CNN, July 29, 2008
The AIDS epidemic among African-Americans in some parts of the United States is as severe as in parts of Africa, according to a report out Tuesday.
“Left Behind—Black America: A Neglected Priority in the Global AIDS” is intended to raise awareness and remind the public that the “AIDS epidemic is not over in America, especially not in Black America,” says the report, published by the Black AIDS Institute, an HIV/AIDS think tank focused exclusively on African-Americans.
“AIDS in America today is a black disease,” says Phill Wilson, founder and CEO of the institute and himself HIV-positive for 20 years. “2006 CDC data tell us that about half of the just over 1 million Americans living with HIV or AIDS are black.”
Although black people represent only about one in eight Americans, one in every two people living with HIV in the United States is black, the report notes.
o AIDS remains the leading cause of death among black women between ages 25 and 34. It’s the second-leading cause of death in black men 35-44. Explainer: AIDS: A black disease »
According to this report, if black Americans made up their own country, it would rank above Ethiopia (420,000 to 1,300,000) and below Ivory Coast (750,000) in HIV population. Both Ethiopia and the Ivory Coast are among the 15 nations receiving funds from the President’s Emergency Plan For Aids Relief. The United States has given about $15 billion to PEPFAR nations in the past five years.
The Black AIDS Institute says it’s not criticizing the federal government for helping poorer countries cope with the AIDS epidemic. Rather, it’s saying the “AIDS epidemic [in the U.S.] is not getting the kind attention that it merits.”
“We understand the needs of black folk in Johannesburg (South Africa),” Wilson says. “Why can’t we understand the needs of them in Jackson, Mississippi? We understand the needs in Nigeria or Botswana, why not understand the needs of Los Angeles or Oakland?”
Wilson says more needs to be done to prevent the spread of HIV in this country. The report states that the U.S. government “increased spending on HIV prevention, treatment and support programs for low-income countries dramatically, at the same time that domestic remained all but flat.”
In this report, Wilson and others urge the federal government and private foundations to significantly increase funding for HIV prevention and treatment programs. The report also calls on international agencies to hold the U.S. government accountable for failure to address HIV/AIDS epidemic in its own country (despite lauding it for its PEPFAR efforts). It also urges black communities in the United States to fight the stigma and overcome prejudice associated with being infected with HIV.
[Editor’s Note: “Left Behind! Black America: A Neglected Priority in the Global AIDS Epidemic” can be read or downloaded here.]
The United States leads the global response to HIV/AIDS, but fails to mobilize the same commitment to address the large and growing epidemic within its own borders, finds a new report released today by the Black AIDS Institute. “Left Behind! Black America: A Neglected Priority in the Global AIDS Epidemic” praises the United States for it vital efforts to address HIV worldwide, but criticizes the government’s profoundly inadequate response to the epidemic within its own borders, where Black Americans are most severely affected by the disease.
“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,” noted Phill Wilson, CEO of the Black AIDS Institute and one of the authors of the report, referring to the U.S. government’s program of extraordinary aid for countries severely impacted by the epidemic. “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.”
“Left Behind!” illustrates a clear and startling gap between the U.S. government’s appropriate concern about AIDS overseas, and its ongoing denial of the epidemic at home—despite the fact that, in areas of the United States such as Detroit, Newark, New York, Washington D.C. and the Deep South, HIV levels among segments of the Black community approach those of many severely affected countries in Africa. For example, HIV prevalence among middle-aged Black men in Manhattan is almost as high as overall prevalence in South Africa, home to the world’s largest population of people living with HIV.
The report points out that, while the U.S. government requires countries receiving PEPFAR support have a national AIDS strategy in place, the United States itself has no strategy for its own epidemic, and was one of 40 countries that failed to fulfill its commitment to report to the Joint United Nations program on HIV/AIDS (UNAIDS) on its response to AIDS at home. At the same time that the United States has dramatically, and appropriately scaled up funding for AIDS overseas, it has simultaneously cut real spending for domestic HIV prevention and care initiatives—even as HIV caseloads in Black America have risen sharply.
“U.S. policy treats AIDS as a foreign policy priority, but virtually ignores the epidemic among Black citizens here at home,” said Rev. Al Sharpton, founder and CEO of the National Action Network (NAN). “U.S. policy makers seem to be much more interested in the epidemic in Botswana than the epidemic in Louisiana. This is an unnecessary and deadly choice. Both need urgent attention.”
What If Black America Were Its Own Country?
“Left Behind! Black America: A Neglected Priority in the Global AIDS Epidemic” incorporates a new analysis by the Black AIDS Institute showing how Black America would rank on the global health and HIV scale if it were a separate country. The results put the U.S. government’s neglect of its own citizens’ healthcare into stark relief.
