Organized by #ShutDownDC, demonstrators formed a 15-car motorcade that drove past hospitals 'to ... [+]
Although COVID-19 and HIV/AIDS differ in myriad ways, these two diseases share one ignominious feature. Both disproportionately burden communities of color. In fact, the numbers are eerily similar. Let’s look at COVID-19. The Michigan Department of Health and Human Services recently reported that African-Americans accounted for 32% of all confirmed cases of COVID-19, and 41% of all COVID-19-related deaths. Data from the CDC show similar numbers nationally.
And what about HIV/AIDS? At the end of 2018, the CDC reported that African-Americans comprise 42% of all new HIV diagnoses in the United States. Yet, in both Michigan and the U.S. as a whole, African Americans constitute only about 14% of the total population.
The near-term causes for these over-representations in COVID-19 and HIV certainly differ. However, their ultimate causes may be the same.
For COVID-19, where you work matters. According a 2018 report from the U. S. Bureau of Labor Statistics, almost 30% of white workers could work from home. For people who identify as black or African-American, however, that number drops to less than 20%. BLS data also show that employed blacks and African Americans are more likely than whites to work in service occupations. People in these jobs not only can’t work from home, but also interact more directly with customers, increasing their risk of infection.
Where you live matters, too. A report by researchers at Harvard University’s Joint Center for Housing Studies showed that homeownership rates between whites and African-Americans differ considerably. Renting, per se, doesn’t increase one’s risk of exposure to the COVID-19 virus, but living in high-density housing, such as an apartment building, does.
For COVID-19, your general health matters, too. Various underlying medical conditions increase the risk of severe disease following infection with SARS-CoV-2. Indeed, the CDC notes that people of any age with certain medical conditions are at increased risk of severe complications. These medical conditions include, for example, asthma, obesity, and diabetes. So, what do we know about these medical conditions? According to recent data from the U.S. Department of Health and Human Services, African Americans are 3 times more likely than whites to die of asthma, 1.3 times more likely to be obese, and 60% more likely to be diagnosed with diabetes. The disproportionate burden of COVID-19 mirrors these differences in general health.
Causes of the racial disparities in HIV infection are more difficult to discern. However, we can point to a couple factors. Again, general health matters. Transmission of HIV occurs more frequently if an individual has another sexually transmitted infection (STI). And data from the CDC show that rates of chlamydia and gonorrhea are higher among African Americans than among whites.
Access to healthcare matters, too. We know that the risk of transmitting HIV to another person drops dramatically if an HIV-positive individual is receiving adequate care. In fact, the risk of transmitting the virus is virtually zero, if an infected person receives treatment and has a reduced viral load. Unfortunately, we see disparities in the levels of viral suppression among different groups. Among whites, nearly of 60% of infected individuals exhibit viral suppression. Among people who identify as black or African American, that number drops to 46%.
We know, too, that pre-exposure prophylaxis, or PrEP, greatly reduces one’s risk of becoming infected with HIV. However, PrEP awareness and use among African American men who have sex with men lags behind their white counterparts. Combined, these various factors contribute to the increased burden of HIV/AIDS among African Americans.
But what about the ultimate causes of these disease burdens?
The immediate reasons that COVID-19 and HIV/AIDS affect African Americans disproportionately differ. But the underlying reasons do not. According to a Kaiser Family Foundation report, 7.5% of whites, but 11.5% of blacks were uninsured at the end of 2018. At that same point in time, 9% of whites in the United States, but 22% of blacks were living in poverty. According to data from the U.S. Census Bureau, median family income in 2017 for whites was $68, 145. For blacks, it was $40,258. Throughout the U.S., African Americans have less access to quality healthcare. Throughout the U.S., people of color are more likely to live in food deserts, areas without adequate access to grocery stores.
Of course, neither a lack of insurance, nor a lower family income, nor limited access to a grocery store will cause one to become infected with SARS-CoV-2 or HIV. But these basic disparities do lead to poorer overall health outcomes. Moreover, COVID-19 and HIV/AIDS are not the only conditions that show this pattern. As noted above, disparities in asthma, obesity, and diabetes exist. Add to the list maternal mortality, infant mortality, and heart disease. The disproportionate burdens of COVID-19 and HIV/AIDS among African Americans that we see today are not anomalies. Rather, they reflect socioeconomic disparities that have existed for far too long.
