HIV has changed a lot since the height of the AIDS epidemic in the late 1990s and mid-2000s. Today, better treatments help people with HIV live long, healthy lives.
But the progress hasn’t reached every community in the same way. HIV affects Black Americans at higher rates than other racial and ethnic groups.
HIV and AIDS in Black Communities: What to Know
Brian Harper, MD, a preventive medicine and public health doctor, witnessed an early chapter of the epidemic while training at Harlem Hospital in the late 1980s. Back then, doctors didn’t have many ways to fight the virus, and, instead, treated the infections that took hold as HIV weakened the immune system.
“Most people, unfortunately, did die from the disease initially because there was no good way to attack the HIV virus itself,” Harper says.
As the epidemic continued into the 1990s, HIV more often affected Black communities.
Although treatment has transformed HIV outcomes since then, the racial disparities that emerged during the epidemic haven’t disappeared.
Epidemiology: Understanding the Numbers
In 2024, Black Americans made up just 12% of the U.S. population but 39% of HIV diagnoses. The HIV diagnosis rate among Black Americans was 42.2 per 100,000 people, compared with 13.3 per 100,000 overall.
The disparities become even clearer when looking at specific groups. Black women represented just 13% of the U.S. female population but accounted for 52% of HIV diagnoses among women in 2024. Their diagnosis rate was more than three times that of Hispanic or Latina women and 12 times that of white women.
HIV also affects gay, bisexual, and other men who have sex with men at higher rates. Among men ages 13-24 whose HIV was linked to man-to-man sexual contact, nearly half of diagnoses were among Black men.
There’s been some progress in lowering the HIV rate in the Black American community. The CDC estimates that new HIV infections among Black Americans fell 18% from 2018 to 2022.
But gaps still remain, and Harper says they reflect broader health inequities.
“Your ZIP code may be more important than your genetic code,” Harper says.
In other words, factors tied to where you live — such as access to medical care — can have a major impact on your health.
Why Does HIV Disproportionately Affect Black Communities?
There’s no single reason why HIV affects Black Americans at higher rates. And race itself doesn’t make you more likely to get HIV.
Instead, a mix of social and economic conditions, unequal access to healthcare, prejudice, and stigma can make it harder for some Black Americans to avoid HIV or get the care they need.
Systemic barriers
Where you live, work, and get medical care can shape your chance of getting HIV. Poverty, lack of health insurance, transportation problems, and limited access to trusted healthcare providers can create barriers to HIV testing, prevention, and treatment.
And getting through the doctor’s door doesn’t always break down those barriers.
Research shows there are real differences in the quality of healthcare you can get.
“One [difference] is you don’t have access,” Harper says. “And then even when you do have access, the quality of care you receive may not be equal to that of other communities.”
Black LGBTQ+ people can face added stress from racism and prejudice based on their sexual orientation. Researchers call this minority stress theory.
Over time, racism, homophobia, and rejection can affect your mental and physical health and make HIV prevention and care more difficult.
Historical discrimination and medical mistrust
The mistrust of healthcare providers and medical organizations can contribute toward how Black Americans get treatment. The U.S. has a rich history of denying and preventing access to care for people in Black communities.
For example, white physicians in the 18th and 19th centuries pushed falsehoods about Black health — including that Black women were “biologically different” and felt pain differently — which helped establish inaccuracies and long-lasting biases against people in Black communities.
These falsehoods, coupled with structural racism, fueled other instances of Black people not getting the care they deserved. From 1932 to 1972, researchers in the U.S. Public Health Service untreated syphilis study at Tuskegee withheld available treatment from Black men with syphilis without their consent.
In 1951, doctors took cells from Henrietta Lacks, a Black woman being treated for cervical cancer, and used them for research without her knowledge. And Lacks is just one Black woman of many who were kept in the dark regarding their own health and medical information.
But medical mistrust isn’t just rooted in history: Black Americans continue to report prejudice and unequal treatment in the healthcare sphere.
Research shows that experiences of discrimination and a lack of trust in healthcare providers can lead to less involvement in HIV care and lower rates of following treatment plans.
HIV and AIDS stigma
HIV stigma includes negative beliefs and judgments about people with the condition. It can lead to shame, isolation, and fear of an HIV diagnosis. And it may keep you from getting tested or treated.
For some Black LGBTQ+ people, HIV stigma can overlap with homophobia. Harper recalls that during the early AIDS epidemic, some Black churches condemned homosexuality, which made it harder for people to openly discuss their sexuality or HIV status.
