By Odi Uhegwu
Introduction
Intersectionality allows for the understanding of several identities that a person possesses that are different but not independent of each other. These identities include race, sex, gender identity, class, sexual orientation, ability, etc. It is important to recognize all aspects of someone’s identity because they affect the way a person navigates through life. Additionally, movements that fight for the liberation of marginalized groups, for example, the feminist movement, tend to exclude members who are a racial or sexual minority, like women of color or transgender women. Intersectionality promotes inclusivity by examining every factor of a person’s identity to understand how different modes of inequality can affect different groups of people.
Intersectionality is important to consider, especially because discrimination also occurs systemically. This type of discrimination is different from individual racism because it is oppression that is ingrained in law and organizations. For example, in education, the workforce, healthcare, and political systems, barriers are put in place to keep minority groups from thriving when compared to their cisgender, white, male counterparts. For example, when it comes to policing, neighborhoods with a lower median income tend to be overpoliced, including having law enforcement presence in schools which leads to more arrests. A direct result of this is the school-to-prison pipeline, which ends up disproportionally affecting Black children. Systemic discrimination can also be seen in healthcare. The healthcare system is meant to promote wellness in patients but for some groups, their identity can become a risk factor. This could be due to their physician’s implicit biases, prejudices against a community, societal factors like income, or stigmas that keep people in the marginalized group from seeking care, or environmental factors that make it difficult for patients to receive care. These factors result in health disparities.
Health disparities are the differences in health outcomes between two groups. Human immunodeficiency virus (HIV) is a disease where large health disparities can be seen between different identities, including race and sexuality. These are most evident between heterosexual men and men who have sex with men (MSM), and within that, white homosexual men and Black MSM. These disparities are caused by biological, behavioral, and psychosocial factors.
HIV in MSM vs. non-MSM
Within men of the same race, heterosexual men have lower rates of HIV/AIDS than men who have sex with other men. . In 2016, 26,400 MSM had contracted HIV/AIDS which is almost 3x larger than the 9,100 heterosexual men who contracted it. (CDC) This is a disparity that has existed since the AIDS epidemic in the 1980s. During the AIDS epidemic, most of the deaths were of gay men and resulted in intolerance of the LGBTQ+ community. Michael Harney, an LGBTQ+ activist from Newport News, Virginia told a story of how he promotes HIV prevention. He spoke about his outreach program which specifically targeted gay men.
“Many of the places where you would find me might be in a gay bar. Kind of the highest concentration is still in and among men who have sex with men, in this state, and across the country. About 66 percent of new HIV infections occur among men who have sex with men.” (Harney, 01:23:11)
This sort of disparity has biological factors that contribute to it such as the nature of the mode of sex. Anal sex has an 18x greater infection rate than vaginal sex and MSM are more likely to have anal sex than heterosexual men are. (Pebody, 2010) Psychosocial factors also contribute to the disparity, like the stigma associated with HIV/AIDS and homosexuality. Homophobia, harassment, and childhood bullying would result in internalized homophobia which makes men who have sex with men more likely to practice risky behaviors like unprotected sex. (HIV.gov, 2021) The criminalization of gay sex led made MSM less likely to disclose their sexual behavior to their physicians. These attitudes towards the LGBT contribute to the rates of HIV. Stephanie Atkinson is a nurse from Clinton, NC who works with HIV patients and explained how the stigma around HIV/AIDS leads to shame with their patients.
“What I found is that because the population that we serve are patients who are [HIV] positive, we oftentimes replace their family. So many patients have experienced stigma from their family or just feeling like they can’t be who they are, they can’t share their diagnosis because they’ll be judged or their family members will look at them differently, so we become their safe place.” (Atkinson 00:25:07)
Though these factors contribute to the disparity between heterosexual men and homosexual men, there are also racial health disparities associated with HIV.
