Black people are at higher risk of HIV-related morbidity and mortality than people of other races, and studies have shown that having a white medical provider may actually exacerbate this disparity. Existing health disparities have resulted in many non-Black health care workers seeing Blackness solely as it relates to disenfranchisement, as opposed to addressing the causes of said disenfranchisement. This viewpoint perpetuates longstanding beliefs that Black people lack the capacity or the knowledge to self-sustain, and suggests that some external person, generally a white medical provider, is needed to restore order to a patient’s life. This grossly inappropriate viewpoint is one held by many within the medical community, specifically within the HIV care field, and is maintained through the silencing of Black voices in health care.
Blackness must be seen outside the lens of disenfranchisement, marginalization, and all the other fun public health buzzwords. Lack of doing so results in Black patients being assumed incapable of taking charge of their health. Patients can tell when providers have this assumption about them, and it often dissuades patients from continuing to engage in care. It also plays a substantial part in minimizing the voices and opinions of Black staff within the health care field. Dismantling this existing complex means assessing how health care institutions contribute to narratives of Black helplessness and addressing the ways in which the voices of Black health care workers are minimized.
Origins of the White Savior Complex
The concept of white saviorism stems from a longstanding tradition of masking imperialism and elitism through volunteering and public service. It allows for white health care workers, philanthropists, public health workers, and more to justify making decisions on the behalf of Black people, often poor, who white authority-holders have deemed in need of help—without listening to the wants of the served population. It relies on the belief that Black people have an inherent helplessness about them and is enforced by statistics related to elevated levels of poverty, illiteracy, and unemployment among this group. The ideology centers around white people using their elevated place in society to come in and set Black people on the “right path.” The motivation behind this ideology is steeped in racism and fuels the belief that white people, and whiteness, know best, and that the closer other races can get to whiteness, the better off they will be. Multiple researchers and advocacy workers have called this out to be what it is—racist. And yet there are still heavy amounts of white savior tendencies in many service-oriented fields, especially within health care.
White Saviorism and the HIV Care Field
Despite roughly 13% of the United States population being Black, almost half of all people living with HIV are Black, with 42% of new diagnoses in 2018 being among Black people. Less than half of Black people living with HIV are virally suppressed, compared to the national rate of 85.9% among Ryan White HIV/AIDS Program clients. While knowing these statistics is important, it’s equally important to contextualize the why behind this increased risk. As a result of centuries worth of overt and systemic racism, Black people are significantly more likely to battle with housing instability, lack of access to regular health care, and other barriers to prevention and treatment. Note that none of these barriers indicate incompetence, yet many providers assume lack of intelligence or education as the primary reason behind this disparity. In fact, studies have shown providers are significantly more likely to approach Black patients with a condescending tone, exclude Black patients from contributing input on health decisions, and make treatment decisions based on assumptions about a patient’s lack of potential for adherence. Health illiteracy does impact patients, but the solution to it is to provide information to patients, not to act on their behalf.
What starts as an assumption of patient incompetence results in the erasure of autonomy from Black patients. Patients are no longer part of their own care team and are instead merely doing whatever is decided upon by their often white medical provider. Encounters like this feed into the belief that Black people are unable to handle the weight of making medical decisions. This air of medical superiority also feeds into the longstanding history of medical mistrust within the Black community. It additionally warps the idea of what medicine is supposed to be, with saving patients as opposed to partnering with them in their care becoming the expectation of medical professionals. As a result of being removed from one’s own medical care, patients disengage, and medical providers assume that this disengagement must be a result of the patient being from a “marginalized background,” as opposed to the provider’s own actions.
Erasure of Black Voices in Health Care
More Black health care workers than not are aware of the existing white savior dynamic. A central factor that perpetuates this unhealthy patient-provider dynamic is the lack of Black, Indigenous, and people of color (BIPOC) representation in health care, as well as the minimizing of existing Black voices within the field.
If I had a dollar for every time I heard something along the lines of, “You know, life is just so hard for them, they really can't help themselves,” with “them” being people who look like me and the speaker being a white medical provider, I’d have enough money to pay off the six figures I owe in student debt. And then some. In 2016, less than 5% of the physician workforce identified as Black, and the current workforce serving HIV patients looks drastically different from those they are serving. This lack of diversity is even more exacerbated as one goes higher up the chain of command in most nonprofit and clinical settings. Often in scenarios where Black health care workers challenge the existing narrative of Black helplessness, they are met with backlash. Over three out of four Black employees report experiencing some form of discrimination from colleagues within their workplace, much of which includes colleagues assuming lack of education, aggressiveness, or unprofessionalism. A narrative is created in which Black health care workers are difficult to work with, or a hinderance to patient care, when many are doing what is actually needed: setting healthy boundaries and empowering patients to be an active part of their own medical decisions. Black health care workers are caught having to defend both Black patients and their own thoughts and beliefs to coworkers, in a work environment that gaslights and minimizes their role in the care team.
Black patients are the experts on their lives and what works for their bodies. To holistically care for Black people living with or at elevated risk for HIV, it is essential to address the ways in which Black input is allowed that go beyond symbolism, and ways in which the white savior narrative is championed. When Black health care workers at your organization speak up about their concerns, believe them. Value Black voices, even when they tell you you’re wrong. Respect that Black health care workers know what they’re doing and that when they set healthy boundaries, they are not a hinderance to care. Question the organizations you work for and see if their statements about Black Lives Matter and racism being a public health crisis go beyond a banner or an email.