Public health’s focus on HIV/AIDS typically tilts toward men. That’s because men who have sex with men still face the greatest risk of getting the disease and represent most new cases.
But out of the spotlight, how are women faring?
"HIV/AIDS among women is skyrocketing in Austin," Austin City Council Member Ora Houston told council colleagues Sept. 8, 2015, "and we need to do some specific targeting for that."
Houston, who represents District 1, sought an additional $150,000 in spending in the 2015-16 budget year for the Austin/Travis County Health and Human Services Department’s HIV/AIDS initiatives. Houston’s ask was made in the context of bolstering efforts aimed at improving the quality of life of African-Americans in Austin, an initiative the city launched several years ago.
The proposal didn’t win council approval, although the department drew a 16-percent surge in its overall budget.
Also, it turns out, Houston wasn’t right about HIV and AIDS among Austin women "skyrocketing." Yet for decades and across the nation, African-Americans have been the racial group hardest hit--with black women the most disproportionately affected. It’s a wide gap that similarly persists in Travis County.
Houston says she misspoke
Houston, asked how she reached her "skyrocketing" declaration, told us by phone she misspoke. "The larger issue is what do we do to save the women in my community infected with HIV/AIDS," she said.
Some background: In Travis County, fewer than one in 10 residents is black, but more than one in five of the 4,401 residents living with HIV at the end of 2014 was black, according to health department data. Also that year, nearly 711 in every 100,000 black females living in the county, or 318 individuals, had the human immunodeficiency virus that causes AIDS.
That was double the number of Hispanic females (156) and nearly triple the number of white females (109) living with HIV. From another vantage point, the rate of black females living with HIV in Travis County was over 17 times higher than the rate for white females and nearly nine times higher than the rate for Hispanic females.
There were still many more men, of all races, with HIV. The rate of black males living in the county with HIV was 1,589.4 per 100,000 in 2014, reflecting 670 individuals. The rates were 634.9 for white males (1,743 people) and 617.8 for Hispanic males (1,235 individuals). Put another way, the rate of black males living with HIV/AIDS in Travis County was 2.5 times higher than the rate for white or Hispanic males.
A national pattern
The disparity in rates of African American women getting infected with HIV or diagnosed with AIDS, which has deepened since the epidemic began, is rooted in a variety of factors, according to the U.S. Department of Health and Human Services’ Office on Women’s Health.
A key factor is poverty, which is more widespread in the African-American community and can result in less access to care and, often, a failure to know one’s HIV status.
Also, the office says, because African-Americans tend to have sex with partners of the same race, and because the disease is higher in that population, their risk of getting HIV is greater.
"Stigma, fear, discrimination, homophobia and negative perceptions about HIV testing can also place too many African-American women at higher risk," the Office on Women’s Health says. "Many at risk for infection fear stigma more than infection. They may choose instead to hide their high-risk behavior rather than get counseling and testing."
No skyrocket among Travis County women
In Travis County, annual diagnoses of HIV and AIDS for women mostly declined from 2005 through 2014, health department figures show. Most recently, 4 in 100,000 female residents in the county were newly diagnosed with HIV in 2014 compared to an average 6.1 incidence rate from 2005 through 2013. The AIDS incidence rate for all women in the county was 1.9 per 100,000 women in 2014 compared to an average 4.3 rate from 2005 through 2013.
Women of all races represented a small number of Travis County residents diagnosed with HIV in 2014: just 23 of the 244 cases. Also in 2014, 98 Travis County residents, including 11 females, were diagnosed with full-blown AIDS.
We did not learn how many black females fell into these categories. Health department staff epidemiologist Jeff Taylor advised us by phone that because very few women are diagnosed with HIV/AIDS each year, the department doesn't publicly release raw numbers based on by race and ethnicity. "Some of those numbers may be one, two, three or four, and people get concerned about confidentiality," Taylor said.
We were, however, able to compare rates among racial and ethnic groups for a decade. Each year, from 2005 through 2014, the rates of HIV and AIDS among African-American males and females in Travis County was higher than the rates among Hispanics and whites. The far higher rates in black females, when compared to Hispanic and white females, are "startling," Shannon Jones III, director of the city/county health department, said at a recent conference on health disparities.
Then again, the data show a 27 percent drop in new HIV diagnoses for black females between 2013 and 2014, though there was an increase in AIDS diagnoses; the incidence of 16 black females per 100,000 black women was up from 12.3 in 2013.
Between 2013 and 2014, HIV rates also fell for white females but ticked up among Hispanic females from 3.2 per 100,000 in 2013 to 3.7 per 100,000 in 2014.
New diagnoses of HIV are the best barometer of how the disease is trending in a community, Taylor said. Between 2005 and 2014, the rate of new HIV infections for black females in the county ranged from a high of 42.9 per 100,000 black women in 2006 to a low of 19.4 in 2011.
Houston said HIV/AIDS among women is skyrocketing in Austin.
That’s not so. While black women have persistently been diagnosed with HIV/AIDS at higher rates than other women, HIV/AIDS incidence rates for Travis County women declined for most of the past decade.
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Video, Austin City Council meeting, Sept. 8, 2015. http://austintx.swagit.com/play/09082015-580 In Part 4 of 4, starting around the 5-hour, 18-minute mark
Telephone interview, Jeff Taylor, staff epidemiologist at the city/county health department, Sept. 23, 2015
Telephone interview, Shannon Jones III, director of the Austin/Travis County Health and Human Services Department, Sept. 24, 2015
Documents showing HIV/AIDS diagnosis data, by race and ethnicity, in Travis County, 2005-2014, City of Austin/Travis County Health and Human Services Department, Sept. 21, 2015; Memo on prevalence data for HIV/AIDS, Sept. 24, 2015 (received by email from Jeff Taylor, staff epidemiologist, city/county health department, Sept. 23-24, 2015)
Telephone interview, Ora Houston, Sept. 25, 2015
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