Racial Health Disparities between MSM
Within MSM—a group that is disproportionally affected by HIV, there are disparities between white men and Black men. Overall, gay and bisexual men have a 1-in-6 lifetime risk of HIV. With white men, that risk decreases to 1 in 11 while the risk for gay Black men increases to 1 in 2. Although the percentage of new HIV cases among white gay men is decreasing, the rate among gay Black men is increasing. (HIV.gov, 2021) The reasons for the racial disparities differ from the causes of sexuality disparities. The causes of the racial disparities include distrust in the medical system, social and environmental struggles, lack of housing, mass incarceration, financial need, and marginalized status. (Fullilove, 2017) The prolonged mistreatment of African Americans in the United States has resulted in a heightened distrust of medical professionals. There are also higher levels of conspiracy theories surrounding diseases, one being that HIV was created to destroy the African American community. (Fullilove, 2017) Because of this level of distrust and lack of information on the disease, African Americans are less likely to get tested for the disease or adhere to suggested clinical treatment. This can be seen with the lower levels of African Americans on PrEP, a drug used to prevent HIV. Although African Americans have higher rates of HIV, the number of white gay and bisexual men on PrEP is 42% while for African Americans it is 26%. (Grove, et. al., 2015) The reason for this difference includes distrust of the medical system and/or difficulty obtaining medical care. Stephanie Atkinson, who worked at a clinic explained that medical care is unattainable to some because of the lack of insurance and high copays. She says she wishes she “[could] make the services more available to more people and give people insurance without these high copays and deductibles and these costs that they can’t even afford.” (Atkinson, 00:53:30) There are systemic factors that contribute to the lack of access, one being financial need. Poverty is a factor that disproportionally affects African American communities which ultimately impacts their healthcare and places them at higher risk. Systemic factors that keep African American communities impoverished like over-policing, mass incarceration, the introduction of drugs in lower-income communities, environmental racism and lack of affordable housing leads to higher rates of HIV and many other diseases within the African American community.
The factors that contribute to high rates of HIV between gay men and those that contribute to high rates in racial minority groups affect MSM of color making their lifetime risk of catching HIV/AIDS significantly greater than any other group of people. Intersectionality is important when it comes to the nature of the disease because multiple identities affect one’s risk. There is a high disparity between Black heterosexual men compared to Black homosexual men as well as a high disparity between gay men of color and white gay men. Neglecting to consider how one of the identities contributes to contracting the disease makes it difficult to examine all the risk factors associated with the disease. By considering intersecting identities when it comes to this disease, it can help with prevention among patients belonging to multiple minority groups that are considered high risk. This can be done by educational outreach programs like Michael Harney, Stephanie Atkinson, and Brian Cornell do. By acknowledging how identity may put patients at higher risk for diseases, more efficient prevention methods can be implemented.
References
Atkinson, Stephanie. Interview with Maddy Kameny. 25 June 2018 (Y-0003). Southern Oral History Program Collection (#4007), Southern History Collection, Wilson Library, University of North Carolina at Chapel Hill.
Baptiste-Roberts, Kesha et al. “Addressing Health Care Disparities Among Sexual Minorities.” Obstetrics and gynecology clinics of North America vol. 44,1 (2017): 71-80. doi:10.1016/j.ogc.2016.11.003
Chapman, E.N., Kaatz, A. & Carnes, M. Physicians and Implicit Bias: How Doctors May Unwittingly Perpetuate Health Care Disparities. J GEN INTERN MED 28, 1504–1510 (2013). https://doi.org/10.1007/s11606-013-2441-1
Content Source: HIV.govDate last updated: March 17, 2021. “U.S. Statistics.” HIV.gov, 21 Apr. 2021, www.hiv.gov/hiv-basics/overview/data-and-trends/statistics.
Cornell, Brian. Interview with Nick Allen. 28 June 2018 (Y-0014). Southern Oral History Program Collection (#4007), Southern History Collection, Wilson Library, University of North Carolina at Chapel Hill.
Fullilove, Robert E. 2006, pp. 1–27, African Americans, Health Disparities and HIV/AIDS: Recommendations for Confronting the Epidemic in Black America, nmac.org/wp-content/uploads/2012/08/African-American-health-disparities-and-HIV-AIDS.pdf.
Grov, Christian et al. “Willingness to Take PrEP and Potential for Risk Compensation Among Highly Sexually Active Gay and Bisexual Men.” AIDS and behavior vol. 19,12 (2015): 2234-44. doi:10.1007/s10461-015-1030-1
Harney, Michael. Interview with Emma Miller.30 July 2019 (Y-0070). Southern Oral History Program Collection (#4007), Southern History Collection, Wilson Library, University of North Carolina at Chapel Hill.
Pebody, Roger. “HIV Transmission Risk during Anal Sex 18 Times Higher than during Vaginal Sex.” Aidsmap.com, 28 June 2010, www.aidsmap.com/news/jun-2010/hiv-transmission-risk-during-anal-sex-18-times-higher-during-vaginal-sex.