Myth: HIV/AIDS Rate Among Black Women Traced To 'Down Low' Black Men

The rate of HIV and AIDS in the Black Community is startling. African-Americans, who only make up 12 percent of the U.S. population, account for nearly half of those living with HIV. More specifically, black women represent 61 percent of the new HIV cases among all women. The popular suspicion has been that many infected black women have contracted the virus from their black male companions, who secretly have sex with other men (also known as the "down low"). But a new study shows that correlation is flawed. Dr. Kevin Fenton, of the Centers for Disease Control, explains the misconception and talks about prevention.

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MICHEL MARTIN, host:

I'm Michel Martin, and this is TELL ME MORE from NPR News.

Coming up, with World Series fever in the air, we check in on one effort to find new baseball talent in an unlikely place. How about India? We'll meet the winner of the reality show the "Million Dollar Arm." That's in just a few minutes.

But first, on a very different note, we want to spend a few minutes talking about the alarming HIV and AIDS infection rates in the black community. And as you might imagine, some of our conversation over the next few minutes might not be appropriate for younger or more sensitive listeners. So please be advised.

African-Americans who make up only 12 percent of the U.S. population are nearly half of the people with HIV. And African-Americans make up 61 percent of the new HIV cases among all women and most of them contract the virus through heterosexual contact. For years, the suspicion has been that many of those infected women are contracting the disease through sex with men on the down-low, men who don't tell their female partners about their sexual activities with other men.

Well, a slew of new studies show that just isn't the case. With us to talk about this is Dr. Kevin Fenton of the Centers for Disease Control and Prevention. He is the director of the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. Well, that's certainly a mouthful, doctor. Welcome. Thank you for joining us.

Dr. KEVIN FENTON (Director, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention): Thank you so much, Michel.

MARTIN: How did this series of studies come about? Was it partly because this whole down low question had become so much a part of the popular culture that researchers felt that they needed to pin it down?

Dr. FENTON: Indeed. You know, what we're seeing now is that we're in the midst of a crisis as far as HIV in the African-American community is concerned. And it really is important that we understand why the infection is spreading and where the infection is spreading within the community, so we can take effective action. And part of the response must be to address some of the myths and misinformation regarding how HIV is being transmitted within the community.

MARTIN: And what is the major finding that you would want us to know about?

Dr. FENTON: It's critically important to know that we're dealing with a very complex epidemic, certainly among the black community. And black women are bearing a disproportionate burden of disease compared with their white or Hispanic counterparts. It's also important to realize that about one in five black women become infected because of injecting drugs. And about 80 percent of women acquire the infection through sexual transmission from male partners who are HIV infected.

And their male partners may become infected either through injecting drugs themselves, through having multiple sexual partners or a smaller proportion through male bisexual activity. So it's important to understand the range of risk factors which occur in heterosexual transmission of HIV in the United States.

MARTIN: So, is it fair to say that it is just simply not true that the majority of new infections among black women occur because of having sex with men who have sex with men.

Dr. FENTON: Yes, that would be true. It is crucially important to bear in mind that there are a range of risk factors which face black women in the United States today. And, you know, the reality is that bisexual black men account for a very, very small proportion of the overall black male population in the United States. Our research suggests that about two percent of black men will report being bisexually active.

And, therefore, you need to look at the risk factors which are far more prevalent in the community - having multiple sexual partners with unprotected sex with heterosexual partners, injecting drugs. Those are going to be factors which are far more prevalent in the population and are driving risks.

MARTIN: But, you know, you mentioned though that a lot of this is based on self-reporting. You're saying that a very small percentage of African-American men identify themselves as bisexual. The CDC itself has reported that many black men who report having sex with other men see themselves as heterosexual, even though their behavior may be at variance with how they identify themselves. Could it be a factor in the transmission of the disease because men don't necessarily accept or disclose to researchers or to their partners that they're engaging in this behavior?

Dr. FENTON: Indeed. And, you know, this factor of nondisclosure of this sort of diversity in sexual attitudes or lifestyles is certainly seen across all racial and ethnic groups. So you wouldn't want to say that this is something which unique to the black male community. And what our research also suggests is that even among men who are bisexually active, the bisexual males who have no other risk factors, for example, like injecting drugs, actually report having lower risk sexual behaviors than gay and bisexual men.

So it's a very complex picture, and one that we're really trying to do more research to understand and to describe and to characterize. But even these early findings are helping us to challenge some of the preconceived ideas about how infections are being transmitted and among whom.

MARTIN: One factor that is not much discussed in the studies that we've talked about is the whole question of the incarceration rate. Men who may be incarcerated may be having sexual activity but that doesn't - they don't see themselves as anything other than heterosexual. It may be coerced. There may be some continuum of consent here that, you know, might be hard to talk about. But is that a factor also?

Dr. FENTON: You know, I'm so glad you raised that. Incarceration is certainly one of the topics and areas that we're particularly focused on at CDC to better understand both the disproportionate impact of this factor on the black community and how it facilitates HIV transmission.

And there are a few things that we do know. First of all, although there is HIV transmission ongoing in prisons, it's not at high a level as had been previously thought. And what we actually believe is occurring is that there are a number of HIV-infected individuals who become incarcerated. So HIV goes from the community into the prison sector. There may be some onward transmission in prison.

But the real factor that occurs is on release from prison, people who are at high risk or HIV infected reenter communities, form new sexual partnerships and that's where the potential for onward transmission of HIV occurs. Incarceration also has another key effect on the community, and that is by removing eligible African-American males from the community.

It means that African-American women who are looking for African-American male partners have fewer choices in their sexual partnerships and relationships and may be forced into relationships where they have multiple partners or males who will have multiple female partners, etc. Or those women may not be able to negotiate safer sex and protected behaviors because of fear of losing eligible male partners in the community. So it's a very complex set of and series of factors which we observed with incarceration and the community transmission of HIV.

MARTIN: Dr. Kevin Fenton is the director of the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention at the Centers for Disease Control and Prevention. He was kind enough to join us from his office in Atlanta. Dr. Fenton, thank you so much for speaking with us.

Dr. FENTON: Thank you so much.

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