Sent to the SF Chron:

I understand that, outside the editorial pages, newspaper articles fall into three basic types: information, entertainment and titillation. It is sometimes hard to be sure which category an article falls into.

After considering your…latest…series on “Black men on the down low,” I’ve decided it falls into the titillation category. That may not have been the intent, but research points in a totally different direction than your article does.

In February 2005, the 12th Conference on Retroviruses and Opportunistic Infections had a session titled The Evolving HIV Epidemic: Risk Behavior, Incidence, and Prevalence. The abstracts of the presentations are available online, and I would like to quote from The Prevalence of HIV in the United States Household Population: The National Health and Nutrition Examination Surveys, 1988 to 2002:

An analysis of risk factors in the current survey demonstrated that only intravenous drug use and herpes simplex-2 antibody were significant risks for infection among non-Hispanic blacks.

This, of course, isn’t the whole story. The Washington Post, in reporting on this conference, noted:

The prevalence of HIV infection in blacks ages 18 to 59 in 1991 was 1.1 percent, about five times higher than what was found in whites. In 2001, it was 2.14 percent, and the gap had increased to 13 times that seen in whites. The hardest-hit group was black men ages 40 to 49, 3.6 percent of whom were infected with HIV when contacted through the National Health and Nutrition Examination Survey.

These are not happy numbers. But if the rate of infection for 18-59 year olds is 2.14 percent and the rate of infection of the 40-49 year old cohort is 3.6 percent, then both the 18-39 and 50-59 year old cohorts must have considerably lower rates. If the series was intended to inform, this would have been made clear.

Given that I am in the 40-49 year old group, making this information widely known may mean I never get laid again, but sometimes that’s the price you pay for the truth.

The rate of infection is higher in the Black communities, true, and that does need explanation. Fortunately (a strange word to use in this context), Rucker C. Johnson and Steven Raphael of UC Berkeley’s Goldman School of Public Policy have looked into it already. I quote from an abstract of Black Male Incarceration Rates and the Relatively High Rate of AIDS Infection Among African-American Women and Men, available online:

Coincident with the large increase in black male incarceration rates is a pronounced increase in the AIDS infection rate among African-American women and men. Between 1970 and 2000, the proportion of black men incarcerated on a given day increased from 0.03 to 0.08, with a much larger increase in the proportion that has ever been to prison. Concurrently, the HIV/AIDS infection rate among African-American women went from zero during the pre-epidemic period to a rate of 55 per 100,000 between 2000 and 2003 (an infection rate nearly nineteen times higher than that for non-Hispanic white women). For African-American men, this rate exceeds 100 per 100,000 (in contrast to less than 15 per 100,000 among non-Hispanic white men). Moreover, African-Americans accounted for half of the AIDS cases reported in 2002.

The potential mechanisms through which black male incarceration may affect the AIDS infection rate among African-Americans are several. First, to the extent that the risk of becoming infected while incarcerated exceeds the risk while not incarcerated, a high incarceration rate will elevate the relative HIV/AIDS infection rate among black men. The concentration of HIV-infected people in prison may spread the disease at a faster rate than would have otherwise occurred, which then results in higher risks on the communities they return to. This in turn is likely to accelerate the infection rate among black women through heterosexual contact in years following release from prison.

There is considerable descriptive evidence that lend support to the plausibility of this causal mechanism. First, a disproportionate share of infectious disease is found among people who serve time in prison. Roughly 1/4 of all people living with HIV or AIDS in the U.S. in 1997 were released from prison in that year (Hammett et al., 2002). Three percent of state and federal prisoners have HIV or AIDS—five times higher than that of the general population (Petersilia, 2003). Furthermore, the number of confirmed AIDS cases among prisoners increased by nearly 400 percent between 1991 and 1997 (Bureau of Justice Statistics, 1999). In the New York, California, and Texas prison systems, AIDS is now the leading cause of death (Marquart et al., 1999)

I suspect that if crystal meth users were jailed the way crack users were, H.I.V. infection rates may well be close to the same across the racial groups.

What bothered me enough to write this rather lengthy piece was something at the very top of the first article in your series:

At a time when black women are being diagnosed with HIV at a rate 20 times that of white women, five CDC studies will be among the first to try to learn how many white, black, Asian and Latino men fit the down-low profile; identify how, if at all, being on the down low differs from being "in the closet," and determine whether down-low men have a role in infecting women with HIV.

I’m not clear why or how you made the jump from a cross racial CDC inquiry to focusing on Black men. I just know I’m not very happy that you did it. And no one else should be happy either. You see, since the U.S. imprisons more of its population than any other industrialized nation (and most nations in the world), a lot more white guys will be coming home in the same condition. Not to mention that there are bisexual white men in the closet as well. You do your white female readers a disservice by racializing the issue as you have.

It would be good of you, especially in the wake of your titillating series, to spread some information.