The importance of sexual identification in AIDS rates

Gregory in Seattle left the following comment on my AIDS post yesterday and I thought it was worth reposting in its own right.

You might find this of interest: an interactive map giving the HIV infection rates in the US by county, per 100,000 population. According to the CDC, about 25% of Americans, aged 13 or older, with HIV are women. Of them, 64% are African American. Of all the people with HIV in the US, an estimated 20% do not know they have the virus.

I’m a member of the Community Advisory Board for the Seattle HIV Vaccine Trials Unit. We’ve discussed the racial and regional disparity of the pandemic in the US. Education and religion are parts, but there is also a strong element of identification. Many African American men who have sex with men do not self-identify as gay: they do not march in parades, they do not go to bath houses, they do not fall in love and build a common life with other men. Being gay is a white thing, and the popular sentiment is that only gay people get HIV.* This identification divide exists even in major cities on the coasts. Because much of the outreach over the last 20 years has focused almost exclusively on gay men and has been done through gay newspapers and through outreaches to bars and pride events, nearly all of the “Be Safe” message never reaches them.

Another huge issue is the availability of low-cost, anonymous testing resources. It is established that people who can get tested are much more likely to get tested, and that provides an opportunity for education. Tests can cost around $50 if paid for retail, and few insurance companies will cover them. Even if you have that kind of money, in much of the south getting a test means either driving a hundred miles or more to a city where you can be tested anonymously or explain to your personal physician why you think you need such a test. The result is that people just don’t get one.

So yeah, a lot needs to change before HIV rates in the black south will change.

(*) It is conveniently ignored by the people pushing the “gay = HIV” lie is that, as of the end of 2010, about 2/3rds of the people on the planet with HIV lived in sub-Saharan Africa. That in several countries in southern Africa — South Africa, Swaziland, Lesotho — 15% to 28% of the adult population is HIV+. That about 10% of all people with HIV are children aged 14 or younger, and that most of those got it from infected mothers either transvaginally during birth or from the virus expressing itself in breast milk. That of all adults on the planet with HIV, 56% are women. And that since 2006, HIV/AIDS is the leading cause of death among women in their reproductive years.

It is pretty damn grim.

He also pointed me to the following collection of links from a presentation he gave for MENSA recently.

The importance of sexual identification in AIDS rates

7 thoughts on “The importance of sexual identification in AIDS rates

  1. 2

    I’m a straight female and I’ve had myself tested for HIV/AIDS – not because I had any reason to believe I had it, but because I was curious and wanted to be as certain as I could be that I was negative. When I went in for that slew of STD tests, I specifically asked for the HIV test and the nurse gave me a peculiar look, then asked me if I had reason to suspect I had it. I told her no, I was just curious and I was willing to pay for it out of pocket, so do it.

    It would be great if we could, eventually, create a culture where the expectation was certainty about STIs you might have, and discussion thereof. Boy, though, did I get silently slut-shamed at the clinic, just because I was *there,* dealing with my and my partners’ health in a responsible adult fashion, and I live in Seattle! I can see why most people would want to avoid it.

    1. 2.1

      It would be nice if more places were like the women’s health center at my university. When I went in for my annual gynecological exam last week they were like, “Hey, by the way, do you want a rapid HIV test? Here, have a cheek swab.” I don’t have any reason to suspect that I’ve got it either, but I was curious about the process, so I did it just for the hell of it. By the time I was done with my exam, they had my results ready, and that was it. No stigma, no pressure, just a normal part of basic healthcare.

      They consider chlamydia and gonorrhea testing to be a standard part of the women’s annual as well, and will generally encourage people to get tested even if they don’t think they have either, just to be sure. And of course they have the usual condom jar on the check-in desk (now with female condoms, which I thought was neat). It’s been like this at every university I’ve been to, so I’m always confused and shocked that the larger society seems to handle things differently. I guess most non-crazy-fundy universities have a strong incentive to avoid the bad PR (and the screaming parents) associated with STI and unwanted pregnancy outbreaks among their student population, and they’re pragmatic enough to recognize that they’re not going to be able to prevent students from having sex. It’s a shame the rest of the world doesn’t seem to have figured this out.

      1. My school’s women’s health center is similar, and I’m grateful for it. One thing I am NOT a fan of, though, is that in the questionnaire you fill out about risk factors and whatnot when you request STD testing, they specifically ask if you’ve had sex with a bisexual.

        I really wish there was a comment field (it’s an online form) so I could say, “I’m bi. Does masturbation count?” 😛 More seriously, it’s upsetting to see biphobia propagated in a medical setting in a case where it wouldn’t even serve any purpose if it was a serious, legit risk factor – since they only ask you when you’ve already scheduled a STD testing appointment! It rolls up the common assumptions of bisexual promiscuity and lack of safe practice… which, while there’s absolutely nothing wrong with having multiple sex partners, it’s still patently ridiculous to assume that’s the case based on orientation.


        1. Yeah, I don’t really get what that question is supposed to be about. The only thing I can think of is, like the weird questions about gay sex on blood donor questionnaires, it might be a half-assed proxy for asking about unprotected anal sex, which AIUI does have a relatively high HIV transmission rate. And I guess they don’t want to say “anal sex” because they’re afraid people will flip out or lie because they’re embarrassed? I dunno. It’s not a great way to handle it, that’s for sure.

          In any case, I’ve never seen that particular oddity at any of my schools, so I guess at least there are some places that have apparently figured that shit out. Not that that helps you at the moment. :/

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