Black men wait 32% longer to cross the street than white men, according to a study from Portland, Oregon. Males in their 20s, identically dressed, had very distinct experiences: While the white men waited only 7.4 seconds to cross, Black men waited an average of 9.79 seconds for a driver to yield after signaling their intention to cross.
Such an anecdote, at first glance, seems to have little to do with health care. Yet—as Dr. David Williams of Harvard University, the keynote speaker at the opening plenary of the 2017 U.S. Conference on AIDS (USCA), illustrated with diverse statistics—the overlap between structural racism that people of color, particularly Black people, face every day and significantly lower health outcomes is impossible to ignore. Even Black people with a college degree have a shorter life expectancy than white people without a high school diploma. When it comes to health disparities, there are systemic problems that run even deeper than the already very real and widely acknowledged problem of lack of access to poor and
Access to health care alone is not the only cause of disparities in health outcomes, and increasing access will not eliminate the disparities in the absence of other interventions. If we truly hope to end the HIV epidemic in the U.S., we must address all the barriers to care—we must indeed make access to affordable, comprehensive health care available to all people, but we also must ensure that providers treat and support their patients in an affirming manner and spirit of cultural humility, that people living with and vulnerable to HIV see people who look like and can relate to them when they seek or are offered services, and we must make sure that interventions are appropriate to the populations they are hoping to reach.
A person living with HIV who has a sustained suppressed viral load cannot sexually transmit HIV to their partner. It is clear that engaging and retaining people living with HIV in care is our greatest—and only–hope of eliminating new transmissions, as well as in preventing AIDS-related deaths. Yet far too many health care providers still fail to inform their patients living with HIV that adherence to treatment and maintenance of an undetectable viral load will prevent HIV transmission to their loved ones.
“No provider since I was diagnosed in 2001 has ever told me that being
Jones’s example is echoed by numerous people living with HIV, especially women of color. Asked why they do not convey this critically important information to their patients, medical providers sometimes say that they don’t think their patients can “handle the information;” they worry patients won’t understand that continued viral suppression requires adherence to treatment; they worry that knowing will discourage condom use. Such excuses come off as patronizing, disrespectful of their patients’ intelligence. This is just one example of how providers undermine their patients’ trust in them—a powerful barrier to engagement and retention in care.
Journalist and activist George M. Johnson, a panelist in Wednesday’s session hosted by the Black AIDS Institute highlighting their new report, the State of Healthcare Access in Black America, reminded that the history of being left out of the health care system entirely or used as lab rats by the health care system has created an intergenerational mistrust in the Black community that is hard to break. Even when there is access, people may be reluctant to take advantage of that access.
Read more at BlackAIDS.org.