A new book edited by Northwestern University School of Law professor Dorothy Roberts and by Rhoda Reddock, Dianne Douglas and Sandra Reid draws upon research from a number of disciplines to offer a provocative look at why today poor black women are overrepresented globally in the HIV/AIDS epidemic.

“Sex Power & Taboo: Gender and HIV in the Caribbean and Beyond” pulls back the veil to show how gender and economic power imbalances play out in the bedroom and make black women particularly vulnerable to the infection.

Responding to the AIDS crisis in the Caribbean, the book explores the relationship between gender and sexuality in that region and elsewhere to illuminate the impact of gender on HIV risk and prevention. Many of the book’s authors initially came together at a conference designed to offer a deeper understanding of the global epidemic.

Much of past HIV research aimed at stopping risky behaviors, and studies dealing with gender tend to focus on how HIV/AIDS is different for men and women, without exploring the underlying power imbalances and gender norms that perpetuate the epidemic, said Ms. Roberts, who also is a faculty fellow at Northwestern’s Institute for Policy Research (IPR).

“We’re not focusing on especially stigmatized groups like sex workers,” said Prof. Roberts. “We’re looking much more broadly at the political, social and economic conditions that make black women and men, especially those who are poor, vulnerable to HIV risk.”

Celeste Watkins-Hayes, an assistant professor of sociology and African-American Studies and IPR faculty fellow at Northwestern, wrote a chapter titled “The Social and Economic Context of Black Women Living with HIV/AIDS in the United States.” She points out that 15 years ago the study participants she has been following for a number of years would not be alive.

Compared to HIV’s probable death sentence 25 years ago, people today are more likely to live many years with the virus if they have access to medical treatment because of the powerful class of anti-HIV drugs that were introduced in the 1990s.

Prof. Watkins-Hayes says it is imperative to address the daunting social dynamics that women at the bottom of the economic pyramid face while living with AIDS. “The critical question for those already infected is ‘How do women who are HIV-positive go from believing they have a death sentence to believing they can live with AIDS?’”

The problems of poor black women, like those of many women, often are compounded by the consequences of male dominance inside and outside the bedroom. “Even powerful women who wield a lot of influence in their professional lives report they sometimes have difficulty asking men to use a condom,” said Prof. Roberts.

And women’s experience of violence is a strong predictor of HIV infection. Research shows that fear of violence prevents women from refusing unwanted sex or discussing condom use with their partners, according to the book. 

In the United States, nearly half of over one million Americans living with HIV are black. African-American males continue to bear the greatest burden of HIV infection, according to the Centers for Disease Control and Prevention (CDC). One in 16 black men will be infected with HIV in his lifetime, compared to one in 30 black women, according to the CDC. African-American women are 15 times more likely to be infected than white women.

Prof. Roberts began her work on the book when she was on a Fulbright fellowship in the Caribbean region, ranked second in HIV infection statistics. The book grew out of a conference that was part of the Research Initiative on Gender, Sexuality and the Implications for HIV and AIDS at the University of the West Indies (UWI) in Trinidad and Tobago. Roberts helped launch the project, and the UWI research initiative is ongoing.