HIV in the US: Black and Female in Washington DC?

26 Jun

Between 2008 and 2011, HIV infection in black women doubled in Washington DC. Women were also found to be about three times more likely to be HIV positive than men. Just what kind of vulnerabilities do black women in DC face? The huge increase may result from changes in the way data is collected, but why should women have a substantially increased risk just because they are black in a country where the biggest risks are receptive male to male sex and intravenous drug use?

2.7% of DC residents were found to be HIV positive in 2010. This compares with Rwanda (2.8%), Burundi (2%), Ghana (1.9%) and Guinea-Bissau (1.8%). But in DC, 92.4% of HIV positive women are black. Prevalence is also particularly high among poor women. But by what means are most poor, black women in DC infected?

Are we supposed to believe that they are generally infected through unsafe sex? If so, unsafe sex with whom? Many HIV positive men are infected through receptive anal sex with men. Many others are infected through intravenous drug use, as a result of sharing syringes and other equipment that becomes contaminated with HIV and other diseases. But heterosexual sex should not be such a high risk, though it is higher for women than for men.

Apparently ‘links are made’ between housing, violence against women, economic insecurity, sexual and reproductive health, racial disparities and HIV/AIDS risk and infection. So women and poor people face multiple vulnerabilities in DC, just as they do in other countries. But how, exactly, do these result in the large scale transmission of HIV?

A provocative example of the kind of vulnerabilities women face may be found in the case of Kermit Gosnell, who was found guilty last year on three counts of first-degree murder through performing late term abortions in Philadelphia. His behavior was truly despicable and took place over a period of 30 years. He performed thousands of abortions on poor, desperate women, who were very often African American (Gosnell is also African American).

Health authorities had failed to conduct routine inspections of abortion clinics for 15 years. The facility was described as being in such a filthy condition that the lives of the patients, perhaps even the staff, were also at risk. Do health authorities also fail to conduct routine inspections in other kinds of health facility? Or did this case arise because it happened in a poor area, inhabited by marginilized people?

It sounds like employees of the clinic were not in much better a position than clients, having little or no medical training, but desperate to work. The clinic was also selling prescription drugs, without routine controls on certain drugs triggering off any investigation into its practices.

Was Gosnell’s clinic an exception, one that flew below the radar for 30 years? Perhaps the links cited above between various vulnerabilities and HIV/AIDS risk and infection should include lack of access to safe healthcare, including sexual and reproductive health care?

The rhetoric from the US Centers for Disease Control (CDC), WHO, UNAIDS and other bodies is that HIV prevalence is high among black women, in Africa and elsewhere, because of their sexual behavior. Of course, other factors are said to increase risk, such as housing, violence against women, economic insecurity, etc.

Poor housing and economic insecurity, even most forms of violence against women, don’t literally transmit HIV; unsafe healthcare and other skin piercing procedures do literally transmit HIV. By denying access to safe healthcare to the poorest and most vulnerable, including sexual and reproductive healthcare, racism could be one of the biggest risk factors for HIV in Washington DC. Because racism doesn’t literally transmit HIV either; but it might explain failures to prevent the transmission of HIV through unsafe healthcare.

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