Chicago Tribune - July 20, 2008
Johnathon E. Briggs

That's right. If the show had been "Sex in the Inner City" chronicling the sexually liberated adventures of four black women-let's call them Wanda, Jalissa, Tracy and Kim-one of the lead characters could credibly have tested positive for the virus that causes AIDS.

You see, condom use rarely was discussed or shown on the risque HBO series. And given that federal health data show that black women are nearly 23 times more likely to get a diagnosis of AIDS than white women, an HIV story line in "Sex in the Inner City" would have been most believable.

For decades, the public service message on HIV infection has been, "It's not who you are, it's what you do."

But in the case of black women, that is only partially true. The fact is, black women have far higher HIV infection rates even though studies show that they engage in risky sex no more often than their white counterparts.

Further underscoring the notion that behavior is not the sole contributing factor driving HIV transmission, researchers reported last week that a gene mutation could make black people more susceptible to HIV. The mutation, which likely protected sub-Saharan Africans and their descendants from a form of malaria, affects about 60 percent of African-Americans, according to the researchers. It could partially explain why HIV is more common among blacks than whites.

So it's not only what you do, it turns out, it's also who you are. Some people are more likely to become HIV positive than others, even if they engage in the same amount of risky behavior (i.e., unprotected sex, multiple sexual partners, intravenous drug use).

HIV is concentrated in poor, segregated neighborhoods saddled with high rates of incarceration. African-Americans and Latinos account for nearly two-thirds of the 2.2 million Americans in prison nationwide.

This reality dramatically skews patterns of marriage and courtship-key themes of "Sex and the City."

"In many communities, when one sexual partner is imprisoned, the person left behind chooses another partner," Robert Fullilove, associate dean of Columbia University's Mailman School of Public Health, and his colleagues noted in a recent Washington Post editorial. "When widespread, this behavior creates an efficient, effective pattern for introducing and maintaining an STD [sexually transmitted disease] through a network of sexual relationships."

A black woman in a poor neighborhood, for example, who engages in the lowest levels of risky behavior is dramatically more likely to acquire a sexually transmitted disease than higher-risk women in communities with low rates of infection, according to public health experts.

Think of it like this: If you're driving along a stretch of road with the occasional pothole, there's a slight risk of a bent rim. Driving along a pothole-plagued road raises the risk of a bent rim dramatically. The fact is, driving a lot along the first road is even safer than driving a little on the second.

We don't think of driving as an inherently dangerous activity. It depends on the road, that's all.

And city health figures show that "potholes" abound on the South and West Sides of Chicago, in large part because of high rates of poverty and incarceration, which fuel the spread of HIV.

Neighborhoods such as Humboldt Park, North Lawndale, West Englewood, East Garfield Park, Roseland and Auburn Gresham, where large numbers of ex-convicts return after release, are wrestling with poverty, unemployment and some of the highest AIDS rates in the city. Studies have found higher HIV rates among incarcerated people and the family members they leave behind.

"We have seen that social factors like lack of housing, less access to health care, and being in a tough financial situation also can make people vulnerable to HIV/AIDS," according to the New York-based Community HIV/AIDS Mobilization Project.

AIDS advocates say it's no accident that people facing severe poverty, discrimination and stigma also have the highest rates of HIV: Black gay men; black and Latina women; intravenous drug users; communities with high imprisonment rates; gay men and other men who have sex with men; transgender women; undocumented immigrants; and people in the Deep South.

In short, who you are, and where you live and, consequently, the sexual partners you choose, matters when it comes to HIV prevention.

Though it is true that nearly every major character on "Sex and the City" had an STD scare, the most severe disease any of the four white Manhattan women ever got was chlamydia. When diagnosed, chlamydia is easily treated and cured with antibiotics.

But the reality of sex in the inner city requires more than medicine. It also demands effective prevention programs and tools to change the environments that lead to disparities in disease.

It's far removed from the hard-candy gloss and glimmer of its pop-culture counterpart. But it's far more worthy of our attention.

###

Johnathon E. Briggs, a former Tribune urban affairs reporter, is director of communications at the AIDS Foundation of Chicago.

080720
CT080706

Always watch for outdated information. This article first appeared in 2008. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2008. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .