By Jallicia Jolly
Amidst the recent attacks on access to quality health care and sexual and reproductive health services, the assaults on the lives of racial and sexual minorities specifically reveal the systematic violation reserved for poor women of color, particularly Black and transgender women.
The neglect of Black women’s intersectional health experiences in national discussions about HIV/AIDS, coupled with the growing rates of HIV/AIDS in black communities, beg a critical question: How can a reproductive justice approach allow governments and decision makers to properly invest in Black health?
Stepping into the fourth decade of the global HIV/AIDS pandemic, Black women are disproportionately affected, accounting for 61% of new HIV/AIDS diagnoses among women nationally. According to the Center for Disease Control (CDC) and Prevention in 2012, Black women are estimated to be more than 12 times more likely to be infected with HIV than their white counterparts.
Among transwomen, the fastest growing population of HIV-positive people, Black trans people remain at a greater risk of HIV infection (56%) compared to their white (17%) and Latinx (12%) peers. Although transwomen have the highest rates of HIV transmission in the U.S., they remain overlooked when it comes to HIV research and prevention. The misclassification of transgender women as “men who have sex with men” not only prevents researchers from capturing the most accurate data, but also renders current prevention and treatment efforts in this population largely ineffective.
The violations of the health of people of color have a long record in American history. Contemporary assaults on health that have accompanied retractions in public health and social welfare programs reflect the violent dehumanization of the bodies and lives of people of color echoed in the history of amerikan democracy. I’m referring to untreated syphilis among 399 men in the Tuskegee Syphilis Experiment, the coerced sterilization of women of color, judicial welfare reform, the use of eugenics policy to essentially exterminate the Native American population, the neglected HIV infections rates among Blacks in the early stages of the epidemic, and the poisoning of water in urban cities and on ancestral lands, to name a few.
These historical assaults on health highlight the intersecting axes of power and inequality that drive the rates of HIV/AIDS and its entrenchment in certain communities.
At the root of the structural vulnerabilities HIV/AIDS thrives upon are the parallel trends of increased transmission and socioeconomic decay in communities of color, particularly in those that are predominately Black and brown. Researchers frequently note that Black women show low indicators in many areas, including health disparities and economic indicators such as intensified unemployment rates and levels of unequal pay.
For example, Black women in Detroit–a city with the highest concentrated poverty rates of 25 largest metropolitan areas–accounted for 91% of all female HIV cases in 2012, which is over 4 times the national average. Alongside increased HIV infections among Black women are reduced social and economic infrastructure in Detroit, demonstrated by its growing unemployment rate, lack of a transit network, poor housing, and local government corruption.
Across the nation, almost one in five of transgender people reported being homeless at some point in their lives, according to the National Transgender Discrimination Survey. Additionally, they are four times as likely to have a household income under $10,000, and twice as likely to be unemployed as the typical person in the U.S. Alongside disproportionate rates of sexual violence, transgender women of color continue to have increasing murder rates as well.
The Trump administration’s platform of bigotry and lethal divestments in critical HIV/AIDS prevention services and research only strengthens the (not-so) benign neglect that has characterized American approaches to Black health. We see this as proposals are made to reduce the federal funding for health care and repeal Affordable Care Act (ACA), also known as Obamacare, which has provided approximately 20 million uninsured adults with health insurance coverage, funded AIDS service organizations, and made contraception free, relieving poor and marginalized women of a major financial burden.
We see this as efforts are made to roll back expansions of Medicaid, the largest source of public insurance for people with HIV that provides medical treatment for more than 40% of people with HIV in care. We also see this as budget cuts of 20% ($5.8 billion) are made to the National Institute of Health–the world’s engine of biomedical research.
These cuts display an unhealthy truth: The bodies and lives of Black women–particularly those who are poor, trans, disabled, and/or living with HIV–are unworthy of investments in public resources necessary to sustain their functionality on even the most basic level.
Yet, to this day, efforts to address the racial, gendered, and classed dimensions of HIV/AIDS remain few. The experiences, needs, and desires of people of color in general, and Black women and transgender women in particular, are peripheral to policy and law makers, and in the shadows of the larger HIV/AIDS advocacy movement.
Reproductive justice frameworks fight for the rights for people of all genders to live, birth or not birth, parent, and sustain their families. While this approach is grounded in the needs, rights, and visions of women of color, it is not limited to women of color. RJ understands that the rights of transmen and non-binary people often overlap with the needs of women while at the same time the struggles and oppression transgender women face are unique with respect to being trans.
In the context of HIV/AIDS, RJ provides us with the tools to allow Black women and transgender women of color to access the resources, services, and care needed to control their reproductive capacities and live quality lives. RJ addresses the intersecting issues that contribute to the spread of HIV/AIDS: lack of awareness of sexual and reproductive health rights, poor access to timely and quality perinatal care, sexual violence, and access to prevention, testing and treatment services in prisons.
It also addresses institutional barriers that prevent people living with HIV from accessing the services and support they need to survive, such as criminalizing HIV/AIDS disclosure laws, the unequal distribution of wealth and public services, and the lack of respect and knowledge of health care providers, to name a few.
A reproductive justice approach understands that when intimate aspects of Black women’s lives become crucial sites for political battles over health, welfare, and law and order, some bodies become more undeserving than others.
RJ gives us the tools to persist with a tenacity greater than that of the disease itself.
Jallicia Jolly is a writer, reproductive justice advocate, and PhD student at the University of Michigan. She writes about race, gender, HIV/AIDS, and reproductive justice in the lives of African diasporic women. Jolly currently co-leads Resist.Restore. – a “global-health-arts” collective that uses arts, community engagement, and research to improve the health of under-resourced communities in Jamaica, Haiti, and the United States. Follow her on twitter @jallicia