Читать книгу The Social Causes of Health and Disease - William C. Cockerham - Страница 13

HIV/AIDS is another example of how race (and class) serves as a social determinant of health in the United States. In the beginning (the mid-1980s), HIV/AIDS was a disease most characteristic of white homosexual males. But gay men, many of whom are affluent and well-educated, were the first to change their social behavior by adopting safe sex techniques in large numbers and the pattern of the disease changed dramatically. By the 1990s, the magnitude of the epidemic – even though it began to decline after 1995 – had shifted especially to non-Hispanic blacks but also to Hispanics. In 2016, the most recent year data were available as this book goes to press, African Americans accounted for 41.1 percent of all HIV diagnoses and Hispanics for 16.1 percent, followed by 12.6 percent for multiracial persons, 9.9 percent for Native Hawaiians and Pacific Islanders, 8.8 percent for American Indians and Native Alaskans, and 5.1 percent for both Asians and whites. Some 81 percent were male and 70 percent gay or bisexual. Most women contract HIV through sexual intercourse with infected men.

There are no known biological reasons why the shift from a predominately white infected population to one that is largely black and other racial minorities took place or why racial factors should enhance the risk of HIV/AIDS. Simply being poor and living in economically disadvantaged areas is not the entire answer as many Hispanics and whites are poor but have lower rates. In addition to poverty, joblessness, minimal access to quality medical care, and a reluctance to seek treatment because of stigma, social segregation is also a factor. Edward Laumann and Yoosik Youm (2001) concluded years ago that blacks have the highest rates of sexually-transmitted diseases because of the “intra-racial network effect.” They point out that blacks are more segregated than other racial groups in American society and the high number of sexual contacts between an infected black core and a periphery of yet uninfected black sexual partners act to contain the infection within the black population. Laumann and Youm determined that even though a peripheral (uninfected) black has only one sexual partner, the probability that partner is from the core (infected) group is five times higher than it is for peripheral whites and four times higher than for peripheral Hispanics. In this instance, the core is the agent, the periphery the host, and the intra-racial network the environment.