African American Women

African American Women

HIV/AIDS is a leading cause of death of African American women in many age groups. And of all U.S. women living with HIV/AIDS, more than half are African American. There are many reasons why African American women are affected by HIV/AIDS more so than women of other races, including:

• Poverty — The U.S. Census found that one in four African American women lives in poverty. Studies have shown a strong link between poverty and the risk of HIV infection. People living in poverty also get lower-quality health care in general, which can mean advancing from HIV infection to AIDS more quickly.
• STIs — HIV is most commonly spread to women through sexual contact. Untreated STIs that break the skin, such as genital herpes and warts, give HIV easy access into the bloodstream. African American women are at much greater risk for some STIs. For instance, gonorrhea rates among African American women were 14 times higher than among white women in 2006.
• Incarceration of African American men — Based on current rates of incarceration, nearly one-third of all African American men will enter prison during their lifetimes. Cycling in and out of the prison system leads to fewer available African American men in the community. Living in prison also exposes many men to anal sex, whether forced or by choice, and injection drug use. These practices raise the risk of passing HIV to both the men and their female partners at home.

African American men "on the down low" may also be a factor in the burden of HIV on African American women.

Women Who Have Sex With Women

Women who only have sex with women might think they are safe from HIV. But experts think it’s possible for a woman to get HIV through sexual contact with a woman infected with HIV. Experts think this could happen if soft tissues, such as in the mouth, come in contact with the vaginal fluid or menstrual blood of a woman infected with HIV. Women who have sex with women also can become infected with HIV through injection drug use or by having unprotected sex with a man who has HIV.

A woman who has sex with women should know her HIV status as well as her partner’s status. That way, she can take steps to protect herself from HIV or prevent the spread of HIV to others. You can lower your risk of HIV by using condoms correctly and every time you have sex with men or when using sex toys. Dental dams have not been studied, but might lower the risk of getting or spreading HIV.

Barriers to Care

Women infected with HIV may have less access to or lower use of health care resources. This may be due to:

• Fewer financial resources
• Less access to transportation
• Added responsibility of caring for others, especially children

Many experts also believe poverty, unemployment, and lack of education are helping to "drive" the growing HIV problem among women. Women living in inner-city poor neighborhoods are often in poor health and without access to health care for prevention or treatment. While risky behaviors in these communities directly spreads HIV/AIDS, urban poverty is clearly playing an important role.

Yet, the HIV problem does not only belong to poor neighborhoods in large cities, such as New York and Washington, DC. HIV also affects women in more rural communities in southern states. Researchers in North Carolina found that African American women with HIV infections were more likely to:

• Be unemployed
• Receive public assistance
• Have had 20 or more lifetime sexual partners
• Have a lifetime history of genital herpes infection
• Have used crack or cocaine
• Have traded sex for drugs, money, or shelter

In addition to these challenges, research has highlighted other issues that affect the lifespan of women with HIV. Studies have shown that women with HIV do not live as long as men with HIV, perhaps because women are less likely to be diagnosed early. Early diagnosis of HIV allows women to benefit more from antiretroviral treatments. Other issues may also play a role in this difference in survival.

• Women with HIV may have less access to or lower use of health care resources than men with HIV.
• HIV-positive women in abusive relationships may suffer violent reactions from partners.
• Women who are homeless have less access to care. Homeless women who are able to get treatment may not be able to stick with care routines because of irregular meals or not having proper places to store medicines.
• Some women with HIV may not have people around to provide emotional support or other types of help.

A Secret World: Men on the "Down Low"

The term "down low" or "DL" means to keep something private, whether related to information or actions. Being "on the down low," "on the DL," or "on the low low," are terms often used to describe men who have sex with men as well as women, but do not identify themselves as gay or bisexual.

While the term "DL" has most often been identified with African American men, research has shown that it also describes the lives of some white and Hispanic men. Yet because being on the DL is defined by secrecy, very little is known about these men. It is not known how many of these men:

• Have HIV or AIDS
• Practice unsafe sex with any partner
• Engage in other actions that put them at risk of HIV, such as injection drug use

Researchers are working to better understand the sex-related HIV risks of men who are on the down low. The concern for women remains exposure to HIV without them knowing, if their partners get HIV from unsafe sex with HIV-positive men.