New Report on HIV/AIDS in Black America

In a new report released July 29, the Black AIDS Institute sounded the alarm on high rates of HIV/AIDS among African Americans.  The title of the report pretty much says it all: “Left Behind! Black America: A Neglected Priority in the Global AIDS Epidemic.”

To bring the statistics into perspective, the report considers the black population of the United States as if it were the population of a separate country.  The hypothetical country of “Black America” would rank 35th on a list of the world’s most populous nations, and would have the 28th largest national economy.  And it would have the 16th highest national prevalence of HIV/AIDS.  This, the report stresses, would attract the attention of the United States.

As it is, the authors of the report say, the HIV/AIDS epidemic in the black American population is not getting nearly enough attention from the US government.  In the meantime, the US is embarking on a massive international AIDS funding program with the re-authorization of PEPFAR.  Among many observers, this contrast is attracting attention.

As I did for the UNAIDS 2008 Report on the global AIDS epidemic, I’m going to post some excerpts from a few news articles about the report, and try to lay out the key facts more or less topically.  I’ll be useing the following sources:

Reuters (July 29): U.S. AIDS Policies Neglect Blacks: Report
New York Times (July 30): U.S. Blacks, if a Nation, Would Rank High on AIDS
Washington Post (July 30): Efforts Against AIDS Among Black Americans Criticized

 

The Stats

Nearly 600,000 African-Americans are living with H.I.V., the virus that causes AIDS, and up to 30,000 are becoming infected each year. When adjusted for age, their death rate is two and a half times that of infected whites, the report said.   – NY Times

While blacks account for one in eight people in the United States, half of all Americans infected with HIV are black, the report found.

“We are 30 percent of the new cases among gay men, 40 percent of the new cases among men in general, 60 percent of the cases among women and 70 percent of the new cases among youth,” Black AIDS Institute CEO Phill Wilson told reporters in a telephone briefing.  
Reuters

According to the CDC, 1 million to 1.2 million people in the United States are HIV-positive, although that estimate is now five years old. The CDC on Sunday will release more precise estimates of the HIV incidence, or the number of new infections that occur each year. It is believed to be about 50,000. The 2 percent HIV prevalence in adult African Americans exceeds the 1 percent threshold that defines a “generalized” epidemic, rather than one limited to certain subgroups.   – Washington Post

  

In Perspective: Black America as a Hypothetical Country

Phill Wilson, the [Black AIDS Institute’s] chief executive and an author of the report, said his group supported the government’s international anti-AIDS program. But Mr. Wilson’s report also said that “American policy makers behave as if AIDS exists ‘elsewhere’ — as if the AIDS problem has been effectively solved” in this country.  
NY Times

The group said that more black Americans were living with the AIDS virus than the infected populations in Botswana, Ethiopia, Guyana, Haiti, Namibia, Rwanda or Vietnam — 7 of the 15 countries that receive support from the administration’s anti-AIDS program.  
NY Times

“More black Americans are infected with HIV than the total populations of people living with HIV in seven of the 15 countries served by PEPFAR,” Wilson said.

“Were black America a separate country, it would elicit major concern and extensive assistance from the U.S. government. Instead, the national response to AIDS among black Americans has been lethargic and often neglectful.”   – Reuters

“The U.S. response to the epidemic in black America stands in sharp contrast to our response to the epidemic overseas,” said Phill Wilson, a longtime AIDS activist who is executive director of the Black AIDS Institute.

He added that his purpose in making the comparisons is not to criticize the global program but to urge that more money and attention be directed to the domestic one.   – Washington Post

  

The Demographics of HIV/AIDS in Black America

Black American women are 23 times more likely than white women to become infected with the human immunodeficiency virus that causes AIDS, the report found.   – Reuters

Two of the striking features of the epidemic in black Americans is the high rate of infection in women and the frequency of heterosexual transmission, both characteristic of Africa.

The CDC estimates that 38 percent of all new infections in African Americans from 2001 to 2005 were in women. Of new infections in black men and women, 46 percent were the result of heterosexual contact. In the District, about 40 percent of new infections are acquired heterosexually, 30 percent from male homosexual contact, and 15 percent from injected drug use.

Among white Americans during the same period, 16 percent of new infections were in women, and 16 percent of new infections in men and women were attributed to heterosexual transmission. […]

“I think there are important parallels between the epidemic in Africa and the epidemic among black people in the United States,” said Helene D. Gayle, an epidemiologist who spoke in support of the new report during a teleconference yesterday. “In a lot of places, it is a generalized epidemic.” […]

“The report cited numerous other similarities between the African and African American epidemics. In each, there is HIV prevalence in some rural areas (such as the Mississippi Delta) as high as in cities. Sexual networks in which people have many partners at the same time — rather than practicing “serial monogamy” with many partners — is characteristic of both. So are the assertions by many women that they are powerless to negotiate condom use or abstinence.”  
Washington Post

  

What Needs to Be Done?

“The federal government’s approach to the epidemic in black America is fundamentally flawed,” Gayle said. This includes both a lack of funding and poor targeting of the money, she said.

Approaches that would work among black Americans include policies to empower women. “Black women often cannot insist on abstinence or the use of condoms for fear of violence or other emotional trauma,” Gayle said. […]

A lack of education works against young people, who are often powerless and in sexual relationships with older people, who can infect them, Gayle said. Wider testing for HIV among blacks is also essential, the report stressed.

And better prevention messages that use language that will reach drug users, youths and men who have sex with men are key.

“We have focused on abstinence-only (methods) even though they don’t work in our community,” Wilson said.

Information about condom use is important, Wilson said. “We also need to look at needle exchange,” he said — noting that although needle exchange programs work to reduce HIV transmission while doing nothing to encourage drug use, they are frowned upon by the federal government.

Education campaigns can battle myths about disease transmission, as well as conspiracy theories that cause many blacks to mistrust the medical system, Wilson said.   – Reuters

Kevin A. Fenton, the head of HIV/AIDS prevention at the Centers for Disease Control and Prevention, said the argument that government prevention efforts are not tailored to the black epidemic is mistaken. “CDC prevention efforts have really tried to follow the epidemic,” he said.

The proportion of AIDS-prevention funding devoted to the black community has risen as the epidemic has become more concentrated there and now constitutes about $300 million of the $600 million spent each year, Fenton said.   – Washington Post

[T]he hypothetical nation of black America would rank below 104 other countries in life expectancy.

Those and other disparities are “staggering,” said Dr. Kevin A. Fenton, who directs H.I.V. prevention efforts at the Centers for Disease Control and Prevention, the federal agency responsible for tracking the epidemic in the United States.

“It is a crisis that needs a new look at prevention,” Dr. Fenton said. […]

The international effort is guided by a strategic plan, clear benchmarks like the prevention of seven million H.I.V. infections by 2010 and annual progress reports to Congress, the group said. By contrast, it went on, “America itself has no strategic plan to combat its own epidemic.”

In a telephone interview, Dr. Fenton said, “We recognize this is a crisis, and clearly more can be done.”   – NY Times

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~ by h.e.g. on August 2, 2008.

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