HIV/AIDS from an African American Studies Perspective

AIDS (acquired immunodeficiency syndrome, or HIV/AIDS) is a global pandemic, affecting most of the world, especially those suffering poverty, social inequality, and marginalization. In the US epidemic, African Americans suffer disproportionately. Although approximately 13 percent of the US population, African Americans accounted for nearly 42 percent of new HIV infections and 40 percent of people living with HIV as of 2019. Over half of all AIDS-related deaths in the United States have been African Americans. Understanding this racially disproportionate disease suffering depends on how one defines AIDS, which, while seemingly technical, is inherently political and contested. Although a few scholars have questioned it in the past, almost all contemporary scholars agree that, most simply, AIDS is the name for the gradual impairment of a person’s cellular immune system by the action of the Human Immunodeficiency Virus (HIV), leaving the infected person increasingly vulnerable to diseases (“opportunistic infections”), many of which can be fatal if untreated. Pharmaceutical treatments exist for preventing HIV infection, suppressing HIV for those living with it, and for many of the opportunistic infections, although these treatments are neither universally effective nor universally available. But beyond the individual experience of a virus, defining AIDS depends on how to define an epidemic, or population-level disease phenomenon, given that the AIDS epidemic has affected some more than others. Two major schools of thought have addressed AIDS as an epidemic. In the United States, the dominant model for understanding the epidemic has been biomedicine, which treats epidemics and their dispersion as aggregates of individual transmission events, focusing attention on the biological qualities of HIV transmission from individual to individual and on the behavioral qualities of those who are at risk of infection (“risk behaviors” and “risk groups”). Critiques of biomedicine have emerged from social epidemiology, which has a rich history in African American reflections on health and disease. Rather than focusing exclusively upon the biology of HIV and the behavioral mechanisms of its transmission from individual to individual, social epidemiologists have prioritized the structuring of human populations, including the ways that racism, poverty, sexism, homophobia, and transphobia have structured vulnerabilities to exposure to HIV (including control over one’s behavioral environment) and embodied susceptibility to infection. Social, political, and cultural responses to the AIDS epidemic in the United States and among African Americans have been shaped by these competing understandings of epidemic disease.