In the forty-one years since doctors first recognized what would become known as Acquired Immune Deficiency Syndrome (AIDS) among gay men in New York and San Francisco in 1981, the disease has devastated Black communities, both in the United States and around the world. In 2019, African Americans accounted for around 13 percent of the U.S. population, but 42 percent of those newly diagnosed with HIV, the virus that causes AIDS. Among Black gay and bisexual men, Black women, and especially Black transgender women, the disparities in HIV infection even more stark. As I showed in my book To Make the Wounded Whole: The African American Struggle against HIV/AIDS, such disparities have been with us for as long as we’ve known about the disease, and African American activists have mobilized since the early 1980s to fight back against AIDS in Black communities.
Black Perspectives readers may be familiar with the story of Robert Rayford, the first known person with AIDS in the United States. Rayford, a Black teenager living in St. Louis, was hospitalized in 1968 with swelling, fatigue, and shortness of breath. Doctors diagnosed him with a systemic case of chlamydia, which his immune system wasn’t fighting at all. The only sexual encounter that he reported was with a girl in his neighborhood, not long before he became ill. His condition progressively worsened, and Rayford passed away from pneumonia, an opportunistic infection commonly associated with AIDS, fifty-three years ago this month. In the 1980s, after his mysterious symptoms became associated with the new disease, doctors tested archival samples of the teenager’s blood and tissues and found evidence of HIV.
As I explained in my post for National Black HIV/AIDS Awareness Day, Rayford’s story helps us to rethink our timeline of AIDS in the United States. In recent years, researchers have determined that HIV was circulating among gay men in New York as early as 1970, around a decade before doctors began to see the clusters of cases that would signal a new epidemic. But that doesn’t explain how Rayford contracted the virus at least several years earlier, in a city almost a thousand miles away from Manhattan.
Indeed, the where of Rayford’s story matters as much as the when. Rayford’s story resituates the early years of AIDS in the United States, and not just because St. Louis is far from both New York and San Francisco. More importantly, it shifts our focus from the gay ghettoes of those cities to the “second ghetto”: the part of the American city created by disastrous public policies that underwrote white flight to the suburbs and decimated the Black communities that remained in the urban core. In this way, Rayford’s story helps us to see AIDS in Black America as the product of what Adam Geary calls “state intimacies,” or “the structured forms of violence and inequality mediated by the state that have produced conditions of embodied vulnerability to disease and ill health for black people in particular.”
Focusing on St. Louis helps us to see these state intimacies in action, to think through how they may have prevented doctors from recognizing AIDS sooner, and to situate AIDS within the larger story of anti-Black racism in the United States. As Walter Johnson argues, “much of American history has unfolded from the juncture of empire and anti-Blackness in the city of St. Louis.” In the Gateway City, “white supremacist ideology and the practices of empire, extraction, and exploitation” come together in a formation of racial capitalism that for centuries has devalued and degraded Black lives, with far-reaching consequences. This was certainly the case for Robert Rayford’s young life.
Rayford was from North St. Louis, a part of the city where most residents were Black. As was the case in similar neighborhoods in cities across the country, residents rented run-down row homes from absentee landlords, were kept out of lucrative jobs by racist hiring practices and were prevented from moving to the suburbs by racial housing covenants that white homeowners enforced with outright violence.
In spite of the constraints of white supremacy, Black residents of North St. Louis “turned segregation into congregation,” creating a vibrant community in the face of poverty and discrimination. That community, however, was torn apart by “urban renewal” schemes that bulldozed Black neighborhoods to make room for freeways, parking lots, and, eventually, St. Louis’ iconic arch. In the minds of urban planners, such projects would generate wealth for the postwar city. If it meant the destruction of “blighted” neighborhoods and the displacement of Black residents, so much the better.
Ironically, some of the displaced ended up in the Pruitt-Igoe Apartments, a massive public housing complex that itself sat on the 57-acre site of a predominantly Black district that had been leveled to make room for the project. Pruitt-Igoe was completed in 1954, the year after Rayford was born, just a few blocks from his family’s home. Underfunded and understaffed, and buildings quickly fell into disrepair. Within a few years, the name Pruitt-Igoe became synonymous with urban misery even though, as Candace Borders shows, Black women in particular forged bonds of community within the project’s towers. Nevertheless, when Rayford died in 1969 the complex was half empty, and a few years after that it was demolished.
Exactly how Rayford contracted HIV is unknown and will almost certainly remain a mystery. And as Theodore Kerr argues, speculation about Rayford’s sexual identity “rob [him] from the grave of either the ambiguity or specifics [of] his life.” But we can say that, since Rayford never traveled outside of St. Louis and is not known to have ever received a blood transfusion, someone at some point in his community also had the virus. As I argued previously, the displacement caused by urban renewal, not to mention residents’ flight from the crumbling Pruitt-Igoe, may have prevented doctors from recognizing a cluster of cases like Rayford’s.
But urban renewal doesn’t only matter to this story insofar as it may have shaped the epidemiology of HIV/AIDS. As social psychiatrist and longtime HIV/AIDS researcher Mindy Fullilove argues, urban renewal—which by her estimate destroyed some 1,600 Black neighborhoods nationwide—inflicted significant trauma on both the individual African Americans who were displaced and on Black America as a collective. This trauma, which she labels “root shock,” left residents with a sense of tremendous loss, severed bonds of mutual aid and support, and made affected communities less healthy in all kinds of ways. According to Fullilove, “the current situation of Black America,” including the disproportionate impact of HIV/AIDS on Black communities, “cannot be understood without a full and complete accounting of the social, economic, cultural, political, and emotional losses that followed the bulldozing of 1,600 neighborhoods.”
If urban renewal made North St. Louis residents feel as if they were living in a war zone—Fullilove writes that the practice bore a “bizarre resemblance to wide-area bombing”—they weren’t alone. St. Louis police, as Johnson shows, referred to Pruitt-Igoe as “Korea,” in reference to the war, and as “a combat zone.” Here the St. Louis Police Department piloted a model of policing based on counterinsurgency tactics that featured the random harassment of Black residents, treating fellow Americans as though they were enemy combatants. Such encounters were not only terrifying, but also resulted in the deaths of a long list of Black residents, many of them teenagers like Rayford, at the hands of police.
In as much as racist urban planning and policing made Rayford’s neighborhood look and feel like a war zone, they also likely created conditions that we know render both individuals and communities more vulnerable to HIV. In addition to the breakdown of community bonds, police violence and displacement through urban renewal inflicted significant trauma on Black communities. As researchers have documented, experiences of trauma correlate to higher vulnerability to HIV. But urban renewal also drained wealth from Black communities and, as Fullilove points out elsewhere, forced them to expend the resources they did have on resettling and rebuilding. No wonder that HIV/AIDS, which is closely linked to poverty, would devastate those same communities in decades to come.
Again, we are unlikely to ever know exactly how Rayford contracted HIV. What we do know, however, is that the teenager was born into a community that was suffering from both urban renewal and racist policing. And while it may be tempting to think of Rayford’s story as a strange footnote to the history of AIDS in the United States, the story of his North St. Louis community was in many ways typical.
Robert Rayford was perhaps the first of so many young Black men in this country whose lives were cut short by the disease. While so much about his short life will remain shrouded in mystery, his story throws into sharp relief the ways in which AIDS in Black America has been made worse by public policies that devalue Black lives and inflict lasting trauma on Black communities.permission.