Looking at HIV with a consideration towards racial and genetic heritage
This commentary is the opinion of the author and may not necessarily reflect that of other authors at Box Turtle Bulletin
March 31st, 2010
It has long been known that HIV and AIDS in the United States is not experienced proportionately across racial demographics. About 42% of all cumulative AIDS cases, and over 50% of new HIV infections are in African Americans, even though they only comprises about 14% of the population.
And results released last week about a survey of gay men in Washington, D.C. confirm the pattern. While the study found that 14% of the sample of gay men are HIV positive, this was not uniformly distributed.
Men of color who were 30 years or older had the highest rate, more than twice the overall HIV positivity rate. By race and all ages, over a quarter (25%) of black men who participated in the study were HIV positive, more than any other racial group. Over 10% of men who identified as multirace (11%) and other (10%) were HIV positive and 8% of white males who participated in the study were HIV positive.
In fact, this difference was most notable in participants under 30. While 12.2% of young men of color were HIV infected, “of the nearly 100 white men younger than 30, none were HIV-positive.”
This disparity is usually discussed, when it is discussed at all, in terms of social or cultural difference (especially by those who are not African-American). Non-equivalent infection rates are “part of the down-low” or “the result of homophobia in the black community” or “resultant from a lack of self-worth” or some other culture based phenomenon that hints at irresponsible behavior or an inadequate appreciation for safer sex rules.
I do not doubt that there are some social factors (discrimination, economic inequalities, social position, or even media representation) that do contribute to the prevalence of HIV in Black America. But something in this study caught my attention.
Over 40% of men did not use a condom at last sex, though men of color used condoms nearly twice as much as white men.
Younger men who have receptive anal sex (“bottoms”) and older men who have insertive anal sex (“tops”) were less likely to use condoms.
But if black men were twice as likely to use a condom, then how exactly is it that they were more likely to seroconvert?
One explanation that has been bandied about is that because the pool of black men who sleep with black men is already disproportionately infected. Therefore, because there is an increased risk of contact with infected sex partners it raises the likelihood of higher infection rates.
But that doesn’t seem to be evidenced by the results of this study.
The research allows us to compare those who were already aware of their HIV status to those who were newly infected, by race. Assuming that black men were adhering more closely to safe-sex guidelines, this should have been reflected in the ratios. But newly infected men were even more disproportionately men of color than were those already detected.
This seems contradictory to the notion that black men use condoms at higher rates than whites. So perhaps something else is going on. Perhaps there is something other than behavior that is contributing to the disparity.
We know that some communities inherently carry higher risk of certain diseases while others are fairly immune. Tay-Sacks is more commonly found in Ashkenazi Jews, sickle cell anemia is associated with people with recent ancestry from parts of Africa, the Mediterranean, India and the Middle East, and some Scottish islands have higher incidences of color blindness. These are all the results of inherited genes.
So it should not surprise us that various communities may have inherited genetic susceptibilities or immunities that greatly impact the extent to which any individual in that community is at risk for HIV transmission. And, indeed, research does seem to suggest that not all ancestor-location based gene pools respond to potential infection in the same way.
Some people seem to have inherited a resistance to HIV, effectively leaving them immune from infection.
Genetic resistance to AIDS works in different ways and appears in different ethnic groups. The most powerful form of resistance, caused by a genetic defect, is limited to people with European or Central Asian heritage. An estimated 1 percent of people descended from Northern Europeans are virtually immune to AIDS infection, with Swedes the most likely to be protected. One theory suggests that the mutation developed in Scandinavia and moved southward with Viking raiders.
Similarly, it appears that some communities have inherited ahigher susceptibility to HIV infection.
New research shows Africans and people of African descent could be up to 40 percent more likely to get HIV, the virus that causes AIDS, than people of other races.
This appears to be related to the Duffy antigen, a protein on the surface of red blood cells, which plays are role in defense against malaria. This trait appears to be present in over 90% of black Africans and about 70% of African Americans.
Indeed, as I looked for further discussion on the subject of gene-linked susceptibility, it seems that the community of scientists looking for transmission patterns, infection factors, and treatment possibilities share an assumption that genes play a significant role, and one we do not yet fully understand. And even within specific racial groups, some genetic families may be far more susceptible than others.
But this contributing factor seems to be, to a great extent, outside of common knowledge. Even most gay men – including those I know of African descent – seem not be be aware of genetic factors that contribute to increased or decreased infection risk.
And this troubles me. I believe that this is of such significance that it should be emphasized, particularly among those who may have inherited a higher possibility of infection.
As I see it, there are several reasons why an increased understanding of possible racial group or family genetic traits should be part of our consciousness.
First, if African-Americans are not aware of increased risk, they cannot be prepared. And as we learn more about subgroups or families, individuals of all races can take steps to define “safe sex” in more specialized ways. As unfair as such knowledge may seem, knowing that you can’t live by the same standards as everyone else may have life impacting importance for some individuals.
It’s all fine and good to say “always be safe”, but everyone knows someone who slipped up and ended up okay. But if some individuals have inherited higher risk , they need to know that the answer to “what are the odds” is “much higher for me so I don’t dare risk it… ever.”
Second, a different response in one’s body to the presence of HIV should be reflected in treatment and management. It would be foolish not to test to determine whether some treatment protocols were more or less effective based on inherited factors.
Our nation has a history of medical research that assumes that everyone is a white male, and a fairly interchangeable one at that. But if different protocols are more effective for those of African descent, or for others with specific genetic heritage, it would be immoral not to test for such differences and instead rely on, “this is what works for wealthy white men in West Hollywood”.
Third, vaccines under testing should be studied for whether race or inherited attributes impacts effectiveness. I am troubled by the possibility that some vaccines which were discarded as ineffective in some trials may have been very effective in a different demographic.
But I think we need to approach this with sensitivity. HIV/AIDS has a history of blame and stigma; And any discussion which seeks to assign blame or which seeks to make HIV a “black disease” will do more harm than good.
Additionally, we should remember that individuals are, above all else, individual. We should not make assumptions or assign stereotypes.
Instead, we need to focus research and funding, coordinate outreach and education, and for once talk about the impact of HIV on the African American community without hinting that the phenomenon can be explained in terms of behavior.
And in the meanwhile, let’s find a way to be part of the solution. You can contribute to HIV/AIDS prevention efforts that specifically target the African-American community:
(my appreciation to those who read the draft and provided some insight and suggested revision)