“Once you have a situation where people are afraid to share information, that’s what allows the virus to spread even more, because nobody wants to talk about it,” Harper says.
At the same time, Black churches and other community organizations have also played important roles in fighting HIV stigma and bringing prevention messages to their communities.
How Does HIV Spread?
HIV spreads through certain body fluids from someone who has HIV. Most people get the condition through anal or vaginal sex or by sharing equipment used to inject drugs, such as needles.
For HIV to spread, these fluids must come into contact with damaged tissue or a mucous membrane, such as those inside your rectum, vagina, penis, or mouth. HIV can also enter your body when infected blood is injected directly into the bloodstream. And you can pass the HIV virus to your baby during pregnancy or childbirth or through breastfeeding.
Preventing HIV and AIDS
There are many useful ways to stop HIV. These include:
- Using condoms during sex
- Getting tested
- Taking medicines that prevent HIV
- Never sharing needles or other drug injection equipment
Safe sex education
Knowing how HIV spreads can help you make informed choices about prevention. Using condoms the right way every time you have sex can lower your chance of getting HIV and other sexually transmitted infections (STIs). Talking with sexual partners about HIV and STI testing is also important. Also, having more partners puts you at greater risk for any STI, including HIV.
Routine testing
HIV testing helps you know your status so you can take steps to protect your health and your partners. Gaps in testing continue to be a challenge among Black Americans.
PrEP and PEP
Pre-exposure prophylaxis (PrEP) is medicine for people who don’t have HIV but may have higher odds of getting it. Black Americans have a lower rate of using PrEP than other groups.
Post-exposure prophylaxis (PEP), on the other hand, is an emergency option after a possible HIV exposure. You must start PEP within 72 hours and take it for 28 days.
Diagnosis and Testing
Some people show flu-like symptoms within two to four weeks after getting HIV. These can include:
- Fever
- Chills
- Fatigue
- Sore throat
- Swollen lymph nodes
- Muscle aches
- Headache
- Diarrhea
- Rash
But some people have no symptoms, and these symptoms can have many other causes. The only way to know for sure if you have HIV is to get tested.
There are three main types of HIV tests:
- Antibody tests look for your body’s response to HIV and include most rapid and at-home tests
- Antigen/antibody tests, the most common type, look for both HIV antibodies and part of the virus
- Nucleic acid tests (NATs) look for the virus itself in blood and can spot HIV sooner than other tests
No HIV test can detect the virus right away after exposure, so you may need to test again if you test too early. If you have a positive result, you’ll need follow-up testing to confirm it.
If you have HIV, see a doctor as soon as possible to start treatment.
Treatment and Living Well With HIV
There’s no cure for HIV, but treatment can help you stay healthy and manage HIV for many years. Antiretroviral therapy (ART) uses a combination of HIV medicines to lower the amount of virus in your body. Treatment may involve daily pills or, for some people, injections given every month or two.
Doctors suggest starting ART as soon as possible after an HIV diagnosis. The goal is to reach and keep a viral load that can’t be detected. When HIV stays undetectable, you can’t spread it to another person sexually.
Your doctor can help choose a treatment based on factors such as side effects, other medicines you take, cost, and convenience. If insurance, medication costs, transportation, stigma, or other barriers make it hard to stay in care, ask your care team about financial assistance, transportation, or other support services.
Building a competent care team
Finding a provider you trust makes it easier to talk openly about your health and stick with treatment. Cultural competence matters, but that doesn’t always mean your doctor must share your racial or cultural background.
“A lot of people think that when they’re looking for a medical provider, they need to look for somebody that looks like them,” says Tyler Evans, MD, an infectious disease doctor and CEO of Wellness Equity Alliance in Scotts Valley, California. “That’s a great search criteria, but it’s not the only one.”
Evans suggests asking potential providers questions about issues that matter to you. Look for someone who listens, takes your concerns seriously, communicates without judgment, and understands how factors such as stigma and access to care can affect your health.
Takeaways
HIV continues to affect Black Americans at higher rates, driven in part by barriers to healthcare, prejudice, medical mistrust, and stigma. But HIV is preventable and treatable. Testing, condoms, PrEP, and PEP can help prevent HIV or catch it early. If you have HIV, starting and staying on treatment can help you manage the condition and protect your and your sexual partners’ health over the long term.
