A new report commissioned by the CDC and presented this morning at the International AIDS Conference in Vienna finds that “[p]overty is perhaps the most important factor in whether inner-city heterosexuals are infected with the AIDS virus.” The report, which excluded men who have sex with men and drug users, examined 9,000 heterosexual adults living in some 23 cities and detected HIV “in 2.4 percent of the people who were living below the federal poverty line” and a significantly lower 1.2 percent of people “who made more money than the federal poverty guideline.”
From CDC’s press release:
Prevalence was especially high in those with the lowest socioeconomic status. Within the low income urban areas included in the study, individuals living below the poverty line were at greater risk for HIV than those living above it (2.4 percent prevalence vs. 1.2 percent), though prevalence for both groups was far higher than the national average (0.45 percent)….The absence of race-based differences in this analysis is likely due to existing high prevalence of HIV in poor urban areas, which – regardless of race or ethnicity – places individuals living in these areas at greater risk for exposure to HIV with each sexual encounter.
Authors note that other factors associated with poverty also likely contribute to high HIV prevalence in these settings. Some of these factors include limited health care access, which can reduce utilization of HIV testing and prevention services; substance abuse, which can increase sexual risk behavior; and high rates of incarceration, which can disrupt the stability of relationships.
Of course, the absence of race-base differences doesn’t mean that they don’t exist; it suggests that black people are disproportionately affected by AIDS not because they are disproportionately poor. In fact, given that black and Hispanic Americans are more likely to live in neighborhoods with concentrated poverty than other racial and ethnic groups, the study’s participants were 77% black, 15% Hispanic and only 4% white.
As the Black AIDS Institute put it, “We believe this is essentially a difference without a distinction.” The gap in AIDS rates have been “driven by social determinants of health: socioeconomic status, high rates of sexually transmitted diseases, high rates of incarceration, man sharing (knowingly and unknowingly) due to gender imbalances, lack of access to healthcare, lack of a regular health provider and low HIV literacy.” Black people “are disproportionately poor” and “when Whites and Latinos live in poor Black communities, they are negatively impacted by the same social determinants that undermine the health of their Black neighbors.”
“Black people still bare the brunt of the AIDS epidemic in America today,” the organization notes. “This study demonstrates one of the reasons why. Race matters and so does poverty. Black people are disproportionately impacted by HIV; Black people are disproportionately poor. ‘You say tomato; I say tomato.’” The CDC’s own statistics demonstrate this reality:
Obama’s new AIDS initiative re-allocates “more attention and resources” to “populations at highest risk of HIV infection,” including Black and Latino Americans — many of whom are living in poverty. The initiative also instructs federal agencies to consider additional efforts to support housing assistance and community clinics and notes that under the health law, poorer Americans will be eligible for Medicaid coverage.