December 6, 2007 — Vol. 43, No. 17
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Apathy fueling black AIDS epidemic in U.S.

Adrianne Appel

The United States has slashed the AIDS death rate among white and wealthy U.S. citizens, but the disease continues to ravage the black community at full force, leaders say.

African Americans are 13 percent of the U.S. population but are 50 percent of those diagnosed with HIV each year and 50 percent of those who die of AIDS annually, according to the Centers for Disease Control and Prevention (CDC).

“We are in a public health state of emergency in the African American community,” said Debra Fraser-Howze, head of the National Black Leadership Commission on AIDS. “We have the highest rate of death among all illnesses and, on top of that, AIDS. … HIV/AIDS looks the same in our community as it looks in some third world countries.”

HIV is a virus that attacks the immune system and, if untreated, leads to AIDS. An otherwise healthy person may get infected with HIV and live for 10 years before experiencing any symptoms. When the body begins to weaken from the infection, medicines called anti-retrovirals are given to help the body fight it.

About 32 million people worldwide have HIV/AIDS, according to recently revised figures from UNAIDS.

One million people in the United States are living with HIV/AIDS, and a steady 40,000 people each year are newly diagnosed, according to the CDC.

“For African Americans, HIV rates remain uncomfortably high. It’s really simply alarming this late in the epidemic,” said Carolyn Barley Britton, president-elect of the National Medical Association, an organization of black physicians.

Among whites and the well-to-do, people with HIV/AIDS are generally living 20 years and longer with the disease because of good medical care and access to anti-retroviral drugs, on the market since 1995, according to the Kaiser Family Foundation.
As a result, the average U.S. death rate due to AIDS has dropped 80 percent since the mid-1990s, according to the CDC.

But hidden behind this progress are numbers that describe an epidemic in full swing in the African American community in the U.S., leaders say.

Sixty-seven percent of women diagnosed with HIV are black, according to the CDC. Seventy percent of young people diagnosed with HIV are black. And AIDS is the leading cause of death among young African American women. Among white women, it is the seventh leading cause of death.

As a result, young black women have grown up with HIV in their communities.

“It is in their face,” said Jennifer Augustine, director of HIV and STD prevention at Advocates for Youth, an organization focused on health issues.

At the same time, frank, comprehensive sex education that discusses the necessity of HIV testing and condom use is often absent in U.S. schools because the federal government will not pay for it, preferring instead to fund programs for teenagers about how to abstain from sex, she said.

“If your only opportunity to get comprehensive sex education is in school, then we’ve kind of missed the mark,” Augustine said.

Once on their own, young women in communities where education is poor, jobs are scarce and children have already been born have more to think about than to dwell on the risk of HIV, she said.

“There are so many other issues that may take immediate concern,” Augustine said.

The higher rates of HIV are rooted in racial bias, poverty and the stresses that go with it, Frazer-Howze said.

“Race is what’s killing us. Race is at the heart of the lack of new therapies, at the heart of the lack of care regarding prevention policies, and at the heart of the poor public health infrastructure,” Fraser-Howze said. “It’s at the heart of society’s response in general and the government’s response in particular.”

The activism that marked the early years of the epidemic in the 1980s is largely absent today, Fraser-Howze said.

“Unfortunately, now that the disease has become black and brown, there is not the same societal response,” Fraser-Howze said. “We have not had an outpouring of support.”

Forty-two percent of blacks are diagnosed with HIV very late, within a year of developing AIDS, according to the Kaiser Family Foundation. This makes treatment challenging and leads to early deaths, Britton said.

Health care in the United States is expensive and fewer doctors practice in poor communities.

The fact that the U.S. has not made progress in lowering the number of people infected each year with HIV is directly related to the lack of a broad, effective public campaign about HIV risk, said Britton, associate professor of neurology at Columbia University College of Physicians and Surgeons.

“The true tragedy is we know what messages the public needs, ones that de-stigmatize testing and that communicate that preventive measures are available and that treatment is available,” Britton said.

The U.S. needs to make the same level of commitment to an HIV public health campaign as have other nations, some without the resources of the U.S., she said.

“What’s alarming is the inaction. It’s been this way for many years. Effective strategies to deal with these poor statistics are not in place,” Britton said. “We know what works and all we need is to have the will to do it.”

The African American community is going after HIV on its own.

“We will try to do what we can in our community. Many churches have their own programs,” Britton said. “There have been ongoing attempts that have received little notice.”

Most recently, 25 black politicians, doctors, community leaders and clergy came together to form the Black AIDS Mobilization, an organization that will advocate for more funding, educational efforts and treatment aimed at African American communities. Its goal is to end the epidemic in five years.

“Black clergy are leaders in their own right, pioneers and activists who champion our civil rights. We need them to take this on, absent societal support,” Fraser-Howze said.

The widespread ban against condom distribution in prisons, which house massive numbers of black men and poor whites, feeds into the epidemic, Britton said.

Only the state of Vermont and prisons in five U.S. cities make condoms available to inmates, according to an Associated Press/International Herald Tribune survey.

“There are 11 million people in the U.S. who have been in prison at some point. That’s an enormous risk if you have people in that pool who are HIV-infected,” Britton said. “If you go out 10-20 years, you’d have 20 million people who have graduated from prison.”

There is no public health program to test and treat them for HIV after they leave prison, she said.

A recently released report by the criminal justice research group JFA Associates estimated that one in three African American men will spend time in prison during their lives.


Former South African President Nelson Mandela and his wife Graca Machel (right) arrive at the Nelson Mandela 46664 World AIDS Day Concert in Johannesburg, South Africa, on Saturday. (AP photo/Schalk van Zuydam)

Sandra Mubiana Banda of Zambia, a person living with HIV/AIDS, is touring the United States with the Washington, D.C.-based advocacy group Global Justice, speaking about women’s leadership in the battle against AIDS. Here she discusses her anti-AIDS activism at Global Information Network in New York City. (William Farrington photo)

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