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USA: AIDS & Black America
AfricaFocus Bulletin
Aug 2, 2008 (080802)
(Reposted from sources cited below)
Editor's Note
"U.S. policy treats AIDS as a foreign policy priority, but
virtually ignores the epidemic among Black citizens here at home,
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." - Rev. Al Sharpton
In a new report, "Left Behind!", the Black Aids Institute in Los
Angeles documents the neglect of extent of the AIDS epidemic
among Black Americans. According to Phill Wilson, CEO of the
institute Black AIDS Institute and one of the authors of the
report, "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 [President's Emergency Plan for AIDS Relief."
Wilson and a wide range of other experts involved in the report
applaud the efforts to treat AIDS in Africa, but call for a
comparably urgent response at home.
In areas of the United States such as Detroit, Newark, New York,
Washington D.C. and the Deep South, the report notes, 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.
"Left Behind!" argues 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. In some segments of Black America, however, the
report notes, HIV has spread significantly beyond high-risk groups,
as in many African countries. Once this is the case, the
mathematics of the risks of transmission changes, requiring a more
comprehensive mix of strategies against the epidemic.
This report is one indication that the fight against AIDS, in the
United States as well as in Africa, is still only beginning.
Despite greatly increased awareness and investment over the last
decade, The scale of the response is still too small, and
scientific knowledge about the complex virus, the social paths of
its transmission, and effective strategies to combat it are far
from adequate. A recent genetic study, for example, shows that a
specific gene that evolved to protect against malaria also
increases susceptibility to AIDS by as much as 40%. (For news
stories see http://tinyurl.com/635n9c). Without this gene, the
study researchers estimate, the burden of AIDS might be some 11%
lower.
This AfricaFocus Bulletin contains the executive summary of the
Black Aids Institute report. The full report is available at
http://www.blackaids.org
Another AfricaFocus Bulletin sent out today contains excerpts and
links to several other new reports on the fight against AIDS
released recently, as the XVII International AIDS Conference gets
under way this coming week in Mexico City
(http://www.aids2008.org).
For a selection of books on AIDS & Blacks in the Americas,
including the United States and Haiti, visit the AfricaFocus
Bookshop at
http://www.africafocus.org/books/themes.php#aids2 or
http://www.africafocus.org/books/themes_uk.php#aids2
For previous AfricaFocus Bulletins on health issues, visit
http://www.africafocus.org/healthexp.php
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U.S. Leads Global Efforts Against Aids, but Neglects the Epidemic
in Black America, Says New Report
7/29/2008
Black AIDS Institute Report Finds AIDS in segments of Black America
as Severe as in Many African Countries, But Receives Much Less
Attention.
(Los Angeles, CA) -- 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 its 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:
- 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.
- 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.
- 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.
- 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.
- Black women in the U.S. are 23 times more likely than White women
to be diagnosed with AIDS.
- 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:
- 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.
- 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.
- 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."
AfricaFocus Bulletin is an independent electronic publication
providing reposted commentary and analysis on African issues, with
a particular focus on U.S. and international policies. AfricaFocus
Bulletin is edited by William Minter.
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