According to the report:
o Standing on its own, Black America would constitute the world’s 35th most populous country, but would rank 16th in the world in the number of people living with HIV.
o A free-standing Black America would rank 105th worldwide in life expectancy and 88th in infant mortality. Blacks in the U.S. have a lower life expectancy than do citizens of Algeria, the Dominican Republic or Sri Lanka.
o Outside of sub-Saharan Africa, only four countries—and only two in the Western Hemisphere—have adult HIV prevalence as high as the conservative estimate (2% among adults) for Black America. Blacks represent about one in eight Americans, but account for one in two people living with HIV in the U.S.
o Despite extraordinary improvements in HIV treatment, AIDS remains the leading cause of death among Black women between 25-34 years and the second leading cause of death in Black men between 35-44 years.
o Black women in the U.S. are 23 times more likely than White women to be diagnosed with AIDS.
o Blacks make up 70% of new HIV diagnoses among teenagers and 65% of HIV-infected newborns.
“The AIDS pandemic, including the epidemic right here at home, is a worldwide crisis. That is why we must ensure it is addressed it in a truly global way,” said Barbara Lee, member of Congress from California and a co-author of the legislation that created PEPFAR.
A Misdirected Response
“Left Behind!” posits that the Federal government is taking a fundamentally flawed approach to the epidemic in Black America, applying the prevention paradigm developed for concentrated epidemics, which focuses almost exclusively on so-called “high-risk” groups.
“The ‘concentrated epidemic’ approach reflects a fundamental misunderstanding of the social networks of Blacks in America. We are experiencing an epidemic with significant transmission beyond vulnerable populations. Nothing short of a mass Black mobilization will be sufficient to turn around the AIDS epidemic in Black America,” noted Wilson. “The U.S. should understand from its work in countries with similar epidemiological profiles that a more effective approach for Black America would include a mix of targeted programs for high-risk populations; broad-based initiatives that mobilize entire communities; and efforts to address the role of concurrent partnerships and the rapid spread of HIV transmission in social networks.”
“Black women are particularly affected by the domestic AIDS response and attention to their needs are inadequate. Lives are lost as a result,” said Dr. Helene Gayle, President/CEO of CARE. “As in other parts of the world, Black women in the U.S. often face increased vulnerability to HIV due to lack of a perception of power in sexual relationships and low self-esteem. Many cannot insist on abstinence or the use of condoms because of fear of emotional or physical abuse by their partners. Development of female-initiated prevention methods is not only a critical priority for Black women overseas, but also for Black women here at home.”
The report illustrates that young people in Black America, as in other parts of the world, are often at highest risk of infection because of inadequate knowledge of HIV infection, a high prevalence of inter-generational relationships, and a shortage of youth-tailored HIV prevention programs. And it points out that the silence that masks the particularly high risk of HIV confronting men who have sex with men in Africa and other heavily impacted regions also exacerbates AIDS in Black America. “Among men who have sex with men worldwide, Blacks in the U.S. may have the highest HIV prevalence. In the U.S., Black gay men experience more than twice the rate of infection as their White counterparts,” noted Jesse Milan, Vice President of the non-profit health management consultancy Altarum. “Black men who have sex with men in the U.S. share important attributes related to HIV risk with their peers in other regions, including the experience of severe stigma and discrimination that often impedes HIV prevention efforts.
Drug use is one of the leading modes of HIV transmission in the U.S., particularly among Blacks, who account for more than half of drug-related HIV infections in the U.S. Black America experiences some of the same challenges to effective HIV prevention as other heavily-impacted regions of the world, such as government hostility to evidence-based harm reduction strategies and high rates of incarceration without adequate access to HIV prevention or treatment.
When it comes to AIDS treatment, the report shows that many of the same factors that contribute to excessive rates of HIV illness and deaths in developing countries also apply to Black America—including late initiation of treatment, a high prevalence of co-occurring medical conditions, and impediments to treatment adherence.
Reversing the AIDS Epidemic in Black America: An Action Agenda
“Left Behind! Black America: A Neglected Priority in the Global AIDS Epidemic” presents a clear action agenda for bringing the U.S. response to AIDS at home on a par with U.S.-supported efforts to fight the epidemic overseas. Among these, the report calls for immediate action to:
o Enhance support for community mobilization against HIV in Black America, including efforts to mobilize Black America to fight stigma, overcome prejudice, and promote solidarity against the epidemic. Leading Black organizations, constituencies and media outlets are struggling to promote AIDS information and prevention with little or no government support. Far greater government support is needed to maximize the impact of community responses to the epidemic in Black America.
o Significantly increase support for the scale-up of essential HIV prevention, treatment and care services in Black America. In particular, the report notes the dire need for increased funding for HIV prevention efforts in Black America; the virtual absence of prevention strategies designed for Black Americans; and the need to prioritize research on HIV vulnerability and infection patterns that Black America shares with other countries.
o Break the silence on AIDS in Black America. The report calls on global AIDS leaders to speak out on the neglect of the epidemic in Black America. While the U.S. government should be lauded for the PEPFAR initiative, it must also be held accountable for its failure to address the epidemic within its borders.
“America has claimed a leadership role in the fight against the global HIV epidemic,” said Wilson. “Yet, America’s failure to respond to its own epidemic among its Black citizens undermines its credibility in addressing AIDS epidemic worldwide. For the U.S. to truly be a global AIDS leader, it must put its own house in order, too.”