It’s a puzzle inside a mystery, wrapped in an enigma.
For years, epidemiologists have informed us of the disproportionate rates of HIV infection among African Americans. The population of the United States is roughly 13 percent black, yet African Americans account for 38 percent of AIDS deaths and nearly half of all HIV infections. A recently published report from the Black AIDS Institute states that two percent of adult black Americans are infected with HIV. At first blush, that might not sound like much, but the situation is dire. To put it in perspective, only four countries outside Africa have a higher prevalence than black America!
The statistics for the city of Houston reflect the national trend of the overrepresentation of blacks among those with HIV/AIDS. According to the city’s Department of Health and Human Services, African Americans account for 40 percent of the AIDS diagnoses in Houston since 1981 and 54 percent of the HIV infections reported in our city since 1999. Yet only 18 percent of Houston’s population is black.
Why is this? No one knows for sure, but theories abound and address a variety of issues. One thing is for certain—the real answer, once discovered, will be multifaceted and even convoluted.
Let’s take a look at some of the current hypotheses:
Some scientists report that condom use is not as common among African Americans as it is in other racial groups. One possible contributing factor to this reduced condom use could be that some African-American women are, or feel, disempowered and unable to negotiate condom use. This theory may contain a thread of truth because HIV/AIDS is the leading cause of death for African-American women between the ages of 25 and 34! However, women’s inability to require their male partners to wear condoms does not explain the entire epidemic in black America.
A leading theory points to the sexual networks that exist in many African-American communities. In these networks, people have many partners at the same time (rather than engaging in serial monogamy), so there is much cross-pollination, if you will, amongst the members of these networks. And while that is an efficient way to foster an epidemic, it alone does not account for the disproportionate rates of infection among blacks.
Other theories have implied that African Americans engage in more promiscuity and high-risk sexual behavior than do their white counterparts, and that is the root cause of the epidemic. However, a report published in the January 2007 issue of the American Journal of Public Health suggests otherwise.
This study concluded that white young adults are at increased risk of HIV infection when they engage in high-risk behaviors. No big surprise. But the study found black young adults were at high risk for infection even when they don’t engage in high-risk acts! These results suggest there may be biological influences at work.
New research published in the July 17 issue of Cell & Microbe (what’s on your coffee table?) suggests that people of African descent are much more likely to have a genetic trait that makes them more susceptible to HIV infection. According to one of the study’s authors, Matthew Dolan, this trait provides protection against the Plasmodium vivax form of malaria but makes HIV infection 40 percent more likely.
The researchers reviewed data from a 25-year study of people living in Africa, and they also examined 1200 members of the U.S. military who became infected with HIV. They found 90 percent of Africans and 60 percent of African Americans have this genetic trait. (It is virtually non-existent in whites.) It is estimated that the increased susceptibility tied to this trait could account for millions of extra cases of HIV worldwide.
These findings may provide one more clue to the African-American HIV epidemic mystery. However, applications for this information may be limited and not likely to be helpful in the search for new treatments. This research certainly points to the need for effective, targeted prevention education and social marketing campaigns in black communities, as well as the necessity of consistent use of condoms by African Americans.
In other scientific news, University of Texas researcher, Dr. Sudhir Paul, and his colleague, Dr. Miguel Escobar, announced in late July 2008 that they may have found a novel way to kill HIV! Dr. Paul stated they discovered a “weak spot” on HIV—a section of the protein code that doesn’t mutate when the virus reproduces. The scientists found they could apply naturally produced human abzymes (whatever those are) to the weak spot and disable the virus.
This technique has worked in laboratory settings and with animal subjects. However, it is way too early to know if it will lead to a preventive vaccine or a cure. We are still several years, numerous human trials, and millions of dollars away from that answer.
Until that day arrives, the best protection against HIV infection is prevention. Get tested. Know your status. Use a condom every time you have sex. Stay healthy. It’s just that easy, and just that complex. Just like the epidemic.
Kelly A. McCann is the chief executive officer of AIDS Foundation Houston. For testing information, call AFH’s Prevention Services Department at 713/623-6796 or log on to www.aidshelp.org.