Racism, HIV and How Women Are Still Pushed to the Sidelines

At the President’s Advisory Council on HIV/AIDS meeting last February, Dr. Dawn Smith, a Medical Officer in the CDC’s Division of HIV/AIDS Prevention, reported that “Black women still accounted for 6 in 10 new HIV infections among women in 2016,” despite the fact that they comprise only 14% of the female US population. She added that one in 54 Black women uninfected with HIV at the age of 18 will become HIV positive in their lifetimes.

Fortunately, Smith added, they generally have a higher rate of treatment than men because HIV testing is a routine part of contraceptive care for most women. This, however, may soon change.

You’ll recall that in 2015, a sudden outbreak of new HIV infections occurred in Scott County, Indiana. Five Planned Parenthood clinics in the region – the only source of anonymous HIV testing in that area – had shut down in 2013 because they were de-funded by the state. Subsequent epidemiological investigation verified that Indiana’s cluster of 215 new HIV cases was attributed in large part to the loss of local, free HIV testing.

Now, in 2020, over 900 more Planned Parenthoods clinics are at risk of closing in the wake of new Title X eligibility requirements announced last year. If this happens, the National Latina Institute for Reproductive Health reports more than half of those affected will be women of color – the same women already disproportionately vulnerable to HIV transmission.

In 2016, the Centers for Disease Control and Prevention (CDC) reported that “African American women are hit hardest by HIV as the rate of diagnosis is 15 times as high as that of white women, and almost five times that of Latino women. The CDC also identified HIV/AIDS-related illness as a leading cause of death for Black women ages 25-44.

Geography is also a factor. Black women comprise 67% of all new HIV diagnoses among women in the southeastern states. In Florida alone, the HIV rate among Black women is 17 times the rate among white women. In 2018, nearly 2000 Floridians died directly due to HIV – 70% of them male and 30% of them female.

The above data do not even begin to account for transgender women. In 2019, the CDC estimates that nearly one million people in the US are transgender. Of them, transgender women, in particular, are at highest risk of HIV. The CDC reports that the “mean HIV prevalence was 44.2% among African American transgender women,” 25.8% among transgender Latinas, and 6.7% among white transgender women.

These stark figures illustrate what we all know – that white Americans, overall, have better access to comprehensive health care than do Black and Brown Americans. They also itemize the harsh consequences of being born Black or Brown, living in a state without Medicaid expansion, losing one’s access to family planning (especially when it’s one’s only affordable access to primary care) and being subjected to constant, potentially deadly transphobia.

The HIV-related challenges faced by Black and Brown women (cisgender or transgender) are often ignored by policymakers and lawmakers. They warrant far greater attention, especially given that the Ending the HIV Epidemic project is being implemented in high-risk areas.

We, the Academy, need to be thinking about where cisgender women who are used to relying on their local family planning clinic – for their HIV/STI screening, contraception and other medical needs – will go if that clinic is closed due to restrictive federal and state funding. This is especially an issue for rural women with few or no other affordable care options.

Above all, with an optimistic eye towards this election cycle, we need to continue to advocate for a universal health coverage system in which our access to HIV care and prevention does not depend on one’s skin color, finances, place of residence or gender identity.