The Centers for Disease Control and Prevention (CDC) in the United States recently released a study showing that in heterosexual communities, people living in poverty are five times more likely than the general population to be infected with HIV. For impoverished communities, where people are living above the poverty line, but not living well, people are two and a half times more likely to be infected.
This just in: Poverty is bad for your health.
Just so we’re all operating on the same page, the current poverty line in the United States is set at an annual income of $10,830 USD for a single person, $22,050 USD for a family of four. There’s a reason I was gravely concerned about the AIDS Drug Assistance program recently. This study shows that people living in poverty aren’t just less likely to be able to access HIV/AIDS treatment, they are also more likely to need that treatment in the first place.
Guess who is most likely to live in poverty in the United States? Black, Native American, and Latin@ populations. People with disabilities. Young people and older adults. We’ve known for a long time that all of these groups are more likely to have health problems as a direct consequence of living in poverty, and this study shows us that poverty is also a key factor in HIV infection rates among these groups. In 23 US cities, we are looking at a ‘generalized epidemic’ in the heterosexual population; that’s a fancy way of saying ‘this is not going away unless we do something about it.’
One obvious solution would be outreach and education programs. Provision of medical care. Access to safer sex supplies. Community education provided by people actually living and working in these communities who can provide that education in an accessible format.
Yet, there are a lot of barriers to doing this. There’s the furor from US conservatives opposed to any kind of community education, outreach, and healthcare when it comes to anything even tangentially related to sex; after all, if we hand out condoms, that’s like saying it’s ok for people to have sex! As Cara Kulwicki points out at The Curvature, there’s also a serious stigma against sex workers when it comes to funding for HIV/AIDS work. Not only do we not want to help sex workers, we don’t want to provide funding to any organisations that work with them.
At Racewire, Kai Wright notes:
Today’s CDC study establishes that the U.S. epidemic is instead best understood as two separate epidemics–one in poor neighborhoods and one in the rest of the nation. That’s because HIV prevalence is a shocking 2.1 percent among heterosexuals in the poor neighborhoods CDC studied. These are explosive findings that ought to fundamentally redefine our understanding of the U.S. epidemic and its gravity.
This study is a stark illustration of intersectionality in action. If we’re going to talk about disparities in HIV infection, we need to talk not just about poverty, but about race, the social structures that cause certain classes of people to be more likely to live in poverty, and the way these systems intertwine.
What the CDC is telling us is that people who live at the intersections of oppression are much more likely than the rest of the population to be infected with HIV, and that this is, in part, our collective fault, for failing to adequately serve vulnerable populations. For failing to address the tremendous class disparities in the United States and for choosing to ignore the clear intersections within those disparities; there is absolutely no reason why entire classes of people should be more likely to live in poverty than others.
Phill Wilson, writing at the Black AIDS Institute, underscores the importance of viewing race and poverty as interconnected, not separate, issues when evaluating the results of this study and the HIV/AIDS epidemic as a whole:
So, the question is: Is race or poverty the driver of HIV in Black communities? We believe this is essentially a difference without a distinction. In America, Black people are disproportionately poor. Almost 25 percent of Blacks live in poverty, compared to 9 percent of Whites. According to a study by U.S. Department of Agriculture, nine out of every 10 Black Americans who reach the age of 75 spend at least one of their adult years in poverty. The uncertainty about why Blacks are disproportionately infected has never been about biological or genetic determinants–or for that matter even difference in levels of risk behavior. It has always been driven by social determinants of health: socioeconomic status, high rates of sexually transmitted diseases, high rates of incarceration, man sharing (knowingly and unknowingly) due to gender imbalances, lack of access to healthcare, lack of a regular health provider and low HIV literacy. These overlap significantly with the issues driving the AIDS epidemic in poor communities of all races.
This study challenges a lot of assumptions about how HIV is understood in the United States. It clearly shows that by focusing on injection drug users and men who have sex with men, we’ve done a tremendous disservice to other communities at profound risk for HIV infection. HIV has been stigmatised from the start, it dovetails very neatly with a number of social oppressions in the United States, and our chickens are coming home to roost now.