Black AIDS Institute CEO Phill Wilson says that those who belong to the populations most affected by the disease must mobilize to ensure their own survival.
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By RYAN LEE
Monday, December 04, 2006
The elusiveness of AIDS is part of what has made the disease such a formidable enemy of human life over the last 25 years.
In the early 1980s, it took scientists years into the epidemic to determine exactly what was killing thousands of Americans, most of them gay men. Once that cause — a virus — was discovered, HIV showed its cunningness again with its ability to outsmart an army of medications, mutating its appearance to avoid detection by the healing drugs.
The disease is as hard to pin down socially as it is medically, which might help explain why, as HIV-fighting science and information has gotten better and better, the number of people infected with the disease continues to climb. Everyone knows they can get it, but few think they will.
For years, it was easy for many Americans to ignore AIDS because many believed it to be only a gay disease. Today, many gay Americans seem to have joined their fellow citizens in not paying much attention to HIV/AIDS, thanks to the widespread belief that it is now an African disease.
“People are so much more concentrated on the international epidemic that they forget we have not yet dealt effectively with this epidemic at home,” said Rowena Johnston, director of research for the Foundation for AIDS Research. “Of all the developed countries, the United States is doing worse in terms of [domestic] HIV.”
Many experts believe a dichotomy exists in U.S. AIDS policy as well, as the government takes the lead role in fighting the disease across the globe, while the astonishingly high infection rates that continue to be seen domestically are met with relative silence and inaction from public officials.
Yet another piece of the AIDS puzzle is figuring out whom the disease is affecting domestically. Is it a gay disease? A black disease? A heterosexual female disease? A human disease?
“It’s one disease, but the sociopolitical factors make it such a different epidemic in every part of the world, even in different parts of the United States,” Johnston said. “This is a wily virus — it throws up barriers to everything we’ve thrown at it.”
The question of who is being most affected by HIV/AIDS in the U.S. has been answered to a certain extent — African Americans, and gay men, with both groups accounting for 49 percent of new HIV diagnoses in 2005, according to the Centers for Disease Control & Prevention. Still, another, more blunt question lingers: Who cares?
“The whole universe of who is focusing on AIDS is getting smaller, and smaller and smaller,” said Phill Wilson, founder and CEO of the Black AIDS Institute.
‘HIV is a gay disease’
The domestic HIV/AIDS epidemic couldn’t have asked for a more prominent platform than when it was recently discussed on one of America’s most-watched and influential television programs. The Oct. 24 episode of “The Oprah Winfrey Show” introduced viewers to the “new faces of AIDS,” but Jim Key kept waiting for Winfrey to mention the group of Americans most impacted by HIV/AIDS.
“As a society we have so effectively de-coupled sexual orientation from this disease, and that’s been to the detriment of our community,” said Key, chief public affairs officer for the Los Angeles Gay & Lesbian Community Center.
Last month, the L.A. Gay & Lesbian Center embarked on a controversial but unapologetic campaign that included the tagline, “HIV is a gay disease.” Leaders at the Gay & Lesbian Center concede that the statement is provocative, but challenge anyone to dispute its accuracy in a city where 75 percent of people living with HIV/AIDS are gay and bisexual men.
“Our objective was to initiate a new dialogue about HIV prevention,” Key said. “Our community no longer realized the extent to which HIV continues to disproportionately affect gay and bisexual men.”
A recent analysis of U.S. Census data estimated that gay men and lesbians account for about 4 percent of the U.S. population. According to data released by the CDC to coincide with World AIDS Day on Dec. 1, gay and bisexual men comprise 45 percent of all Americans living with HIV, and represented 49 percent of all new HIV diagnoses in 2005.
Of the more than 1 million Americans living with HIV, 74 percent are men, and of those men, between 67-72 percent of them contracted the disease via gay sex. National estimates suggest that 25 percent of white gay men are living with HIV, compared to 50 percent of black gay men.
“These are numbers that mirror the very worst African countries in terms of prevalence of HIV,” said Johnston, who nevertheless is somewhat weary of the L.A. Gay & Lesbian Center’s prevention campaign.
“We take ourselves back to square one, where we’re fighting to get it known that HIV/AIDS doesn’t care whether you’re gay or straight — the virus doesn’t know your sexual orientation,” Johnston said.
But as HIV/AIDS continues to infect alarming numbers of gay and bisexual men, the social discussion about the disease has shifted, as has the make-up of those at the leadership and policy-making table, said Susan Cohen, director of health education & prevention at the L.A. Gay & Lesbian Center.
