In the early 2000s, a young researcher at the Centers for Disease Control named Greg Millett set out to solve an epidemiological mystery. Nobody could explain why black Americans, particularly black gay men, had such high rates of HIV infection compared to the rest of the population. How were they putting themselves in so much danger? What were they doing differently from everyone else?
Millett began with a survey of the published research, but that only seemed to raise more questions. Study after study seemed to arrive at the same conclusion: Black gay men take fewer risks in the bedroom than white gay men. They are just as, if not more, consistent about condom use and STD testing. They have fewer sex partners. They are less likely to abuse injection drugs. Despite all this, black men—gay, straight, or bisexual—are 6 times more likely than white men to contract HIV in a given year.
In 2006, Millett wrote up these findings in the American Journal of Public Health, alongside a careful review of alternate theories for what was going on. Some thought that genetic risk factors or circumcision or the prison systems played a role, but Millett found that the most promising theories involved healthcare disparities. For instance, black men are more likely to have other STDs like gonorrhea or syphilis, which increases one’s risk of contracting HIV. The sheer prevalence of HIV in the community means that despite getting tested just as frequently, black men are still more likely to have an undiagnosed infection, a circumstance that makes them more likely to pass on the disease. Lack of healthcare access raises another issue, in that those who do have HIV are less likely to be on the antiretroviral therapies that could make them less infectious to others.
But those explanations didn’t seem enough to account for the vast chasm between black and white HIV rates. So Millett began to consider another theory, a stunningly simple one, that could tie all the facts together.
Millett, who is himself black and gay, was well aware that black men tend to have sex with other black men, almost exclusively. What if that behavior was putting them in danger? It’s simple mathematics: the closer-knit a community is, the more any risk factors for infection become amplified. He began to wonder: What if the most dangerous thing a gay black man could do was what came naturally to him: to date the people he was attracted to, the people he was friends with, the people who surround him?