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6 October 2009
Vast racial differences in HIV prevalence

HIV prevalence among African Americans is an astonishing ten times greater than the prevalence among whites despite the many billions of dollars spent to combat HIV, say researchers in the American Journal of Preventive Medicine.

The researchers, from the University of North Carolina at Chapel Hill, have examined the factors behind the stark racial disparities in HIV infection and note that while individual-level sexual behaviors can contribute to the disparity, these observed differences in individual behaviors do not fully explain the marked differences in infection prevalence.

Even when comparisons are normalized by education, poverty index, marital status, age at first sexual intercourse, lifetime number of sex partners, history of male homosexual activity, illicit drug use, injection drug use, and HSV-2 antibody positivity, HIV prevalence among African Americans exceeds that of whites, typically substantially, the study notes.

The authors suggest a number of social factors that may contribute to the difference in infection rates. Because of racially segregated mixing patterns and the much higher HIV seroprevalence in African Americans, exposure to the virus is more likely among blacks than among whites for any given number of partners or frequency of sexual contacts. The prevalence of concurrent sexual partnerships (relationships that overlap in time) is higher among U.S. blacks than whites and this can spread infection through a sexual network faster than the same number of new, sequential relationships.

Other factors noted by the researchers include poverty and gender ratio (high male mortality and disproportionate incarceration of black men reduce the gender ratio among African Americans). This likely influences not only marriage rates, but also participation in sexual risk behaviors and sexual mixing and other network patterns.

According to the authors, the overall impact of these factors constitutes structural violence; a social system characterized by inequalities in power and life chances of sufficient magnitude to restrict a group of people from realizing their full potential and put them "in harm's way." Although the link between social context and disease is increasingly recognized, with a few notable exceptions, the specific role of structural violence in the HIV epidemic among African Americans has received considerably less research attention.

"Existing interventions have failed to control the epidemic in African Americans in part because critical features of the socioeconomic context promote behaviors that transmit HIV and increase the risk of HIV infection even among those who do not have high-risk behaviors. Failure to address these structural determinants has allowed the epidemic to continue in the black community," concluded researcher Adaora A. Adimora.

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Source: American Journal of Preventive Medicine

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