Friday, August 25, 2006

AIDS in black America

I just saw an alarming news story by Terry Moran of ABC News called “Out of Control: AIDS in Black America” last night. According to this report, even though African Americans make up only 13% of the U.S. population, they make up 50% of all new cases of HIV infections. Black women are 23 times more likely to be infected than white women, mainly through heterosexual sexual contact. Yet most discussion about the current AIDS problem ignores these facts. Whenever I’ve heard AIDS being discussed, I hear either that the number of new infections has stabilized at 40,000 a year, suggesting that we have the epidemic much more under control these days, or that the really big problem is in Africa. Africa certainly is a major disaster. But the fact that the epidemic taking place right here at home among black Americans isn’t more widely discussed is just amazing to me. I thought I was current on the AIDS issue, and yet I was totally clueless about the seriousness of this particular problem until last night.

How it began

Basically this is how things got started. AIDS first entered the black community largely through needle sharing among drug addicts. In the 1990’s Dr. Anthony Fauci of NIH saw the handwriting on the wall for the spread of AIDS among African Americans. He said he could see from the very beginning that all the factors that contribute to the spread of infection in a community were present in the black community. He was one of the main guys who pushed the Clinton Administration to implement a needle exchange program, which would allow addicts to exchange dirty needles for clean ones free of charge. The program had been statistically proven to be successful in other countries and was being implemented in Baltimore, MD, but it needed federal funding to spread to other parts of the country. President Clinton was very seriously considering it, but the Monica Lewinsky scandal distracted his energies from it and it fell by the wayside. You could see how crestfallen Dr. Fauci was when he recalled this turn of events during his interview. Then the Republicans came into power. They have consistently opposed the needle exchange program because they think providing clean needles to drug addicts will only encourage their addiction.

How it spreads

Meanwhile, because the U.S. government had declared a “war on drugs,” HIV infected addicts were being thrown into prison where 40% (if I recall correctly) of male inmates have sexual contact with other male inmates, thus spreading the disease. Prisons are a breeding ground for the HIV virus, and infection is five times greater there than outside prison walls. This is the worst aspect of the problem for the African American community because there are currently more college-age black American males in prison than in college. (Another statistic says that "almost one in three black men in their twenties is in prison, jail, on parole, or under some other form of correctional supervision," which gives you an idea of how many people are in or have gone through the prison system.) They come in HIV negative and leave HIV positive. To make things worse, these prisons refuse to distribute condoms to protect people from disease transmission. Why? Because that would be an admission that sex takes place in prison. Gosh, wouldn’t want to let that big secret out of the bag now, would we? Furthermore, there is no mandatory testing for HIV infection before prisoners are released back into society, so many men leave without knowing they are HIV positive.

How women are infected

Once HIV infected black men are released from prison, ignorant of their condition, they of course infect black women. Some factors contribute to the promiscuity that allows the infection to spread to black women at alarming rates. First of all, there are about 85 black men to every 100 black women, because the mortality rate among male black youth is so much higher. This disproportion means multiple women are fighting for one man, which gives more opportunities for black men to have (and infect) multiple partners. Secondly, the hip-hop culture which has become so big in the black community glamorizes sex and promiscuity. Thirdly, the vast majority of gay black men are closeted (or what they call “down low” or “DL”) due to the intense shame and stigma in the black community regarding homosexuality. They live as straights publicly but they have male sex partners in secret, which means they won’t disclose to their wives or girlfriends that they might potentially be infected with HIV.

Why are black leaders silent?

Why haven’t black leaders addressed this issue? Black leadership comes mainly from black churches, which have always been the center of political activism and spiritual strength for the African American community. But the church is partly where the stigma and shame over homosexuality and AIDS comes from. Only a handful of black pastors have been willing to address the problem of AIDS from the pulpit.

What about the Rev. Jesse Jackson? He would take on a growing crisis in his own community, wouldn’t he? But Terry Moran’s interview with Jackson showed that he was only interested in making excuses and blaming it on the President and Congress. Moran kept pressing Rev. Jackson on why he himself has kept silent about this, and how could this happen to his community under his watch? But Jackson kept skirting the issue. It was the worst, most disturbing interview I’ve seen since I saw our local news station question Cardinal Roger Mahoney on why he knowingly reassigned pedophile priests to other parishes instead of barring them from the priesthood. You came away from the interview thinking there must be something really, really wrong with this guy.

Simple ways to curb infection rates

I concluded from Moran's story that there appear to be some simple and inexpensive policies that could be put into place that would really help the situation. One is a federally funded needle exchange program. Another is the distribution of condoms in prisons. A third is mandatory testing for HIV before prisoners are released back into society. The gay community has made a big contribution toward AIDS activism the past two decades. I wonder, is anything being done in these areas on behalf of the African American community? If anyone could tell me, I’d be interested to know.