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HIV has a disproportionate impact among Black, Indigenous, and people of color (BIPOC) communities around the globe.
Taking a global view of HIV by geographic region, we can see that the prevalence in the African region far exceeds that in other regions; in fact, sub-Saharan Africa accounts for approximately 59% of the 1.5 million new HIV infections that occur globally each year, as shown in the red box, and has equally devastating HIV-related mortality rates, with about 460,000 deaths each year.
By contrast, we can see that the global north—the traditionally Colonial White regions of Europe and the Americas—has significantly lower HIV incidence, prevalence, and mortality rates.
In thinking about what would account for this disparity, it is useful to consider the general question of what determines good health.
From a clinical perspective, we often start with genetics, then consider other factors such as nutrition, lifestyle, and environmental considerations such as living near a nuclear site, sewage facility, or other environmental hazard. We also must think about access to quality care and social support.
Each of these nongenetic factors has social undercurrents that we can think of as social determinants of health. These determinants include economic stability, neighborhood and community context, healthcare, and education—as well as race.
We know that health inequities existed well before the COVID-19 pandemic and that BIPOC communities have worse health outcomes than White communities. According to a 2020 review conducted in the United Kingdom, Black women are 5 times more likely than White women to die in pregnancy. In addition, Black men are 2 times more likely than White men to have prostate cancer, and proportionately more die from it.1 Black and mixed ethnic groups have the highest rates of sexually transmitted infections and are more likely to have hypertension, asthma, type 2 diabetes, and kidney disease requiring dialysis. They are more likely to have severe mental health symptoms but less likely to receive treatment. Women from minority ethnic communities also are more likely to have never had a cervical smear.1