The fierce urgency of now: Ending the HIV epidemic in Black communities

I did something in 2022 that many people would have thought was impossible. For many years, I didn’t think it would be possible. And yet, in 2022, I marked my 40th year living with HIV. 

HIV was a death sentence when I was diagnosed in the 1980s. There was little hope. Thousands of people died well before their time. They were my friends. One was my partner.

But that all changed in the mid-1990s when a new class of drugs, antiretrovirals, became available. That is when we shifted from dying from AIDS to living with HIV. Antiretroviral medications changed everything, and I am living proof. 

When someone like me has effective HIV treatment, we can live long and healthy lives. With effective treatment a person can reach a point where the amount of the virus in their blood is so low it’s undetectable in lab tests. When this happens, they cannot pass the virus along to anyone, or undetectable equals untransmittable.

But antiretrovirals aren’t just for those of us living with HIV. We have also learned that these medications can be used by people who are vulnerable to HIV as a means of prevention. This is called preexposure prophylaxis, or PrEP, and it is one of the greatest tools we have to stop the spread of HIV.

These wonderful advances have led many people to think HIV is no longer a threat and that the epidemic is over. Nothing could be further from the truth. Efforts to combat HIV have stalled, and that is particularly true within the Black community.

According to the 2020 statistics compiled at AIDSVu, 42% of the people diagnosed with HIV were Black, despite only making up 13% of the population. HIV diagnoses among Black women outpace diagnoses in white women by a 17-to-1 margin. And there are six times as many Black men than white men living with HIV. One alarming study from the Centers for Disease Control and Prevention suggests that nearly two-thirds of Black transgender women are living with HIV. 

It needs to be said: there is nothing about Black biology or genetics that makes us more susceptible to HIV. Instead, these disparities are driven by social, economic and structural inequities. So many public health threats — from HIV to COVID-19 to mpox — have collectively exposed how the legacy of white supremacy and the persistence of racism in our health care system render Black people vulnerable to disease and death.

Today, on National Black HIV/AIDS Awareness Day, I am calling on policymakers to address these issues. 

First, we need to build a robust Black health care workforce. Significant federal funding for HIV research and prevention at historically Black colleges and universities and their associated medical schools is one step. Another step is to encourage aspiring Black doctors, nurses, technicians and students in public health to enter the HIV field with legislation like the bill Rep. Lisa Blunt Rochester introduced in the last Congress. This legislation would expand and diversify the HIV workforce and facilitate a pipeline of Black medical professionals and public health leaders. These are people our community can turn to and trust. 

Second, we must significantly increase the budget of the Minority HIV/AIDS Initiative, which was created to support Black grassroots community-based organizations. Despite the promise of this project, funding for the initiative has remained stagnant for years. In fact, when we account for inflation, the program took a cut in the 2023 budget. Increased funding for this initiative will allow the community to focus on making HIV-related services and care far more accessible in settings that serve Black communities, such as family planning clinics, community pharmacies, youth centers, faith-based health programs and substance use treatment facilities.

Third, we need new and innovative programs that focus on getting Black people onto PrEP. PrEP is one of the best prevention methods we have to stop the spread of HIV. As mentioned above, Black people make up about half of all new HIV diagnoses, yet only account for 14% of the people on PrEP. We desperately need more Black people on PrEP, and both Congress and the private sector need to fund programs to make that happen.

There are many more things that are needed, and these things alone will not eliminate the social, economic and structural inequities that lead to the vast disparities of the HIV epidemic. They will, however, help us save more Black lives from the continuing threat of HIV.