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By the time a gay, black man reaches the age of 40, he has a 60-per-cent chance of being infected with HIV-AIDS.

That was just of one the staggering statistics presented Monday at the International AIDS Conference that underscore the racial underpinnings of the epidemic in the United States.

Consider that while African-American men who have sex with men make up less than 1 per cent of the U.S. population, they account for 25 per cent of new

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And the impact of the epidemic is not limited to the sexual minority within the racial minority.

Of the 1.1 million Americans with HIV-AIDS, 43 per cent are African-American, even though they make up only 13 per cent of the population.

In fact, blacks make up the greatest proportion of HIV-AIDS cases in every conceivable transmission category – men who have sex with men, women, heter0sexual men, intravenous drug users, prisoners – according to the U.S. National HIV-AIDS Strategy.

"For many of us, the system is terribly, terribly broken," said Phill Wilson, president and CEO of the Black AIDS Institute.

He uttered those words in downtown Washington, where 2.7 per cent of all adults are infected with HIV, a rate deemed "epidemic," and a city where the infection rate is four times greater among blacks than whites.

Mr. Wilson said that, in the nation's capital, and across the richest country on Earth more broadly, the response to AIDS is lagging and no one is feeling the brunt more than minority groups.

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In the war on AIDS, he said, blacks are treated as "disposable." Ernest Hopkins, chairman of

the National Black Gay Man's Advocacy Coalition was equally blunt: "While black men are at the front of the line when it comes to need, they remain at the back of the line when it comes to services."

African-Americans, he noted, are less likely to be tested for HIV, more likely to have undiagnosed HIV, less likely to have access to lifesaving AIDS drugs, and more likely to be deterred or unable to access services because of poverty, discrimination and stigma, and each of these problems feeds off the others to create a cascade of failure.

Mr. Hopkins said that the impact of AIDS in black America is just the latest example of the ravages of inequality and correcting the problems should be seen as part of the civil rights struggle.

But there is no question that there is a lot of stigma about HIV and AIDS in the black community.

"That's the real reasons we're not protecting ourselves – stigma," said Sista Yaa Simpson, a Chicago-based community epidemiologist.

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There is also a lot of stereotyp-ing and prejudices that make it easy to not direct programs and resources to needy minority communities, she said.

"Blacks are not more sexually irresponsible than whites," Ms. Simpson said. "The research shows clearly that young white males have more sexual partners than young black males, but that's not the perception." The explanation for higher rates of HIV transmission is not promiscuity but the fact that social networks are smaller.

With fewer numbers on your dice, Ms. Simpson said by way of analogy, "Your chances of rolling snake eyes are a lot higher." The high rates of incarceration of black men – the rate is eight times higher than among white men – have also fuelled the epidemic.

"Sexual activity that occurs in male prisons is particularly risky," said Rucker Johnson, an associate professor at the Goldman School of Public Policy at the University of California, Berkeley.

His research shows that about three per cent of prisoners are HIV-positive, though the rate is as high as 17 per cent in some facilities.

In addition to the sex that goes on in prison – consensual and otherwise – when men are incarcerated it destabilizes their relationships, and makes it more likely their wives or girlfriends will also have risky sex.

The treatment of people living with HIV-AIDS is also tied up with the bitter, continuing debate about the U.S. health system.

Of the 1.1 million HIV-positive Americans, 325,000 have no health insurance and, again, the majority of the uninsured are black.

That's why activists like Mr. Wilson are vocal supporters of the Affordable Care Act – also known as Obamacare.

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