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Years of neglect, misguided policies have led to crisis
CDC has more initiatives in the works
The HIV/AIDS epidemic has wreaked havoc among African American communities in the United States in the past decade, and the government's slow response is partly to blame, one AIDS advocate says.
"It's true that the last eight years in particular have not been happy times for black people with regard to HIV/AIDS, says Phill Wilson, chief executive officer of the Black AIDS Institute of Los Angeles, CA.
In the Centers for Disease Control and Prevention's February, 2009 report on "Fighting HIV among African Americans," the estimated rate of new HIV infections among black men in the United States is 115.7 per 100,000 population. This is compared with the estimated rate of new HIV infections among white men of 19.6 per 100,000 population.
The same report states that AIDS is the leading cause of death among black women, aged 25 to 34, and it's the second leading cause of death among black men, aged 35 to 44.
"The tragedy is some of our AIDS policies over the last eight years have done harm, like prohibiting needle exchange and preventing DC from using their own money for needle exchange," Wilson says.
Also, the Bush administration took money from comprehensive AIDS prevention programs and directed it to abstinence-only programs that studies have shown do not work, Wilson adds.
"We know now that some of the policies have not only been ineffective, but have exacerbated the problem," he adds.
And the policies have particularly been harmful to the black community, Wilson says. "Today, AIDS in America is a black disease, and nobody wants to talk about that, admit it, or own it," he says.
Wilson points out that in Washington, D.C., HIV statistics that mirror the epidemic in some parts of sub-Saharan Africa.
"It's a generalized epidemic," Wilson says. "In D.C., 4% of black people and 7% of black men are HIV positive, and 10% of blacks, ages 40 to 49 are HIV positive."
Also, the CDC was not invested initially in getting African American institutions involved in addressing the epidemic, and black institutions were slow to respond to the AIDS epidemic, Wilson says.
"HIV in the black community has not been important to our society as a whole as it was when people perceived that the people who were getting sick were white gay men," he adds. "We have seen a decline in resources committed to fighting HIV over the last number of years."
This might change now that President Barack Obama has set a tone about HIV/AIDS that is important and helpful to fighting the domestic epidemic, Wilson says.
"I think his leadership will make all the difference in the world in addressing this issue," he notes. "As a candidate, he made sure HIV was on the agenda, and early on he made a commitment that he would develop a national AIDS strategy."
Also, Obama lifted the needle exchange ban and has called for more prevention funding.
'Own the epidemic'
Even if the federal government increases funding and pays more attention to the epidemic in the black community, there will need to be changes in how black institutions and churches treat the epidemic, as well.
"We have to get black Americans to own the epidemic, and every black institution in America should be encouraged to have an AIDS plan," Wilson says. "The good news is the major black institutions have developed national AIDS strategies now."
Major civil rights organizations, the NAACP, the National Urban League, and the Southern Christian Leadership Conference traditionally have set the tone of what black America thinks is important, Wilson says.
"There is a movement that has been brewing over the last few years, but now we're at a critical point that if these institutions have an honest partner [in the federal government], and they haven't in the last eight years, then we have the potential of changing direction," Wilson says.
The issue now is to decide what to do to turn things around.
"We need a new social marketing campaign that encourages people to get tested and uses triage to get them into care," Wilson suggests. "So the Black AIDS Institute is advocating a Test One Million campaign to screen one million African Americans over the next year."
Hopes are that the campaign will identify between 20,000 and 30,000 HIV cases and increase knowledge about HIV status in the black community, he adds.
For its part, the CDC has formed partnerships with African American leaders through its Heightened National Response to the HIV/AIDS Crisis among African Americans (HNR). The CDC is devoting more than half of its prevention budget to efforts in the black community.1
"We've seen a great response from African American leaders, and I think the leaders are seeing the impact the epidemic is having among African Americans and are stepping up to take action and increase attention to this issue," says Richard Wolitski, PhD, acting division director for the CDC's division of HIV/AIDS prevention.
"We're going to be getting ready in the near future to roll out some new efforts that will intensify these efforts between the CDC and leaders of major organizations in the African American community," Wolitski says.
"We do have some things on the horizon that will be fairly substantial, and we hope will lead to further increasing the response within the African American community," he adds.
Some of the CDC's recent prevention initiatives have included expanding the number of proven interventions for black MSM and women, expanding HIV screening in labor and emergency departments, providing rapid testing and prevention services at a range of African American community settings, including churches, black universities, and minority gay pride events, and developing a social marketing HIV testing campaign to encourage regular testing among black MSM.1
"The CDC is currently conducting research to develop and test new interventions for black MSM, and we're also getting ready to launch a million dollar campaign that will promote regular HIV testing among black MSM between the ages of 18 and 25," Wolitski says. "This is going to be an Internet-based campaign that has been developed with input from a group of community representatives and individuals with a long history of conducting HIV prevention with black men who have sex with men."