessing healthcare, including HIV testing, treatment and other prevention services. In addition, African-American gay and bisexual men face specific additional challenges that place them at increased risk. These include:

Smaller and more exclusive sexual networks. African-American gay and bisexual men are a small subset of all gay and bisexual men, and their partners tend to be of the same race. The smaller population size and the higher prevalence of HIV in that population, puts African-American gay and bisexual men at greater risk of being exposed to HIV.

Unknown HIV status. A lower percentage of African-American gay and bisexual men know their HIV status compared to gay and bisexual men of other races/ethnicities. Not knowing your HIV status means you can’t take advantage of HIV care and treatment and increases the risk you may unknowingly pass HIV to others.

Certain socioeconomic factors, such as lower income and educational levels, and higher rates of unemployment and incarceration create additional barriers to accessing quality health care. This may place some African-American gay and bisexual men at higher risk for HIV.

Stigma around homosexuality and bisexuality in the African-American community. This has contributed to the “down-low” phenomenon, which may silence men who have sex with men and keep them from accessing appropriate healthcare.

So now that we have a basic understanding of factors that cause disparities in HIV infection rates, what can we do? Raising awareness about what HIV is and what it’s doing to the African-American community is a start. But there’s more we can do:

Know your status. Think about getting tested for HIV. Then do it. Make it a part of staying healthy. Don’t be afraid to ask your doctor for an HIV test.

Prevention is key to stopping the spread of HIV. Ask your partner about their HIV status and, if possible, ask your partner if they would like to go get tested together. Practice safe sex. Use a latex condom and a water-based lubricant each time you have sex. If you think you may have an STI, see your doctor and get treatment.

If you’re HIV-negative, consider starting PrEP. PrEP, or Pre-Exposure Prophylaxis, is a combination of two HIV medicines — tenofovir and emtricitabine. Taken daily, it can block the virus from entering your body and significantly reduce your risk of HIV infection.

PrEP can be prescribed only by a health-care provider, so talk to yours to find out if PrEP is the right HIV-prevention strategy for you. Keep in mind, you must take PrEP daily for it to work. You will also need to take an HIV test before beginning PrEP to be sure you don’t already have HIV, and every three months while you’re taking it.

The cost of PrEP is covered by many health-insurance plans, and a commercial medication-assistance program provides free PrEP to people with “limited income and no insurance.” The PrEP clinic at Mazzoni Center has navigators who can help facilitate insurance coverage and enrollment in patient-assistance programs.

Dr. Marcus Sandling is a member of Mazzoni Center’s clinical team. His special interests include HIV and hepatitis-C treatment, sexual health and health disparities in minority men. To learn more about Mazzoni Center’s HIV Prevention and Care services, visit