Heterosexual Transmission of HIV/AIDS Devastates Minority Women's Health Status
Tricia Rose's Commentary on Black Women and AIDS
Deadly Silences
African-American women make up less than 15 percent of the U.S. female population, yet they represent 64 percent of all new AIDS cases among women in the United States.1 Put another way, a black woman is twenty times more likely to contract AIDS than a white woman.2
Despite this staggeringly disproportionate rise in African-American women's infection rates, public conversations on the HIV/AIDS crisis rarely, if ever, focus specifically on the prevention and treatment of black women. Two recent examples illuminate this void. Senate Majority Leader Bill Frist's recent agenda highlighting the U.S.'s increased commitment to fighting the global HIV/AIDS epidemic, especially in Africa, is to be applauded but is nonetheless striking for its total silence on domestic cases of HIV/AIDS, particularly the catastrophic rise in infection rates among African-American women.
On another front, a media blitz in African-American magazines such as Ebony, Essence, and Savoy is focusing long overdue attention on HIV/AIDS in the African-American community. Put together by such organizations as the African-American AIDS Policy and Training Institute, the AIDS Foundation in Chicago, and the UCLA AIDS Institute, this media campaign is aimed at prevention, awareness and support. A highly visible component of this effort is Magic Johnson's current public service ad campaign on living with HIV/AIDS sponsored, in part, by GlaxoSmithKline. Although his celebrity status and his leadership role in black economic development make him a valuable spokesman for a battle of awareness among African-American men, he didn't nor should he be expected to represent the specific contexts in which black women are contracting this disease. We need high-profile African-American spokeswomen to speak to this particularly vulnerable population.
Education about safe sex practices and knowledge about how to live with HIV/AIDS remains crucial. Free access to condoms and safe sex education should be a national health policy during such a dire public health crisis. Assessing social forces at work—such as limited health services, higher rates of male incarceration and intravenous drug use among the poorest and most vulnerable members of the community -- is also essential.
Beyond this, though, in trying to understand the startling rise in HIV/Aids among African-American women of all class and educational backgrounds, it is essential that we take into account the histories and expectations that dramatically shape our sexual behaviors.
Limited HIV/AIDS education and substandard levels of access to health services are a significant part of the answer. However, many black women, know about safe sex practices and their ability to reduce the risk of contracting HIV/AIDS, yet, denying their own risk, neglect to adopt them.
To really understand why, in the moment, a woman will practice safe sex or not will require exposing the hidden contours of sexual courtship rituals. Many men interpret behaviors such as using a condom, or following a woman's sexual demands as a threat to masculine prowess. Similarly they perceive women who are sexually informed and who set the terms for a sexual relationship as less desirable or less feminine. These hidden calculations are given added force in a popular culture where black women, especially young black women in music and film, are ritualistically portrayed as highly sexually available and valuable because of it.
At an even broader level, the way African-American sexuality has both been silenced, and stigmatized throughout U.S. history is a vital, yet under-examined contributing factor in the spread of HIV/AIDS among black women. Black women have consistently been portrayed as dysfunctional, deviant and depraved. First developed during slavery to justify the forced breeding of slaves for profit and the sexual domination of black women slaves, these ideas became the basis of many racial stereotypes, public policies and laws and have given rise to negative images of black women's sexuality, such as those of the Mammy, Jezebel, Sapphire and most recently the Welfare Queen, which have become ingrained in our culture. Recent efforts to target crack addicted black pregnant women (not all drug using pregnant women) as unfit mothers and potentially open to charges of homicide and child endangerment because of their addiction is predicated in part on these degrading myths.
These perceptions have discouraged many black women from speaking openly about their sexual desires and experiences for fear that whatever they say will also be distorted and used against them. Negative sexual images are not easily dispelled by openly challenging them. Sexual labels have a special power over women's social reputations; adding racially pejorative labels only makes this worse. Rather than risk attacks on their reputation and self-esteem, many black women have retreated into silence. In the case of HIV/AIDS, many simply hope and pray that the disease passes them by. Such silence can be deadly.
This is a war that must be fought on many battlefields at once. Lobbying for health resources and funding and awareness campaigns must go on full-throttle. However, awareness campaigns must be accompanied by a real commitment to exploring the legacies of sexual stigma associated with African-Americans, the silences they have produced and deep-seated dynamics that shape contemporary sexual behaviors.
Such exploration is not an academic exercise, although serious scholarly attention it a crucial part; instead, it must be linked directly to HIV/AIDS activism. What we learn from listening to people talk safely and openly about the intricacies of intimate connection must be examined, discussed and then pressed into service in ways that illuminate concretely how these infection rates are rising, reduce infection rates and encourage responsible sexual agency, equity and respect during and beyond this crisis.
February 2003 Santa Cruz, CA
A modified version of this commentary was published in the New York Times on March 1, 2003.
1 Chicago Sun Times 12/5/02
2 see ebony mag 11/02- citing CNN/Harvard School of Public Health report
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