Regarding HIV's disproportionate impact on African Americans, observers cite a range of possible reasons, including:

• Silence. "If we could just break the silence, I think that we can prevent a lot of [HIV/AIDS] in the African-American community," said the Rev. John Reed, a volunteer at the AIDS Outreach Center in Fort Worth.
• Poverty. Poor people "are not going to have access to the information they need or the health care they need," said Anne Freeman, an assistant professor at the University of Texas Southwestern's Allied Health Sciences School and director of the Community Prevention and Intervention Unit.
• Distrust of the medical establishment. "We're still living with the legacy of the Tuskegee study," said Dr. Cato Laurencin, a University of Virginia professor and chair of the W. Montague Cobb/National Medical Association Health Institute. In that infamous 40-year experiment, U.S. government health workers withheld treatment from hundreds of syphilis-infected black men to study the disease's progression.
• Racism. "There was a recent study in the New England Journal of Medicine on implicit bias that takes place among physicians treating African-American versus non-African-American patients in terms of the types of treatments that are provided," Laurencin said, noting that racism is "still prevalent."
• Homophobia. According to Stephen Thomas, chief of the Center for Minority Health at the University of Pittsburgh, "Our problems with addressing the issue of homosexuality [have blinded us] to the results of what it means to have people closeted, what it means to have [men who have sex with men] marry because the homophobia is so devastating."
• Fear of stigma. "Black leadership in the early days said, ‘We cannot own HIV/AIDS, because it will be used to denigrate us,'" Thomas said.
• Incarceration. Whereas one black man in 30 was incarcerated in 1984, one in 15 was incarcerated by 1997, Laurencin said.

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