The March reports of sky-high levels of the genital herpes virus among black women set off a firestorm of disbelief and recrimination. The numbers from the Centers for Disease Control and Prevention (CDC) gave many black women an all-too-familiar feeling: shock, concern and an overwhelming sense of fatigue in the face of yet another study bringing bad news and fear.
African-American men and women often seem to be under siege when it comes to the ongoing flood of research trumpeting our higher rates of nearly everything, including sexually transmitted diseases (STDs). No doubt, disparities exist, but in this case, it's reasonable to take a step back from the anger and take a closer look at what the statistics are really telling us.
The new research should not be seen as an indictment of the sexual behavior of African Americans. The numbers—though startling (48 percent of African-American women have been exposed to the virus that causes genital herpes)—are not so much about sex, as they are about circumstances, and, possibly, the way information is gathered for medical research.
Who Was Counted
STDs, notably HIV/AIDS, are more prevalent among African Americans and more effective modes of prevention are needed. These facts have been reported in a multitude of studies, many conducted by African-American researchers. That said, statistics can reflect many things beyond the simple presence of a virus, which is why they are inappropriate tools for judging the culture or conduct of a race or gender, no matter the source.
In this case, the 2010 herpes data comes from the National Health and Nutrition Survey (NHANES). This large, national study is designed to report on the health of the American population by gathering information from a randomly selected pool of 5,000 people who are not in the military or an institution.
"It's a snapshot, a medical assessment that first selects a county, then a neighborhood, then a city block, before choosing individuals who then fill out a survey and are given blood tests to confirm their health status," explains Dr. John Douglas, the director of the division of STD Prevention at the National Center for HIV, STD and TB Prevention at the CDC.
While regular folks are often shocked that just 5,000 people are the basis for a good deal of what the CDC reports, Douglas concedes that the scientifically sound, multi-stage process is difficult to explain to the public. But the study has been the CDC's monitor of our national rates of obesity, heart disease and many of health issues since 1970.
"African Americans are also oversampled to make the study more representative," Douglas said, meaning that larger numbers of blacks are included in the data than their percentage in the population.
What the Numbers Really Mean
The current herpes statistics were based on a group of 893 African-American women, but the 48 percent number has been misinterpreted in most reports. "These women were only tested for antibodies to the HSV-2 virus," explains Dr. David Malebranche, an assistant professor at Emory whose research focuses on STDs in African Americans. "This means that they have been exposed to the herpes virus, but it does not mean that these women have actually developed the disease or have active herpes. In fact, they may never develop active herpes."
"The numbers are consistent with other STD studies that include African Americans," explained Dr. Charlotte Gaydos, co-director of the International Sexually Transmitted Diseases Research Laboratory at Johns Hopkins.
The issue that's often lost in this discussion is that the NHANES and other studies may be the best research we have, but in this case, is the "best" good enough?
Sex by the Numbers
Douglas and other experts say the numbers have very little to do with high-risk sexual behavior. "STDs are shared among people in sexual networks," explains Dr. Irene Doherty, who is part of a team of researchers at the University of North Carolina who explore how STDs spread. "The theory of sexual networks is simple: It's not what you do; it's what your partners do and what your partner's partners do. Our data shows that black women do not have more sex or more high-risk sex than other women. It's fairly well-established that they select partners from a small pool that has a high rate of STDs."
The million-dollar question, of course, is why are there so many STDs in the African-American pool? Many researchers blame concurrency, or people having several sexual partners at once. Dr. Anthony Lemelle, a sociologist who focuses on HIV/AIDS and African Americans, suggests that attitudes about sex play a role as well. "My theory is that in the college years, even middle-class African-American women may have multiple partners because they are searching for that one, long-term relationship. Once they are in their 30s, they marry or become religious and this behavior changes," he said. "In the older group," explains Lemelle, the author of Black Masculinity and Sexual Politics (Routledge, 2010). "it is the men, often married heads of households that are out there. That's where we see all of this sexual activity. It's an important part of manhood and black men go about it more aggressively than men of other races."
Still, brothers who hit on women are nothing new and, Malebranche notes, it certainly happens among white men as well, so what's really going on here? A study by well-respected researcher Dr. Adaora Adimora, reports that "sharply contrasting social contexts in the sexual networks of blacks and whites … such as poverty, illicit drug use in black communities, incarceration rates, along with the sex ratio of men to women," create these disparities. A solid point, perhaps, but many researchers think that even well-intended studies may be missing the mark.
Where Statistics Fail
Several African-American scholars, and other scientists, express concern about how research—even the highest quality research—is conducted when it comes to African Americans. In short, where are the millions of middle-class African Americans who are not living in poverty, using drugs or incarcerated in these numbers?
Dr. Velma Murry, a sociologist at Vanderbilt who studies the black middle class, found, for instance, that "adolescent, middle-class, African-American girls delayed having sex two years beyond the national average," a contradiction of other national reports. "When we look at research, middle-class African Americans are almost excluded," Murry said. "Most research looks at middle-class whites and low-income African Americans. Then the two are compared and a disparity is reported. But there are far more differences within racial groups than between racial groups, so it's very important to know who is in a study and how they were identified."
"There is a problem right now with CDC," says Malebranche, who has had CDC funding, but does not intend to repeat the experience. "A lot of their statistics are myopic and flawed. I don't think it's a concerted effort to ignore the black middle class, but you don't often see research on poor, white populations with high rates of STDs. I'm not in denial that disparities in STDs exist, but researchers often look for the easiest population to track and find," which often means studying poor, urban areas.
"We can't make any conclusive remarks about African Americans because middle-class African Americans are still an invisible population in most research," Murry adds, noting that this not only leads to inaccurate reports about African-American life, "but we miss the positive practices of black families—the practices that work for us, that lead to better physical and psychological health."
So while the numbers may be real, an accurate assessment of the African-American community when it comes to STDs and herpes, in particular, still eludes.
Sheree Crute is a health and medical writer living in Brooklyn, N.Y., and is the editor of Covering Health in a Multicultural Society: A Guide for Journalists.
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