The Shocking Truth About The Aids Epidemic In Black America
With African-Americans making up 50 percent of al new infections, HIV/AIDS is increasingly becoming a “Black disease”
It is the health crisis that Black America has yet to fully comprehend and come to grips with. Festering beneath a shroud of secrecy and facilitated by a complex web of lies, shame and misinformation, it is an epidemic that is placing whole communities in jeopardy. Even in the face of tremendous advances in detection and treatment, even with the mountains of information disseminated about protection and prevention, the spread of HIV/AIDS has become a public health emergency among African-Americans, one that has radically altered the profile of the disease’s “typical” victims.
Long considered a disease that primary affected gay White men, the face of AIDS has changed dramatically in the 20 years since the epidemic was first detected. In the early to mid-1980s when the AIDS crisis first swept through the nation, more than 60 percent of the 200,000 new HIV infections reported each year were in White men. The gay community mobilized, however, promoting condom use and early detection to combat the spread of the disease. Their efforts have been quite successful.
Today, new HIV infections are down to 40,000 a year, according to the Centers for Disease Control and Prevention’s HIV/AIDS Surveillance Report 2000. But what is alarming is where those new infections are concentrated: More than 50 percent occur in African-Americans. In fact, a quick glance at the CDC tables makes it apparent that HIV/AIDS has increasingly become a “Black disease.”
Consider these statistics: For Blacks age 25-44, HIV/AIDS was the leading cause of death in 1998. Black women account for about 64 percent of AIDS cases reported among women. Black children under the age of 13 represent almost two-thirds of all reported pediatric HIV cases in the United States. Add to this the devastating effect that HIV/AIDS is having on the continent of Africa, where two-thirds of the world’s HIV infections currently exist and 17 million people died of complications from AIDS last year, and you have a disease that has taken on a decidedly Black and brown hue.
“What we are seeing is that this epidemic is settling among the most vulnerable among us,” says U.S. Surgeon General David Satcher. “It has a lot to do with access to information, but also with the resources–socioeconomic resources and psychological resources–that one needs to combat the disease and change behavior.”
While it is true that the AIDS epidemic in Black America has deep pockets in poorer urban and rural communities, many say the crisis is so widespread that it defies easy explanation and categorization. “It would be foolish to think that this disease is in one place or fits one kind of person,” says Dr. Robert Scott, an Oakland, Calif., physician who sees more than 400 AIDS patients in his practice.
In Alameda County, where Dr. Scott’s practice is based, African-Americans constitute 60 percent of the reported AIDS cases, a figure so staggering that county officials declared a state of emergency to address the issue. “This is a disease of young folks and old folks, of poor folks and middle-class folks,” says Dr. Scott. “So anyone who thinks they’re safe needs to think again. If you’re sexually active, you’re at risk.”
Some blame intravenous drug use and the clandestine escapades of “double-dipping” bisexual men for the disproportionately high incidence of HIV infections in the Black community, particularly among Black women. The sharing of dirty needles does account for up to 35 percent of the nation’s HIV infections, according to the CDC. And HIV-infected men who have unprotected sex with both men and women have certainly helped spread the disease.
Similarly there is a complex tangle of relationships that can often make charting HIV infection in the Black community difficult. “The Black AIDS problem presents all these new considerations that you just didn’t see when people considered it basically a gay, White male disease,” says LeRoy Whitfield, a senior editor at POZ, a magazine for people infected with HIV/AIDS. “Like the Brother who is in prison, has sex with a guy and gets infected, comes home and infects his girl; he doesn’t consider himself gay or bisexual, so you can’t just lump all the causes for the Black AIDS crisis into one or two areas.”
Indeed, no one can say to what extent any one phenomenon has fueled the Black AIDS epidemic. What is clear, however, is that the disease and the ways to treat and prevent it have not been part of a meaningful dialogue in many corners of Black America, despite its devastating effects.
“We have not done a very good job of providing a climate in our homes and in our schools where people are comfortable talking about sex and where they feel safe and protected getting treatment for or protection from HIV,” says Sandra Crouse Quinn, an associate professor in the School of Public Health at the University of Pittsburgh who has done research into African-American attitudes about AIDS. “On the one hand, there is a lot of information out there about HIV/AIDS. People know more about how it’s transmitted. Still, there is a stigma attached to it in many communities, so people don’t talk about prevention and they don’t get treatment.”
A contributing factor is the veil of secrecy and the disgrace surrounding homosexuality in the Black community. “If we really are going to be serious about helping to end HIV infections and building a proud and strong Black community, we are going to have to begin by making it clear that there can’t be any space for discriminating against gays and lesbians,” says A. Cornelius Baker, executive director of the Whitman-Walker Clinic, an influential non-profit lesbian and gay community health organization based in Washington, D.C. “A lot of the silence on this issue has led to a lot of women being put at risk because men feel that they have to have a girlfriend, that they can’t talk about condoms because it means there’s something wrong with them. All this is creating a breeding ground for infection and a cycle of dysfunction that is killing our community.”
Efforts to combat the stigma and heighten awareness in the Black community have failed, some say, because the early HIV/AIDS prevention messages were not culturally sensitive or relevant to African-Americans. “The traditional model on which a lot of the HIV/AIDS prevention work was built revolved around something called `gay,’ which was a relatively new social and political construct that was exclusively White,” says Cleo Mango, founder and CEO of the Amassi Health Wellness and Cultural Affirmation Center in Los Angeles. “But `gay’ is not something that Black folks, who are stigmaphobic, bought into. We didn’t want to be caught up in something that was going to cause us new pain, or new stigma, or create some new reason for people to oppress or judge us.”
Consequently, Mango says, the HIV prevention and treatment programs have been ineffective in Black communities. To succeed in an African-American setting, he says, the programs must “be steeped in culture so people will want to be there, will want to be engaged in the information and can fit it in as part of their lives.”
Surgeon General David Satcher agrees. At his direction the Department of Health and Human Services launched the Leadership Campaign on AIDS, an initiative that brings together Black leaders from throughout the world to help develop programs and activities that address the disproportionate impact that HIV/AIDS is having on people of color.
“We’ve been struggling to better target our programs to people who are most vulnerable,” Satcher says. “We believe that we have to be more culturally relevant and sensitive with all of our programs. That’s why we’ve gone to the churches, had satellite conferences at historically Black colleges and universities and tried to find people who are part of the communities who will help us get this message out.”
But the Black community has to play a larger role, too. “We have to change our attitude about a lot of stuff,” says Dr. Scott. “We have to get over the stigma. We have to stand up in our churches and tell people that they have to get tested. I don’t care who you are–young, old, middle-aged: Get tested! And keep getting the prevention message out there.”
But the bottom line, some observers say, may be to provide in Black communities a safe place for open discussion about sexuality and about AIDS prevention and detection. “Unless we create this sense of help and nurturing in our community,” says Baker, “people will continue to do things in the dark, not talk about it, and not get the support and treatment they need. They will go on infecting people, and then they’ll go away and die.”
COPYRIGHT 2001 Johnson Publishing Co.
COPYRIGHT 2001 Gale Group