One of the more despicable tactics deployed by some HIV/AIDS denialists is to accuse mainstream medical science of being racist because socially underprivileged groups such as African-Americans have a higher HIV incidence. These HIV/AIDS denialists refuse to accept well-researched statistical and sociological explanations for this observation such as differences in infection base rates, prevalence of other sexually transmitted infections (STIs) that increases transmission probability, knowledge regarding HIV status, time at diagnosis and access to health care etc. Instead, they falsely portray mainstream medicine as racist and genetic determinist with regards to behavior. This goes to show that some HIV/AIDS denialists clearly stop at nothing in their desperate attempts to prop up their pseudoscientific delusions. One such example is that of Henry Bauer and his two recent posts on HIV and ethnic groups.
The pseudoscientific claims made by Henry Bauer has been discussed in great detail on this website. He does not seem to understand the basic biology of viruses or rational risk assessment of medication. He fails to grasp data on population growth and birth rates and does not seem to realize that there are scientific obstacles to developing an effective HIV vaccine. Despite his appeals to the toxin gambit, combined antiretroviral therapy does not increase the risk of death. Astonishingly, he even seems to thinks that HIV should not be able to spread via contaminated needles because needles do not have sex with each other.
Differences in HIV incidence does not mean that HIV tests are racist
People carrying black-African genes test “HIV-positive” at far greater rates than do people without that genetic ancestry. HIV/AIDS theory “explains” that by postulating greater rates of careless “not-safe-sex” promiscuity and infected-needle-sharing drug injection. Thereby HIV/AIDS theory postulates significant genetic determination of behavior, which in other contexts is dismissed as pseudo-science.
The primary reasons for why African-Americans have a higher incidence of HIV is not because of racist stereotypes concerning promiscuity and so on. It has nothing to do with genetic determinism. Rather, there are important statistical and sociological reasons for this difference that cannot be ignored.
These issues are discussed in additional details in various versions of a fact sheet on HIV and African-Americans available at the CDC website. Also note that 2014 PDF version unequivocal states that African-Americans have “levels of individual risk behaviors (e.g., sex without a condom, multiple partners) that are
comparable to other races/ethnicities”.
because African-Americans have a higher prevalence of HIV (and mating is non-random), this means that they, as a statistical implication, is going to have a higher incidence of HIV. This is because a higher proportion of potential partners are going to have HIV. Furthermore, the prevalence of other STIs that increase the risk of HIV transmission (e .g. sores from genital herpes) is also higher among African-Americans.
people who have less access to antiretroviral medication (and thus less likely to be virally suppressed) are more likely to transmit HIV. According to a paper published in early 2014 in Morbidity and Mortality Weekly Report demonstrated that only half of African-Americans with HIV were retained in care and given antiretroviral medications. Only about 35% of African-Americans with HIV are virally suppressed. For the 18-24 age group, this figure was abysmally low (~18%). There are several other socio-economic factors that play a role in this category.
according to the CDC, about 85000 African-Americans living with HIV does not know that they were infected. Had they known about their HIV status, they would probably have taken extra care to avoid transmitting HIV to their sexual partners. This ties into the above and below factor as well.
There are also various kinds of stigma, both related to HIV and sexual orientation that may discourage people from getting tested.
Base rate effects is not a circular argument
To most scientific skeptics and people who have a basic understanding of HIV, this issue seems pretty clear. However, Bauer does not seem to get it at all (for a number of reasons).
He confuses incidence with prevalence. Incidence is the number or proportion of new cases per time unit, whereas prevalence is the proportion of cases. The base rate explanation suggests that since the prevalence of HIV/AIDS among African-Americans is higher and non-random mating occurs, this means that the incidence of new HIV infections is going to be higher automatically. Despite the fact that this is a trivial statistical truth, Bauer considers this a circular argument. He claims that this merely means that “It’s more common because it’s more common” and labels this a “non-explanation”. In reality, the argument is not that it is more common because it is more common, but rather that the incidence is higher because the prevalence is higher. Bauer attempts to move the goalposts by stating that this does not explain why the prevalence is higher in the first place, but his argument was about differences in incidence, not prevalence.
The relative impact of different contributing factors may vary
Bauer tries to dismiss the explanation that relates to differing prevalence of STIs that facilitate HIV transmission by claiming that this is not necessarily true in all geographical locations throughout all time. The cognitive error here is obvious: nothing says that each contributing factor must have precisely the same impact through space and time. In other locations or at other times, this factor might be less relevant and other statistical or sociological factors might take their place. Also note that Bauer is attacking a straw man: the CDC fact sheet only tries to explain differences in the United States and not globally through all time.
Bauer calls the contribution of sociological factors to differences in HIV incidence “waffling, no real explanation, simply bullshit”. His argument is that the richer people in Africa are more likely to be HIV positive than poor. While this is true (also refuting the common denialist belief that poverty, rather than HIV, causes AIDS), it does not have any direct relevance to this issue. This is because the proposed sociological factors does not include poverty per se, but factors that are associated with poverty in the United States. For instance, Africa has gotten a lot of free HIV medications, but this is not the case for poor African-Americans in the United States.
The effect of living in a large city
The New York Times article he comments on in his post on media pundits point out that “25 percent of new infections are in black and Hispanic men, and in New York City it is 45 percent”. This seems to be a result of the fact that sexually transmitted infections are more prevalent in large cities than in rural settings and other places. Bauer tries to twist this into a race issue by claiming that “it’s blackness that contributes overwhelmingly to testing” positive for HIV and that “Hispanics in New York are primarily of black Caribbean-African stock, whereas West-Coast Hispanics are largely non-black, of Latin-American stock”.
Conclusion: HIV/AIDS denialists are a threat to HIV prevention efforts
Because African-Americans have a higher incidence of HIV, it makes perfect sense to focus additional efforts on spreading information about HIV and prevention to this group. This could include giving out free condoms or providing free HIV tests and counseling. Bauer, on the other hand, reaches the following twister conclusion:
Current official statements and practices emphasize that “HIV/AIDS” has become largely a problem for African-Americans and their communities. That is damaging in several ways: increasing the pressure on black Americans to be tested and thereafter subjected to toxic antiretroviral drugs; causing untold harm to people and their families who happen to test “HIV-positive”, for which there are innumerable possible causes […] and providing apparent support for racist stereotypes
Getting more people to get tested for HIV is a good thing because it means that more people get treated with life-saving medications earlier and reduces the risk that they will infect their loved ones with HIV. Because the differences in HIV incidence between African-Americans and European-Americans is largely due to well-known statistical and sociological reasons, effective prevention and information campaigns do not feed racist stereotypes. Quite the contrary, racist stereotypes are probably hardened by the misinformation spread by HIV/AIDS denialists like Henry Bauer.