Structural Racism and Racial Trauma Among African Americans at Elevated Risk for HIV Infection

• Published in: American journal of public health (1971) 2023-06, Vol.113 (S2), p.S102-S106
• Main Authors: Burton, Kelsey L, Ritchwood, Tiarney D, Metzger, Isha W
• Format: Article
• Language: English
• Subjects: African Americans; Antiretroviral agents; Antiretroviral therapy; Bias; Biomedicine; Black or African American; Cisgender; Correctional institutions; Discrimination; Disease prevention; Drug policy; Economic conditions; Economic factors; Epidemics; Fines & penalties; Gays & lesbians; Health care policy; HIV; HIV Infections; HIV/AIDS; Human immunodeficiency virus; Humans; Imprisonment; Inequality; Infections; Laboratory tests; Life span; Mass incarceration; Medical tests; Medical treatment; Men; Men who have sex with men; Mens health; Minority & ethnic groups; Minority groups; Opinions, Ideas, & Practice; Other Race/Ethnicity; Peers; Poverty; Prevention; Prophylaxis; Public health; Race factors; Racial differences; Racial discrimination; Racial Groups; Racial inequality; Racism; Sexual behavior; Sexually transmitted diseases; Social factors; STD; Stigma; Subpopulations; Substance abuse treatment; Systemic Racism; Transgender persons; Trauma; Treatment methods; Well being; Women
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.2023.307223

Forty years into the HIV epidemic, we have witnessed remarkable achievements. People living with HIV (PLWH) can thrive because of the availability of antiretroviral therapy (ART), with a lifespan like those without HIV. We learned that "U = U"; that is, we now know that PLWH whose HIV cannot be detected by laboratory testing cannot sexually transmit the virus to their partners. The advent of preexposure prophylaxis (PrEP) expanded biomedical HIV prevention tools, enabling people without HIV to protect themselves from infection. While we have the necessary HIV prevention and treatment tools to end the HIV epidemic, such a goal remains elusive. Unfortunately, these great achievements in research and practice have been accompanied by profound failures, including inequitable access to new HIV prevention and treatment options among African Americans.Despite accounting for only 13% of the US population, African Americans comprise 42% of all new HIV diagnoses.1 For members of key subpopulations, the situation is even more dire; approximately half of African American men who have sex with men (MSM) are expected to contract HIV in their lifetime.1 Among all cisgender women, African Americans identifying as cisgender comprise 54% of new diagnoses, and African American transgender women comprise 46% of new diagnoses among all women.1 Compared with their peers from other racial/ethnic backgrounds, African Americans have lower rates of engagement in the HIV treatment continuum.1 In 2019 alone, for every 100 African Americans diagnosed with HIV, 74 received some HIV care, 56 were retained in care, and 61 were virally suppressed, indicating lower engagement than their White and Hispanic/Latino peers.1 While individual and social factors (e.g., HIV-related stigma, HIV knowledge, poverty, sexual risk) are frequently cited as the primary contributors to low engagement in the HIV prevention and treatment continuum, the spotlight on such factors masks the broader social, political, and economic conditions that generate and maintain observed racial disparities in HIV infections and related outcomes, such as structural racism and repeated exposures to racial trauma.2,3In this article, we discuss the influence of structural racism (i.e., the way in which society promotes and sustains racial discrimination through larger systems and macro-level conditions that limit the opportunities, resources, power, and well-being of racial minorities) and racial trauma (i.e., the emotional in