Reducing HIV infections among black women will involve more than appeals to avoid risky behavior, asking women to remain abstinent and passing out condoms, said Adaora A. Adimora, an associate professor of medicine and an adjunct professor of epidemiology at the University of North Carolina at Chapel Hill.
"You also have to eliminate the economic factors that dramatically influence behavior, disease and risk," she said.
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Living conditions are "critically important" to fueling the spread of the disease, Adimora said. Communities influence "social networks, partner choices, likelihood of marriage, types of risk behaviors, as well as the consequences of risk behaviors," she said.
Jackson lived in South Los Angeles, formerly known as South Central, a world very much like the ones Adimora has researched. When she found her boyfriend, whom she declined to name for his protection, she said she held on to one of the few men she liked "no matter what." It is the story of tens of thousands of black women in the underclass and middle class.
The man seemed as honest as he was charming. He told her about his crack-cocaine habit, and about his frequent arrests. Looking back, she now wonders if he picked up another habit in jail, where men have sex with other men, by consent and by force. She wonders if he was one of the many African American men who hide their sexual orientation from others in the homophobic black community, a conspiracy of silence called the "down low."
In 1998, Jackson's boyfriend was arrested for drug possession and taken to Los Angeles County Jail, where he underwent a routine HIV test for inmates entering the system. A short while later, a letter was delivered to Jackson from jail "telling me he tested positive and that I should get checked out."
Her positive result arrived in May 1998. "I was 26. I was shocked. I was stunned," said Jackson, who is now an AIDS activist working for a Los Angeles treatment center called Women Alive. "A lot of emotions went through me. I was sad. I was angry at myself because I got caught up. 'Caught up' meaning I was so into keeping this man at all costs."
Other black women have said they were married to men who hid their gay lifestyles while pretending to be exclusively heterosexual. Fraser-Howze said she has encountered dozens of African American women who were infected by husbands who were also having gay relationships. Her Web site abounds with stories, such as a woman in Chicago who learned her husband had a male partner when the man called to inform her that he had been infected, probably by her husband. The woman tested positive a short time later.
Black gay rights activists have said that men are more likely to hide their sexual orientation because the stigma against homosexuality is strong in black communities, particularly in the church. Studies have shown that African American churchgoers are the least likely of all faiths to support gay rights. Numerous black gays attend church but conceal their sexual orientation, said the Rev. Carl Bean, founder of Unity Fellowship Church in Los Angeles.
A study by the Pew Forum on Religion and Public Life showed that since 2000, black Protestants have become much less likely than other Protestant groups to believe that gays should have equal rights. Black Protestant support for gay rights dipped to a low of 40 percent last year, down from 65 percent in 1996 and 59 percent in 1992.