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Survival at Stake

Survival at Stake

University of North Carolina’s Dr. Adaora Adimora searches for answers into HIV transmission among African Americans

By Eleanor Lee Yates

Chapel Hill, N.C.
During the 1980s and into the ’90s, HIV and AIDS primarily affected gay White men. The rates of HIV/AIDS stabilized in the 1990s in the United States, but today the numbers are soaring again. This time around, victims are more likely to be Black and heterosexual. Dr. Adaora Adimora, an HIV/AIDS researcher and associate professor of medicine at the University of North Carolina School of Medicine, is concerned about the disturbing new direction of HIV/AIDS infections. In Adimora’s state of North Carolina, 2,100 people were diagnosed with HIV in 2003. African Americans accounted for 71 percent of the new HIV cases, yet made up only 22 percent of the population. In addition, Black women were 14 times as likely to contract HIV as White women.

Adimora notes that environmental factors, such as poverty and racism, promote risky behaviors that contribute to the spike in HIV rates.

Co-authoring a recent article with UNC colleague Dr. Victor Schoenbach, titled “Social Context, Sexual Networks and Racial Disparities in Rates of Sexually Transmitted Infections,” Adimora’s research shows that concurrent sexual relationships — having overlapping sexual partners — appear to be more prevalent among some African Americans. Among Blacks in rural North Carolina, 53 percent of the men had concurrent partnerships in the preceding five years, compared to 31 percent of Black women.

“Nearly 10 years ago, Dr. Adimora came to me to ask for help with a grant proposal on heterosexual transmission of HIV among African Americans,” says Schoenbach, associate professor of epidemiology at UNC’s School of Public Health. “That topic has been under-investigated and generally, with occasional exceptions, under-reported. She has been drawn to that issue because in treating HIV-infected patients she has been struck by repeatedly encountering patients whose personal behaviors have not been exceptionally risky … Since then, we have worked together under her leadership to try to understand why African-American heterosexuals are at much higher risk than White heterosexuals.”

Adds Schoenbach: “She has persisted in this topic — though it has been difficult to get funding — because she is committed to doing something about the problem.”

According to the 1995 National Survey of Family Growth, the prevalence of concurrent sexual partnerships is greater among Black women than White women — 21 percent in the preceding five years for Blacks compared to 11 percent for Whites.

“And it’s not just the number of partners. Who are these partners and who are they having sex with?” says Adimora. 

She says violence, joblessness, drug use and prison reduce the number of Black men in the marriage pool. Because of drug arrests, almost one-third of Black men between the ages of 20 and 29 are in jail, on probation or on parole.

“Black women often settle for relationships with men who they suspect or know are not monogamous,” she says. 

Drugs are a major factor in increased cases of HIV infection among heterosexual Blacks in the rural South. According to Adimora, crack cocaine has directly altered sexual networks through increased sexual exploitation of women and high-risk sexual behavior. These include increased numbers of sex partners and the exchange of sex for drugs.

“The relative scarcity of men results in low marriage rates and higher divorce rates among those who do marry,” she says. The shortage of men places women at a disadvantage in negotiating and maintaining monogamous relationships because men can easily find another relationship if they perceive that their current relationship is too much trouble.

Ultimately, fighting poverty will go a long way in solving these social problems, and in wiping out HIV and AIDS, she says. Also, she says, segregation — in schools, neighborhoods and much of daily life — perpetuates poverty and all its problems.

Finding Out Why
Adimora, 48, grew up in Manhattan, the daughter of a nurse administrator mother and a physician father. While a student at Yale University School of Medicine, she thought about becoming a psychiatrist. However,while doing an internship and residency at Boston City Hospital, it became apparent to her that her most challenging and interesting cases were those involving infectious diseases.

She did her infectious diseases fellowship at Albert Einstein College of Medicine in New York in the mid-1980s, and went on to join Harlem Hospital Center’s Division of Infectious Diseases in New York City.

“Back then there wasn’t even a lab test for AIDS,” she recalls.

She moved to Chapel Hill when her husband, Dr. Paul Godley, became a UNC School of Medicine professor in hematology/oncology, and it didn’t take long for Adimora to become a high-profile physician herself. She earned a master’s of public health degree at UNC’s School of Public Health, and a National Institutes of Health grant enabled her to study the history of HIV transmissions in North Carolina. She would become the first Black woman in UNC’s Infectious Diseases division to receive tenure.

Adimora hopes within 20 years there will be an effective vaccine for HIV. But she is concerned about the limited growth of NIH funding.

“It would be nice to have some of the funds used in the war in Iraq for AIDS research,” she says.

In addition to her own research and clinical work, Adimora is the principal investigator for UNC’s Fogarty Program. The program recruits and trains doctors from China, Cameroon and Malawi in AIDS prevention research. The doctors primarily come to UNC, but Adimora travels as well.

Her colleagues, Dr. Mike Cohen, chief of infectious diseases at UNC School of Medicine, and Dr. Charles van der Horst, professor of medicine also at UNC’s medical school, use words like “dedicated,” “fearless,” “tenacious” and “insightful” to describe Adimora.

“This is a difficult area to study,” says van der Horst. “You’re talking about stuff people don’t want to talk about. It takes a person of enormous sensitivity. She has chosen to work in a complicated area of behavior. I think she’s unique in that she is a clinician who studies the behavioral.

“Brazil, Senegal and other countries are seeing a decrease in new cases. Yet new cases are increasing in the U.S., and this is a big embarrassment,” says van der Horst. “I don’t think we have done a very good job nationally of understanding the increase of AIDS. But Adaora and her troupe are doing a better job of finding out why.”

Related Links:

“Social Context, Sexual Networks and Racial Disparities in Rates of Sexually Transmitted Infections” by Dr. Adaora Adimora, an HIV/AIDS researcher and associate professor of medicine at the University of North Carolina School of Medicine.

The National Survey of Family Growth

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