The U.S. government is not doing enough to address the spread of HIV/AIDS among blacks in the country, according to a report released on Tuesday by the Black AIDS Institute, the Washington Post reports. According to the report, HIV/AIDS among U.S. blacks in areas of the country with the most concentrated epidemic resembles that seen in many African countries.Advertisement
The report says that HIV/AIDS should be seen as a threat to the entire black community in the U.S. and not just specific high-risk groups. HIV increasingly is transmitted among blacks through heterosexual activity through "networks" in which men have many sexual partners at the same time, according to the report (Brown, Washington Post, 7/30). The report, which was funded by the Ford Foundation and the Elton John AIDS Foundation, says that almost 600,000 blacks in the U.S. are living with HIV and that up to 30,000 are contracting the virus annually. When adjusted for age, the death rate from AIDS-related causes among blacks with HIV is two-and-a-half times greater than among HIV-positive whites (Altman, New York Times, 7/30). Two percent of blacks in the U.S. are HIV-positive, according to government estimates, and the report says that only four countries outside Africa have a higher HIV prevalence. If the U.S. black population were a separate country, it would rank 16th worldwide in the number of people living with HIV, according to the report. Washington, D.C., has the highest HIV prevalence of any jurisdiction in the U.S. of about 5%, or one out of every 20 residents. If viewed in this way, the U.S. black epidemic "would undoubtedly elicit major concern and extensive assistance from the U.S. government," the report says.
Black AIDS Institute Executive Director Phill Wilson said that the U.S. "response to the epidemic in black America stands in sharp contrast to our response to the epidemic overseas" (Washington Post, 7/30). The report found that more blacks in the U.S. are living with HIV than people in Botswana, Ethiopia, Guyana, Haiti, Namibia, Rwanda and Vietnam -- seven of the 15 countries targeted in the President's Emergency Plan for AIDS Relief. PEPFAR is guided by a strategic plan, clear standards and annual progress reports to Congress, the report said, adding, "America itself has no strategic plan to combat its own epidemic" (New York Times, 7/30). According to Wilson, the purpose of making the comparison between PEPFAR and U.S. domestic efforts is not to criticize the global program but to call for more money and attention for domestic issues (Washington Post, 7/30). "When we give aid to foreign countries, we demand that they have a national AIDS plan, but we don't have a plan in the United States," Wilson said (Fulbright, San Francisco Chronicle, 7/30).
In sub-Saharan Africa, 60 percent of new HIV cases occur among women, and the vast majority of all cases are acquired through heterosexual contact. "I think there are important parallels between the epidemic in Africa and the epidemic among black people in the United States," Helene Gayle, president of CARE
, said, adding, "In a lot of places, it is a generalized epidemic." The report also found numerous similarities between the African and U.S. black HIV/AIDS epidemics, according to the Post
. HIV prevalence in rural areas in both epidemics is as high as in cities. In addition, sexual networks in which people have many partners at the same time are common in both, as are the declarations by many women that they do not have the power to negotiate condom use or abstinence (Washington Post
According to Gayle, the U.S. should devote more resources to care for sexually transmitted infections, which can increase a person's risk of HIV. She added that the government and communities should promote increased testing among all populations, particularly blacks, to detect HIV at its earliest stages when treatment is more effective. In addition, she said that more needs to be done to promote needle-exchange programs (New York Times, 7/30). The Rev. Al Sharpton during a news conference about the report said that the U.S. "must have a policy that strictly deals with the racial imbalance. To not deal with the disproportionate way it hits black America is doing a disservice to the issue and a disservice to black America" (San Francisco Chronicle, 7/30). Gayle said that the "federal government's approach to the epidemic in black America is fundamentally flawed" (Fox, Reuters UK, 7/29). The report also calls on global HIV/AIDS leaders to speak out about the situation in the U.S. and says that black communities should fight stigma and discrimination (San Francisco Chronicle, 7/30).
Wilson also criticized the Bush administration for promoting abstinence programs. According to Wilson, studies have shown that abstinence programs do not provide information for people who later become sexually active. He added that the administration has continued a ban on federal funding for needle-exchange programs. "We've allowed ideology to trump science," Wilson said (Lauerman, Bloomberg, 7/29).
The disparities in HIV/AIDS in the U.S. are "staggering," Kevin Fenton of CDC said, adding, "It is a crisis that needs a new look at prevention" (New York Times, 7/30). Fenton added that CDC "prevention efforts have really tried to follow the epidemic." According to Fenton, the proportion of HIV/AIDS prevention funding devoted to the black community has increased as the epidemic has become more concentrated and now totals about $300 million of the $600 million spent annually (Washington Post, 7/30). Bush administration spokesperson Emily Lawrimore said that the administration is spending $402 million in the current fiscal year to fight HIV/AIDS among minority groups. She added that more than $99 billion has been spent for HIV/AIDS treatment and care since 1991. "The administration is committed to fighting HIV/AIDS in African-American communities and in all communities," Lawrimore said (Bloomberg, 7/29).
The report is available online (.pdf).
CNN on Thursday included a segment on the report.
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Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, or sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv. The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of the Kaiser Family Foundation, by The Advisory Board Company. © 2008 by The Advisory Board Company and Kaiser Family Foundation. All rights reserved.