U.S. HIV Cases Soaring Among Black Women

He was, Precious Jackson said, a very fine black man. He was 6 feet 2 inches tall with an almond-milk complexion, dreamy dark eyes and a deep voice. During their nearly two years together in Los Angeles, he was the sunshine of her life, even though he had a habit of landing in jail and refused to use a condom when they made love.

“I didn’t ask him any questions,” Jackson said in a recent interview. “I didn’t ask him about his sexual history. I asked him if he had been tested, and he said one test came back positive but another one came back negative. I was excited to have this man in my life, because I felt I needed this man to validate who I was.”
The man is now Jackson’s ex-lover, but the two are forever attached by the AIDS virus she contracted from him, becoming, in the process, a part of the nation’s fastest-growing group of people with HIV — black women.

That development, epidemiologists say, is attributable to socioeconomic and demographic conditions specific to many African American communities. Black neighborhoods, they say, are more likely to be plagued by joblessness, poverty, drug use and a high ratio of women to men, a significant portion of whom cycle in and out of a prison system where the rate of HIV infection is estimated to be as much as 10 times higher than in the general population.

For black women, the result has been devastating, said Debra Fraser-Howze, founding president and CEO of the National Black Leadership Commission on AIDS.

“We should be very afraid,” she said. “We should be afraid and we should be planning. What are we going to do when these women get sick? Most of these women don’t even know they’re HIV-positive. What are we going to do with these children? When women get sick, there is no one left to take care of the family.”

In 2003, the rate of new AIDS cases for black women was 20 times that of white women and five times greater than the infection rate for Latinas, according to a report by the Centers for Disease Control and Prevention. Black and Hispanic women accounted for 77 percent of all new AIDS infections in 1994. Nine years later, the rate was 85 percent, according to the agency.

That same year, black and Hispanic women made up 83 percent of reported AIDS diagnoses among women, although they represent only 25 percent of all women, according to Fraser-Howze’s New York-based commission. AIDS is among the three top causes of death for black women ages 35 to 44.

In the District, black women represent 90 percent of women living with AIDS while making up only 62 percent of all women in the city, according to a report last year by the District’s Health Department.

Fraser-Howze said the number of health facilities in black communities is inadequate when compared with the growing size of the problem. Official Washington has been slow to respond, said Fraser-Howze, a former member of the President’s Advisory Council on HIV/AIDS under President Bill Clinton.

Reducing HIV infections among black women will involve more than appeals to avoid risky behavior, asking women to remain abstinent and passing out condoms, said Adaora A. Adimora, an associate professor of medicine and an adjunct professor of epidemiology at the University of North Carolina at Chapel Hill.

“You also have to eliminate the economic factors that dramatically influence behavior, disease and risk,” she said.

Living conditions are “critically important” to fueling the spread of the disease, Adimora said. Communities influence “social networks, partner choices, likelihood of marriage, types of risk behaviors, as well as the consequences of risk behaviors,” she said.

Jackson lived in South Los Angeles, formerly known as South Central, a world very much like the ones Adimora has researched. When she found her boyfriend, whom she declined to name for his protection, she said she held on to one of the few men she liked “no matter what.” It is the story of tens of thousands of black women in the underclass and middle class.

The man seemed as honest as he was charming. He told her about his crack-cocaine habit, and about his frequent arrests. Looking back, she now wonders if he picked up another habit in jail, where men have sex with other men, by consent and by force. She wonders if he was one of the many African American men who hide their sexual orientation from others in the homophobic black community, a conspiracy of silence called the “down low.”

In 1998, Jackson’s boyfriend was arrested for drug possession and taken to Los Angeles County Jail, where he underwent a routine HIV test for inmates entering the system. A short while later, a letter was delivered to Jackson from jail “telling me he tested positive and that I should get checked out.”

Her positive result arrived in May 1998. “I was 26. I was shocked. I was stunned,” said Jackson, who is now an AIDS activist working for a Los Angeles treatment center called Women Alive. “A lot of emotions went through me. I was sad. I was angry at myself because I got caught up. ‘Caught up’ meaning I was so into keeping this man at all costs.”

