Ronald D. Stall, PhD, MPH, is a professor of behavioral and community health sciences and of infectious diseases and microbiology at the University of Pittsburgh Graduate School of Public Health. He’s also associate chair for science in the Department of Behavioral and Community Health Sciences and director of Pitt’s Center for LGBT Health Research. Dr. Stall has been studying HIV-related topics since 1984 and is a well-known expert in HIV prevention.
We interviewed Dr. Stall about HIV (human immunodeficiency virus) and its final stage, AIDS (acquired immune deficiency syndrome), and about how it currently affects the African American community.
Please give us a brief overview of where we are now with the HIV/AIDS epidemic.
The AIDS epidemic began more than 30 years ago. It was an unknown disease that was fatal and then thought to be experienced only by gay men. Now, there are tens of millions of people living with HIV all over the world. In a short period of time, this has turned into a pandemic, affecting everyone, in every country on earth. It’s a major threat to global health and will remain so for a long time.
But being HIV-positive is different now. At one point, an HIV-positive diagnosis was like a death sentence. Now, for people who know they are HIV-positive and who have access to medications, HIV has become a chronic, manageable disease much like diabetes.
How does HIV/AIDS affect African Americans?
From day one, HIV/AIDS has been an epidemic that affects African Americans disproportionately. Nationally, African Americans account for 44 percent of all new HIV infections, but African Americans account for only about 12-14 percent of the U.S. population. African Americans are roughly four times more likely to be diagnosed with HIV than other populations in the U.S. African American men are seven times more likely to be diagnosed with HIV than White men. African American women are 20 times more likely than White women to be diagnosed with HIV.
We know that HIV is mostly spread from sexual practice and injection drug use. Many people look at these alarming health disparity data and assume that African Americans are more likely to engage in risky behavior for HIV infection.
Nothing could be farther from the truth. In fact, we know that African Americans as a population are less likely to engage in high-risk sexual practices. African American women are not 20 times more likely to take risks for HIV transmission than other women; the idea is ridiculous.
Why are African Americans at such high risk?
Part of the puzzle is biological. When people are first infected with HIV, their bodies are excellent at making copies of the virus. The body produces a billion new viral particles every day, so people who remain untreated when they are HIV-infected can more easily pass on the virus than people who are in treatment. People infected with HIV who are in treatment and have undetectable levels of HIV in the blood are not good at copying the virus.
African Americans as a population are less likely to know if they are HIV infected. If they are infected, they’re less likely to have medical care. If they’re not seeing a health care professional, they’re less likely to have lower levels of HIV in their blood. Taking all of this into account, we realize that the issue of health disparities and HIV infection in African Americans is not about engaging in high-risk sexual practices or about drug use. It’s about access to medical care. It’s about social justice, having a good relationship with a health care professional and getting the support needed to take HIV medications to lower the level of HIV in the blood. It’s that straightforward.
What can we do to fight the epidemic of HIV infection among African Americans?
The first thing to do is to help more African Americans get tested for HIV infection. The smartest thing people can do for themselves and for their communities is find out if they’re HIV positive.
The next thing that everyone can do is get medical care. We’re in an important moment in our country’s history right now with the Affordable Care Act. More people can get health insurance. Go to your doctor, ask for an annual checkup and tell him/her you want an HIV test. If you’re HIV-positive, you can get on medications that will allow you to live a full life—not only for yourself but for your family and community. If you achieve undetectable levels of HIV in the blood, your chance of transmitting the virus is much less than if you remain untreated.
Another thing we can all do is help HIV-positive people get medical care. If we know people who are HIV-positive, be supportive of their efforts to see a doctor and stay on medications.
The last recommendation may require more courage. We need to fight stigma. HIV/AIDS is not a disease about bad behavior; it’s a disease that’s about a virus. That’s it. Because this disease in African American populations is driven by lack of access to medical care, by poverty and by social injustice, we need to remember that people who are HIV-positive aren’t bad people. When we hear people shame others, challenge them. Making other people feel bad because they have a medical problem is not helpful to them or their community. The more people feel silenced, the less they’ll get tested or seek medical care, which, in turn, affects everyone.
Getting tested, getting medical care, helping HIV-positive people get medical care and not shaming people for their health problems are four straightforward ways to fight this epidemic.
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