In a response to our Comment,1Fields EL Copeland R Hopkins E Same script, different viruses: HIV and COVID-19 in US Black communities. Yudit Namer and Oliver Razum argue that focusing on the vulnerabilities of populations disproportionately affected by HIV rather than their resilience serves to only further marginalise already disadvantaged groups. They posit that an intersectionality of resilience framework would generate the development of more strengths-based community health interventions. Although we agree that there is evidence of great resilience in Black communities, our Comment focused on the social inequities that have required Black communities to be more resilient than other communities to survive. Highlighting resilience without impugning the inequities that necessitate resilience creates a solutions framework centred on coping with, rather than eliminating, inequities.The aspiration to overcome oppression and structural racism has been a common theme in the Black American experience since Black people were brought to the Americas as slaves.2“Despite the odds”: unpacking the politics of black resilience neoliberalism. This reverie has been articulated in art, literature, and music; indeed, We Shall Overcome was the key anthem of the civil rights movement.3We shall overcome: the history of the American civil rights movement. Examples of the strength and resilience of Black communities resound throughout history alongside the social inequities, structural oppression, and resulting health disparities delineated in our Comment. John Henryism is a useful analogy here. First described by epidemiologist Sherman James to explain racial disparities in hypertension,4John Henryism and the health of African-Americans. John Henryism is a behavioural predisposition characterised by active coping against persistent, enduring social disadvantages (eg, racial discrimination and inequity) resulting in long-term negative health outcomes. As James notes, John Henryism illustrates that survival in the face of disadvantage is possible but not without cost.

Rather than focusing on dismantling the systems of oppression that debilitate Black communities, the solutions espoused by Namer and Razum place the responsibility for managing anti-Black oppression on Black communities. By emphasising structural inequities and intersecting systems of oppression, we do not argue against or diminish the resilience of communities. Rather, we decry the cost of that resilience—the persistent HIV disparities weighing on gay and bisexual men, cisgender and transgender women, and adolescents and young adults in Black communities.

ELF has served on HIV prevention and treatment advisory boards for Gilead Sciences. RC has served on community advisory boards for ViiV Healthcare and Merck and has received grant funding from Gilead Sciences. DJM has served on a pre-exposure prophylaxis speakers' bureau for Gilead Sciences and an advisory board for ViiV Healthcare. EH and RAS declare no competing interests. Support for this Correspondence and the Lancet HIV in the USA Series was provided, in part, by amfAR, The Foundation for AIDS Research, The US National Institute on Drug Abuse, and The Desmond M Tutu Professorship in Public Health and Human Rights at Johns Hopkins University.

References1.Fields EL Copeland R Hopkins E

Same script, different viruses: HIV and COVID-19 in US Black communities.

Lancet. 397: 1040-10422.

“Despite the odds”: unpacking the politics of black resilience neoliberalism.

Am Educ Res J. 56: 75-1103.

We shall overcome: the history of the American civil rights movement.

Lerner Publications Company, Minneapolis, MN, USA4.

John Henryism and the health of African-Americans.

Cult Med Psychiatry. 18: 163-182Article InfoPublication HistoryIdentification

DOI: https://doi.org/10.1016/S0140-6736(21)01325-8

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© 2021 Elsevier Ltd. All rights reserved.

ScienceDirectAccess this article on ScienceDirect Linked ArticlesSame script, different viruses: HIV and COVID-19 in US Black communities

The Lancet Series on HIV in the USA describes the current state of the nation's HIV epidemic, including ongoing inequities and challenges for key populations and comorbidities.1–6 Black Americans have consistently shouldered many of these HIV inequities, a pattern also seen in the COVID-19 pandemic. The overlapping racial disparities related to COVID-19 and HIV7,8 highlight lessons that policy makers, public health practitioners, providers, and communities can leverage in their strategies to eliminate the disproportionate burden of HIV and COVID-19 in Black communities.

Full-Text PDF Surviving syndemics

In their Comment on the double burden of HIV and COVID-19 in US Black communities, Errol Fields and colleagues1 focus only on vulnerabilities as an alleged attribute of subpopulations, instead of stressing the importance of communities' agencies, resources, and strengths. Despite the authors ‘reflective analysis of structural inequalities and the intersectional character of systems of oppression, the vulnerability accent—although benevolent—is inevitably alienating the groups that they are intending to prioritise.

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