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AIDS in America - An unequal epidemic
Social divisions - Sexuality
Social divisions - Injecting Drug Users (IDUs)
Social divisions - Race
Social divisions - Gender
Social divisions - Geography
In the early years of the epidemic, it seemed that
HIV was something which predominantly affected gay men. Over the
years since then, however, epidemiological patterns have gradually
shifted - the majority of people currently living with HIV in
America are still men who have sex with men, but in 2003,
heterosexual transmission accounted for 31% of all newly-diagnosed
AIDS cases - up from 3% in 1985.
Men who have sex with men (MSM), however, are still
at a high risk of HIV infection - in 2003 they accounted for an
estimated 57% of AIDS cases amongst men and well over half of HIV
diagnoses. Particularly at risk are younger MSM and MSM from racial
minorities. Perhaps because their age means that they didn't see
friends die in the early years of the epidemic, they are becoming
increasingly complacent about practising safer sex, and remain at
considerably higher risk of encountering a sexual partner who is
HIV+ than members of any other group in America.
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In addition to being seen as a 'disease of gay men',
HIV has been assumed to be something which was a problem for people
who injected drugs, as the early years of the epidemic saw many IDUs
infected, and HIV can be easily transmitted via the sharing of
infected injecting equipment. In 2003, 19% of women and 14% of men
who were diagnosed HIV+ were injecting drug users who were assumed
to have been infected as a result of their drug abuse.
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Ever since the start of the epidemic in the USA, it
has particularly affected racial and ethnic minorities. The
demography of the epidemic has changed considerably over the last
decade - from being previously an affliction of gay males, HIV has
changed course, and, while gay men remain a high-risk group in
America, it is now affecting disproportionate numbers of African
Americans, especially women.
Indeed, racial minority groups now represent almost
three quarters of new AIDS cases. In 2003, African Americans
accounted for 50% of all AIDS cases diagnosed during the year, even
though they accounted for only 12% of the population. Among African
American women, the figures are even more alarming - they represent
up to 72% of all new HIV cases in American women. These high HIV
figures suggest that in years to come, AIDS figures will be made up
largely of African Americans.
|
Race |
% of AIDS
cases in 2003† |
% of
population in 2003‡ |
|
White,
non-Hispanic |
28% |
69% |
|
African
American |
50% |
13% |
|
Latino(-a) |
20% |
14% |
|
Asian/Pacific Islander |
1% |
3% |
|
American
Indian/Alaska Native |
1% |
1% |
† Centers for Disease Control and Prevention.
HIV/AIDS Surveillance Report, 2003
‡ Kaiser Family Foundation HIV/AIDS Policy Factsheet
- December 2004
Racial origin does not make anyone automatically
more or less at risk of HIV infection, so there must be other
reasons for this imbalance. Poverty may be one factor which explains
the increased HIV prevalence amongst African American populations.
Studies have found an association between higher AIDS incidence and
lower income20. It is estimated that a quarter of African Americans
live below the poverty-line, a condition which is associated with an
increased vulnerability to HIV infection21, as people on inadequate
incomes are more likely to experience discrimination, illiteracy,
addiction and sexual exploitation.
Once a person is infected with AIDS, race plays a
factor in determining the type of services they will be able to
access - African Americans are considerably more likely to be
medically underserved than white Americans.
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AIDS in America began as something which mainly
affected gay men, particularly. Over the years, however, the
epidemic has moved towards a gradual gender-balance, as increasing
numbers of women have come to be infected with HIV, something we can
infer from rising female AIDS diagnoses. During 2003 women accounted
for 27% of all AIDS cases, up from 8% in 1985. Heterosexual
intercourse accounts for most HIV diagnoses amongst women - 79% in
2003 - and there are strong indications that the main risk factor
for many women acquiring HIV heterosexually is the risky behaviour
of their male partners, about which they were often uninformed.
Recent research in a low-income area of New York City, for example,
has shown that women were more than twice as likely to be infected
by a husband or steady boyfriend than by casual sex partners. Along
with injecting drug use, unsafe sex with other men on the part of
male partners appears to be a significant risk factor for some
women.
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HIV has become a problem in every state in America,
but is more an issue for some than others. 72% of all AIDS cases to
date have been reported from just ten states, and are found mainly
in urban areas24. This is not exclusively the case, however - there
are no rules governing the spread of the epidemic, and AIDS is also
a serious problem in rural areas in the South. Other areas, however,
have been almost untouched by AIDS - which does not necessarily mean
that they have also been untouched by HIV.
America's HIV and AIDS
epidemic is not equally distributed across the population - there
are some social groups which are more at risk of infection than
others, and there are a number of factors which affect the different
HIV prevalence in different areas.
Estimated
concentration of AIDS cases
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