Nina Harawa, professor of medicine and epidemiology at the field school of public health and David Geffen School of Medicine, sat down with daily Bruin contributor Alyssa Wong to discuss HIV prevention and treatment in the black community.
Harawa holds a Masters and PhD in Epidemiology from UCLA and directs the UCLA Center’s Policy Impact Core for HIV Identification, Prevention and Treatment Services. She is also a professor of medicine at Charles R. Drew College of Medical Sciences and is the assistant director of research at the Drew Center for AIDS research, education and services.
This interview has been compiled for length and clarity.
Daily Bruin: The National Black HIV/AIDS Awareness Day was February 7th. What are the reality that people would like to recognize regarding HIV, such as the disproportionate impact on black people?
Nina Harawa: I want people to know that this is still a problem in the US. I think people often don’t know how much of a problem it is in the US yet, but that’s still a problem. There have been some declines in new cases over the past decade, but there are still around 30,000 new cases per year. We see this overstatement across this overstatement, overall, from the perspective of the black community. Despite making up only about 13% of the US population, there are just over 40% of new cases among black people.
DB: What do you think is the main reason why HIV disproportionately affects black communities in the US?
NH: That’s not a simple question, and I think we have some answers, but perhaps not all of them, but part of it is this idea of sexual networks. They often associate HIV or STI with certain types of risky behavior. However, in general, if you look at the research, which can increase risk, there is no significant difference between races.
There is some evidence that in black communities there is some evidence that between individuals at lower and higher risk than other communities, such as the sex ratio of women and men, contributes to this. Because there are fewer black men, all black women, as there are imprisonment, deaths, and even invasions of the military.
There is another major contributor. If someone has HIV and is detected early, it is recommended that you get treatment immediately. In general, treatment is very effective. It reduces the amount of virus circulating in their blood. If it decreases sufficiently, it is impossible to send HIV through gender. But we know that black people are often diagnosed a little later, and are unlikely to be alerted a little later, often receiving treatment or continuing treatment. Virus suppression is unlikely to occur among black populations, which could lead to more ongoing transmission.
DB: You conducted the study in a diverse population, including racial, sexual and gender minorities. Why is HIV prevention and treatment important to address health disparities, including those facing Black patients?
NH: The gap is very huge. They are there for many different health conditions. They are particularly high in HIV. For example, when comparing rates between trans women and cisgender women, they are much higher. When comparing black people to white people, they are very different.
I have worked a lot with gay and bisexual men of color. Part of the reason I was interested in the job was because many of the dialogues that took place around HIV in the black community seemed to focus on this idea of men who were sacrificing women who were hiding their sexuality and becoming positive. I felt that such framing had a problem of thinking about the victim and the perpetrator. Sex, love and relationships are much more complicated than that.
DB: Can HIV better describe black individuals who identify as LGBTQ+, for example, intersecting identities?
NH: There was a lot of progress in this direction, and many of the reasons why there was progress was because they were ultimately listening to the voices of those in those communities. Most people will still feel that there needs to be more of it.
One of the things I particularly love about doing this job is that much of my work is partnering with people in the community. The core of the study actually came from queer black men and other individuals who lived with HIV.
That’s the biggest thing for general health services. The importance of listening to both the large communities that these services are intended to be useful, and to incorporate them directly into their decision-making, leadership. Often, individuals often hear their concerns, questions, their expertise about them and what is happening doesn’t really listen. That’s one reason why people don’t continue to care for or receive services.
DB: How can HIV policy address HIV in the black community? How do you do your own work, including UCLA tips and Drew Care?
NH: Most of what we are interested in is not just HIV policies, but other policies that disproportionately affect our community. Criminalization policies are a prime example. For example, the potential impact of Proposition 36 is to increase the likelihood that someone will be jailed for committing a certain type of crime. We know that when people are jailed, they experience healthcare disruptions on sexual and social networks. Often they lose their homes and jobs, and all of them put them in a worse position when they return to their community to help them get healthy and keep the people around them healthy. Most of the important aspects of policy are related not only to HIV-specific policies, but these larger policies that affect communities at high risk of HIV.
[Related: California voters to decide on criminal justice propositions in November ballot]
In a related but different way, anti-trans or anti-LGBTQ+ policies create situations where people can’t care about what they want from the perspective of their identity. They are less likely to be able to enter the system to get HIV care, to take care of HIV, or to identify whether they have HIV.
DB: What will be next for you regarding your research and education? Are there any continuous or future jobs related to HIV and/or black health?
NH: I have three major studies now. Two of them focus on people re-entering their communities from prisons and prisons. They are not limited to race or ethnicity, but due to imbalance they have many black participants. We are working with community-based agencies in Los Angeles to change the interventions we tested in several other counties in California, as well as rolling it out within the setting for those who were incarcerated last year. The intervention focuses on people who do not have HIV but may be at increased risk, and one of the goals is to help encourage people to participate in the PREP (before further prevention), but also address many other health issues.
The intervention is tied to the themes I learned in my work, and I think what I’ve learned from my work and the Black patients and Black participants in my community partners is that you really have to deal with people’s needs in a holistic way.
