AIDS workers say many factors contribute to HIV's disproportionate impact on African-American women. "But really what is happening doesn't have anything to do with race," said Vera Owens of the Los Angeles-based Minority AIDS Project. Many black women, she said, are so used to being caregivers that they fail to care for themselves. "We're trying to teach them that their needs are just as important as his needs," Owens said.

Statistics make the scope of the problem clear. Though blacks represent just 13 percent of the U.S. population, they account for nearly half the more than 1 million Americans with HIV. And two-thirds of the nation's 127,000 women with HIV are black.

While much has been written about the role secretly bisexual, or "down low," men play in infecting black women, experts say instead that a much bigger problem is the high rate of incarceration among black men. As of June 30, 2007, 39 percent of U.S. inmates were black, the Justice Department reported.

According to Stop Prison Rape, HIV is four times more common in prisons than outside. While most prisoners with HIV have access to medication, only about 65 percent are on treatment. Jeffrey Green, a public health official who works with Texas inmates upon their release, said many refuse to acknowledge their infection while behind bars for fear of being targeted by other prisoners.

"You have men coming out of prison who had sex with men and they're not really gay, they're just taking care of their sexual needs," Owens said. "He's not going to practice homosexuality when he gets out of prison; he's coming home to his wife."

Texas, where an estimated 2,500 inmates have HIV/AIDS, began testing inmates upon release in 2005 and upon intake last year. The resulting data are expected to produce a more accurate picture of the number of prisoners who are acquiring HIV while incarcerated.

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