“Gay men are exiting the process when we need them back at the table,” Cohen said. “Right now, around our planning tables, gay men have to come back … If gay men aren’t going to stand up for themselves, who is?”
‘AIDS today is a black disease’
Some people worry that labeling HIV/AIDS a “gay disease” or a “black disease,” could open up members of those groups to additional discrimination or exploitation, but to gloss over reality undermines the fight against the disease, said Anthony Fauci, director of the National Institute of Allergy & Infectious Diseases.
“If we drop back and say that the answer to stigma is to not point out the people who really need most the kinds of things that we’ve been talking about, I don’t think you’re going to substantially reduce stigma,” Fauci said. “But what you might do is take attention away from the people who really need the attention.
“To kind of gloss over that 47 to 50-plus percent of new infections are among African Americans, then the resources are going to sort of diffusely go out there to someone picking corn in Iowa somewhere,” Fauci added.
African Americans are about 12-13 percent of the U.S. population, but represent 47 percent of Americans living with HIV, and 49 percent of Americans who were diagnosed with HIV in 2005, according to the CDC. Black men are nearly seven times as likely to have HIV as white men, and twice as likely to be infected as black women. Black women have an HIV diagnosis rate 20 times higher the rate for white women, according to the CDC.
In Washington, which has one of the highest HIV prevalence rates in the nation, 85 percent of cases are among blacks, said Marsha Martin, senior deputy director for HIV/AIDS administration in the Washington, D.C. health department.
“You have to call it for what it is … AIDS today is a black disease, plain and simple,” said Wilson of the Black AIDS Institute. “So we have to get black folks, black institutions to take ownership of this disease.”
Fighting for funding
Those fighting the HIV/AIDS epidemic among blacks can look to early gay AIDS activists for important lessons on how to effectively combat the disease, said Wilson, who noted that the number of annual HIV cases dropped from 160,000 in the 1980s, to 40,000, where it has been for the last 10-15 years.
“[The drop] was a direct response to that kind of all-hands-on-board response of the gay community,” Wilson said. “In the early-to-mid-’80s, every institution in gay America was engaged in fighting AIDS.”
Wilson, who is gay, adds that the terms “black” and “gay” are not mutually exclusive, and “no matter how you look at it, black gay men are in the crosshairs of this epidemic.”
Indeed, the CDC estimates that 46 percent of black men living with HIV/AIDS contracted it through homosexual conduct, compared to 24 percent who were infected through IV drug use, and 22 percent who reported getting the disease through heterosexual conduct. Among white men living with HIV/AIDS, 76 percent reported getting the disease through gay sex, according to the CDC.
Wilson and Key of the L.A. Gay & Lesbian Center agree that HIV/AIDS is both a black and gay disease, and the two groups must realize they are fighting a common enemy. But with the “face of AIDS” determining how resources are allocated, gay men risk being left out if they are no longer included in mainstream discussions, Key said.
In 2006, the CDC spent about $650 million on HIV prevention activities, with 43 percent of the money targeting blacks. The CDC did not have estimates for the percentage of prevention dollars that targeted gay and bisexual men, but CDC sources indicated that “more prevention efforts are targeted to [gay and bisexual men] than any other population.”
The CDC provides about $350 million to state and local prevention programs targeting high-risk populations such as gay and bisexual men, including $8 million specifically to supplement efforts for young gay men of color. Of the 141 community-based organizations that receive CDC funds to implement federally recommended HIV prevention programs, 112, or 79 percent, target gay and bisexual men, according to the CDC.
The diversification of the HIV/AIDS epidemic presents “increasing challenges amongst stable resources,” according to sources at the CDC, which has been virtually flat-funded during the Bush administration.
“The president in his ’07 budget, really for the first time, he has acknowledged the need for increasing investments in the domestic HIV epidemic,” said Kevin Fenton, director of the CDC’s National HIV, STD & TB Prevention.
For Bush and many Americans, the image of African women who get HIV/AIDS from their unfaithful partners, then pass the disease along to their innocent babies, evokes more empathy than the faces of those who comprise the domestic epidemic, said amfAR’s Johnston.
“It’s so easy for us to have sympathy for those people … but when we say that, we’re relegating everyone else to the ‘guilty’ side of things,” Johnston said. “There is a segment of people who feel that people in the United States know better, they deserve what they get, and why should I care?”
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