3 Truths About HIV In The Black Community

Thousands die from AIDS each year — the third and final stage of HIV — but knowing how to stop the spread can prevent death. (Photo by ASphotowed via Getty Credit: Getty Images)

by Alexa Spencer

HIV is not a thing of the past.

Even with advances in science and medicine, thousands contract the virus each year. That’s why the United States observes National Black HIV/AIDS Awareness Day on Feb. 7. The annual observance aims to increase awareness about the disease’s disproportionate impact on Black Americans while rallying community members to help end the epidemic. 

What’s there to know about HIV? A lot. In 2021, over 36,000 Americans were diagnosed. Despite only accounting for 12% of the nation’s population, Black people accounted for nearly half of those diagnoses — a trend that’s persisted since the epidemic began in the 1980s. 

Understanding how HIV spreads — and how infections are prevented — can save lives. Get a handle on your HIV education by starting with three key facts.

1. If untreated, HIV progresses through three phases

Acute human immunodeficiency virus (HIV) infection is the first phase. During this stage, which develops within two to four weeks after infection, some people experience flu-like symptoms. They may develop a fever, headache, or rash. The level of HIV in the blood is very high at this time, as well as the risk of transmission to an uninfected person. This is an ideal time to begin antiretroviral therapy (ART), a treatment that involves taking multiple HIV drugs. 

Phase two is chronic HIV infection (also known as asymptomatic HIV infection of clinical latency), when HIV continues to multiply in the body but at very low levels. People may have no HIV-related symptoms during this phase. If they’re using ART as prescribed, they may maintain an undetectable viral load and have no risk of transmitting HIV to an HIV-negative sex partner, though it is still possible. They may also stay in this stage for several decades. Without ART, the infection may progress to AIDS in 10 or more years.

Acquired immunodeficiency syndrome (AIDS) is the final, most severe stage. An AIDS diagnosis is based on two factors: a CD4 count that’s less than 200 cells/mm3 or the presence of certain opportunistic infections (infections of infection-related cancers). HIV is transmitted easily during this stage. If untreated, people with AIDS typically survive about three years.

As of 2020, Black people developed AIDS at 9.3 times the rate of white people.

2. PrEP protects against HIV, but accessing it can be a challenge

PrEP (pre-exposure prophylaxis) is a medicine that helps prevent HIV infection from sex or injection drug use. If used correctly (daily as a pill or bi-monthly as a shot), chances of infection are reduced by up to 99%. 

The medicine is only for people who don’t have HIV but are at high risk of getting it. 

Although PrEP has been available via prescription for over a decade, Black people struggle to access it. In 2022, Black men and women accounted for 14% of PrEP users, but 42% of new HIV diagnoses. On the contrary, white people represented 26% of new HIV diagnoses and 64% of PrEp users; according to AIDSVu, a project by Emory University’s Rollins School of Public Health and Gilead, a company that produces the PrEP.

Stigma, poverty, racism, homophobia, medical mistrust, and lack of transportation are a few barriers to PrEP access. 

The Affordable Care Act requires PrEP to remain free under most health insurance and state Medicaid programs. Without insurance, the medicine can be costly. A monthly supply runs between $60 and $2,000, depending on the brand.

Help does exist. The federal Ready, Set, PrEP program provides PrEP to uninsured people. Many local clinics also offer it at low to no cost. On a state level, California Governor Gavin Newsom (D) recently signed a bill to make the medicine available to residents without a doctor’s prescription. 

3. Free HIV testing is available nationwide.

A person should get tested for HIV at least once a year if they had sex with someone who has HIV, had sex with more than one partner since their last test, or shared drug injection equipment with another person. 

HIV tests are widely available for free or at reduced costs. To access a test, chat with your healthcare provider, contact your local health department, or purchase an HIV self-test online or at a local drug store.

Find HIV testing, treatment, and PrEP services near you by entering your zip code into the locator below.