Other black women have said they were married to men who hid their gay lifestyles while pretending to be exclusively heterosexual. Fraser-Howze said she has encountered dozens of African American women who were infected by husbands who were also having gay relationships. Her Web site abounds with stories, such as a woman in Chicago who learned her husband had a male partner when the man called to inform her that he had been infected, probably by her husband. The woman tested positive a short time later.

Black gay rights activists have said that men are more likely to hide their sexual orientation because the stigma against homosexuality is strong in black communities, particularly in the church. Studies have shown that African American churchgoers are the least likely of all faiths to support gay rights. Numerous black gays attend church but conceal their sexual orientation, said the Rev. Carl Bean, founder of Unity Fellowship Church in Los Angeles.

A study by the Pew Forum on Religion and Public Life showed that since 2000, black Protestants have become much less likely than other Protestant groups to believe that gays should have equal rights. Black Protestant support for gay rights dipped to a low of 40 percent last year, down from 65 percent in 1996 and 59 percent in 1992.

In her new book, “On the Up and Up,” Brenda Stone Browder lashed out at her former husband, J.L. King, whose book, “On the Down Low,” exposed the lifestyles of black men like himself who cheated on their female lovers with other men.

A recent analysis by the CDC determined that black men infected with HIV were less likely than other groups to disclose their sexual orientation to lovers, male or female. But researchers at health centers and universities say those explanations only scratch the surface of the real cause.

Black women are not more promiscuous than other groups of women, but they are the least likely to be married of all women because most live in communities where men are more scarce, Adimora said.

“A 22-year-old woman who has sex with multiple men in an area with very low HIV prevalence, such as a Georgetown bar for well connected young people in D.C. politics, probably has less chance of getting infected than a 22-year-old woman who had sex with only one man in a poor D.C. neighborhood with a very high HIV prevalence,” Adimora said.

As black men cycle in and out of jail and prison, black women are torn from relationships and go on to have “more concurrent relationships,” or more than one partner in communities where more people are infected, according to an article, “Social Context, Sexual Networks and Racial Disparities in Rates of Sexually Transmitted Infections,” written by Adimora and Victor J. Schoenbach, an associate professor in UNC’s school of medicine

“Incarceration directly affects sexual networks through disruption of existing partnerships,” Adimora and Schoenbach wrote. Black men entering prison are placed in an environment with “a pool of individuals among whom . . . high risk sexual behaviors, HIV infection and other sexually transmitted infections are high.”

HIV infection among prison inmates is estimated to be eight to 10 times higher than that of the general U.S. population, they wrote. But health experts can’t point to any study of male sexual preferences before and after prison sentences, or in behavior once outside, Adimora said. Even if they could, she said, imprisonment and promiscuity in black communities are not the issue. The socioeconomic conditions that lead to them are.

A recent study by Rand Corp. and Oregon State University found that nearly half of all African Americans, almost regardless of age and income, believe that AIDS is a man-made disease, and many believe it was designed by the government to decimate their communities. The study attributed the belief, in part, to the Tuskegee experiment, in which the government studied the progression of syphilis in a group of black men between 1932 and 1972 while withholding treatment without their knowledge.

AIDS prevention activists say those beliefs are hampering efforts to fight the disease’s spread in black communities.

Precious Jackson said people are responsible, too. She tells the women she counsels at Women Alive to take charge of their health, by whatever means. People cannot be trusted, she said — something that became clear recently when she ran into her old boyfriend.

“He’s out now,” she said. “When I told him I was diagnosed, he apologized, said he was sorry, and that he didn’t mean for this to happen. It was actually cool to see him.”

Until he kept talking. “He said he had two more kids,” Jackson said. “That’s when I got mad. I said, ‘How could you?’ He said his girlfriend didn’t want to use condoms. He said she knows he’s infected.”

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