Differences in HIV viral suppression between Black and white people have little to do with their personal behavior, according to a recent study. For years, research has shown that despite having higher rates of HIV testing and condom use, Black Americans are much more likely to acquire the virus than their white counterparts. Now, research suggests that behavior does not account for the gap in viral suppression between Black and white gay and bisexual men in Atlanta.

The study followed 398 men who have sex with men—206 of them Black and 192 white—for a year between June 2016 and June 2017. While a roughly equal number of Black and white participants had jobs, nearly two thirds of those who earned less than $20,000 a year were Black, as were two thirds of those who were students.

While Black men were less likely to have private insurance and 10% fewer Black men had prescriptions for HIV meds, race did not explain the gap between the 79% of white men and the 67% of Black men with an undetectable viral load. Rather, younger age, lower income, unstable or no housing, lack of insurance and anxiety and depression accounted for the difference.

“Health inequities arise from societal inequities, and structural racism is at the core of policies that perpetuate them,” wrote author Patrick Sullivan, PhD, of Emory University, and colleagues.