In the United States, Black men are more likely than men of any other race to contract HIV. Black men who have sex with men (MSM) face an even higher and growing chance of contracting the virus.

The good news: A number of relatively new therapies have greatly improved outcomes for people at risk of HIV and those diagnosed with the condition.

Pre-exposure prophylaxis (PrEP) is a medication recommend for people at risk of contracting HIV from sex or injection drugs.

When taken properly, PrEP reduces the chances of getting HIV by 99 percent from sex and an estimated 74 percent from injection drug use, according to the Centers for Disease Control and Prevention (CDC).

By taking antiretroviral therapy, people diagnosed with HIV can now live nearly as long as people without HIV.

This treatment reduces the amount of virus in the body to an undetectable level. It also:

  • helps slows HIV progression
  • lowers the risk of complications
  • reduces the risk of virus transmission

Yet, a large portion of at-risk Black men aren’t on PrEP, haven’t received a diagnosis for an HIV infection, and don’t receive antiretroviral therapy. Read on to learn the cause for these disparities and how we can address this epidemic.

In 2018, Black people made up just 13 percent of the U.S. population but 42 percent of new HIV diagnoses, per the CDC.

Nearly 38,000 new cases of HIV were diagnosed in the United States and dependent areas in 2018. Among those, 11,905 cases were diagnosed in Black men — and of those, 9,444 cases were diagnosed in Black MSM, according to the CDC.

Per the CDC, HIV diagnoses in Black men are linked to:

  • male-to-male sexual contact in 79 percent of cases
  • male-to-female sexual contact in 15 percent of cases
  • injection drug use in 4 percent of cases
  • male-to-male sexual contact and injection drug use in 2 percent of cases

Signs of HIV infection

Signs of an acute HIV infection are the same for all people, no matter their race or sex. They include:

  • chills
  • fatigue
  • fever
  • mouth ulcers
  • muscle aches
  • night sweats
  • sore throat
  • swollen lymph nodes

Life expectancy

Antiretroviral therapy stops HIV from replicating. This lowers viral count and boosts the immune system.

Antiretroviral therapy can’t cure HIV. But it greatly increases life expectancy for all people, including Black men. The sooner therapy is started and the more closely it’s followed, the better the results.

A 2017 study of nearly 90,000 people found that those in their 20s with HIV who had a CD4 (white blood cell) count of more than 350 cells per mL each year after starting antiretroviral therapy had a life expectancy of 78 years. That’s nearly the same as it is for people who don’t have HIV.

HIV diagnosis rates are declining in most populations in the United States. However, the CDC reported that new diagnoses increased from 2014 to 2018 in Black MSM ages 25 to 34.

The CDC also drew attention to high rates of HIV in Black MSM in a 2016 press release, which highlighted racial disparities in the HIV epidemic.

“The CDC projected that unless something changes, fully half of all Black men of any age who has sex with men will become HIV positive in their lifetime,” D. Rashaan Gilmore, the founder and executive director of BlaqOut in Kansas City, Missouri, told Healthline.

BlaqOut is a grassroots organization that focuses on addressing the environmental and psychosocial challenges that Black MSM face in the greater Kansas City area.

Taking PrEP daily lowers a person’s risk of contracting HIV. However, Black MSM report low levels of PrEP use.

The CDC reported that 18.8 percent of HIV-negative Black MSM reported taking PrEP in the past 12 months as of 2017. In comparison, 30.9 percent of HIV-negative white MSM reported taking PreP.

Many Black MSM also don’t get diagnosed with HIV, reported the CDC. About 1 in 5 HIV-positive Black MSM didn’t know they had the virus in 2018. That’s compared to around 1 in 7 of HIV-positive people overall in the United States.

Even after diagnosis, many Black MSM are less likely to have suppressed viral load from treatment. Suppressed viral load helps increase the odds of living a long and healthy life.

Only 61 percent of Black MSM who had received a diagnosis of HIV had suppressed viral loads in 2018, compared with 65 percent of all people living with HIV in the United States.

According to Gilmore, “racism is the biggest impediment” that Black men face to accessing healthcare and support to prevent and treat HIV.

When BlaqOut surveyed Black MSM in the Kansas City area, respondents said they had experienced racism from healthcare professionals and other community members.

“Each and every time it came to rating the service providers and our community, there was always an issue of bad experiences that had something to do with what I’ll call ‘cultural insensitivity,’” Gilmore said.

The authors of a 2019 review of 124 studies reported that direct exposure to racism and discrimination from healthcare professionals contributes to medical mistrust among Black people in the United States. So does the larger history of medical racism in this country.

A 2015 study that surveyed more than 500 Black MSM found that 29 percent said they experienced stigma related to their race or sexual orientation from healthcare professionals. Nearly half said they mistrusted medical establishments.

Black MSM who reported greater stigma and medical mistrust also had longer gaps in time since their last HIV care appointment.

Social and economic inequalities beyond the healthcare system also pose barriers to HIV prevention and care in Black men.

“Social influences have a tremendous impact — housing, education, employment,” said Gilmore. “I tell people all the time. Housing is HIV treatment, transportation is HIV treatment.”

Centuries of racist laws and policies have contributed to unequal economic opportunities and a persistent inter-generational wealth gap between Black and white people in the United States, Gilmore explained.

People who experience poverty or housing instability may find it hard to access high quality healthcare and HIV prevention education. These economic challenges make it harder for Black people to protect their overall health.

In 2019, the U.S. Census Bureau found that 18.8 percent of Black Americans live in poverty, compared with 9.1 percent of white Americans. Black Americans are also more likely to experience housing instability or homelessness.

A 2021 study of HIV-positive MSM in Georgia found that Black men were more likely than white men to:

  • have low income
  • experience housing instability
  • lack insurance coverage for antiretroviral therapy

These factors were linked to lower levels of viral suppression in HIV-positive Black MSM.

Gilmore told Healthline that members of Black communities that are most affected by HIV need to be granted leadership roles in addressing the epidemic. This includes Black MSM.

Gilmore founded Blaqout in 2016 after working for a federally qualified health center, where he oversaw peer health education and support programing for Black and Latinx MSM.

“It felt like the most important work of my life, in the sense that I knew we not only could make a difference, but we had to make a difference,” he said.

Gilmore said it’s critical to make sure that Black men are close to the decision-making about HIV funding and programming.

“The people who are making decisions about our lives and healthcare don’t look like us. They don’t understand us. And they don’t understand our culture and how that impacts how we approach healthcare, medical mistrust, and that sort of thing,” Gilmore said.

It’s also important to “really empower members of our community to lead, and not just be out front as props, accessories, or ornamentation on some program or messaging,” he added.

Black men are more likely to be diagnosed with HIV than other population in the United States. Black MSM in particular are less likely to be on PReP and to achieve viral suppression.

Racism, discrimination, medical mistrust, and economic inequality all contribute to these disparities.

The first step to improved outcomes is to ensure everyone who’s at risk of HIV is able to get tested for the virus and is offered PReP.

Prompt treatment for those who are diagnosed with HIV helps prevent complications and lowers the chance that a person will transmit the virus to others.

The CDC recommends that people who are at high risk of HIV get tested at least once per year for the virus. Sexually active MSM may benefit from getting tested more frequently.

Addressing other inequalities will require bigger changes and take more time. Advocates say the first step to address this epidemic is to ensure more Black men are part of leadership in HIV decision-making.