“I don’t know a single Black person who is sleeping properly these days” tweeted Dr Crystal Fleming in New York City the other night. As a black British woman this is my new reality. Each morning I wake up with a twist of fear about how I’ll keep my family safe and what new horrors I’ll hear about being unleashed on my community.
Living with my 86-year-old Caribbean mother, the perfect storm of adverse COVID-19 risk with diabetes, hypertension, age and now it seems ethnicity against her, any misstep from my multigenerational household that could let the virus enter the home feels like it would put her life at risk. Juggling this with attempting to maintain some semblance of wellbeing for my teenage children in this new harrowing reality is exhausting. Yet I recognise my privilege. I’m able to stay safer working from a home with a garden. For many black people, particularly those living with HIV, the risks may be greater. The fear and anxiety are palpable.
Initially the statements that people with HIV on effective treatment weren’t at greater risk from COVID-19 were incredibly reassuring. However, we have seen people from black communities dying at an alarming rate. As data from the general population has demonstrated that black people are significantly more likely to be adversely affected, anxiety about COVID-19 in people from black communities living with HIV has unsurprisingly increased.
The recent study reported by aidsmap from King’s College Hospital in London is very concerning. It indicated that black people with HIV were 12 times more likely to hospitalised with COVID-19 than other people living with HIV, although I recognise that it is a very small study and further analysis of a larger cohort is needed. We know that having underlying health conditions, like diabetes and hypertension, increases the risk of COVID-19 and that black people, including those with HIV, are more likely to have these conditions. However, to look at medical factors in isolation, particularly when accompanied with outdated racialised notions of “biological differences” is problematic, frustrating and dangerous.
On a recent episode of aidsmapCHAT, Matthew Hodson and I asked Dr Oni Blackstock why black people seemed to be hardest hit by COVID-19 in the UK and US. “It all boils down to structural racism,” she told us. Structural racism impacts on the type of jobs people from black communities have access to, such as working in care and hospitality settings, putting us at greater risk of catching COVID-19. It impacts on where and how we live – you’re much more likely to catch COVID-19 if you’re living in a deprived area in overcrowded housing. Even some of the underlying health conditions that increase the risk of a poorer outcome have been linked to the impact of racism.
COVID-19 is by no means the only illness that disproportionately impacts black people in the UK with poorer outcomes, often rooted in the institutional racism that can affect the quality of our health care. Black people are more likely to be sectioned for mental illness yet less likely to be offered talking therapies, while black women are more likely to die in childbirth. Black people are more likely to be diagnosed late with HIV, but are often lazily dismissed as “hard to reach”. Dr Rageshri Dhairyawan, another guest on aidsmapCHAT, highlighted the impact of racism in COVID-19 and health outcomes in her brilliant article in Discover Society.
As a black Londoner living in an area of high COVID-19 prevalence I’m afraid. When Professor Kevin Fenton from Public Health England was a guest on aidsmapCHAT, I asked what he felt black people could do to stay safe.
“This concept of fear and distress and grieving about what is happening is very real,” he acknowledged. “There are things we can do. First of all ensuring that our communities have the materials that they need to understand what they can do to protect themselves and their loved ones… There’s a chance for us to really focus on supporting communities to take more control of their health so that they can protect themselves from severe COVID and death”.
The Public Health England report that finally came out this week clearly demonstrated significant racial disparities in COVID-19, something we anticipated. What it doesn’t tell us is how they will be addressed.
What we need now is action from the government to address the insidious health inequalities that blight the lives of so many people from black communities in the UK. This includes people living with HIV, who may be facing the intersection of racism and HIV-related discrimination.
Healthcare professionals, please be nuanced in your advice to black people with HIV. Please listen closely to their concerns when you discuss the risks they may face from COVID-19.