Your Destiny Is in
Your Own Hands
AIDS activist Rae Lewis-Thornton doesn't mince words when she talks about the importance of personal responsibility in preventing the spread of HIV. "No one can infect you if you don't let them infect you," the 38-year-old Chicago AIDS educator says. "No one does anything to you that you haven't permitted. Every time you choose to have sex without a latex condom, you choose to put yourself at risk for HIV."
As a heterosexual African-American woman who has been HIV-positive for 15 years and has dealt with a diagnosis of full-blown AIDS since 1993, Lewis-Thornton speaks about the disease from painful experience. And she believes one of the reasons African-Americans account for more than half of all new U.S. HIV cases each year is an ongoing misperception that AIDS is a white gay men's disease.
"Part of what needs to change is that we need to take ownership—to say that HIV is a problem in our community in a major way," she says. "Once we accept that it is in our environment, in our churches, and on our blocks where we live, then we will see ourselves individually at risk. Right now we don't see that, so we continue to do the things that put us at risk for HIV infection."
The first step in breaking this cycle of risky behavior, she says, is to urge African-American men and women to protect themselves by using a latex condom each time they have sex, even when they believe they are in monogamous relationships.
Lewis-Thornton also suggests that AIDS prevention education targeted at young African-Americans move beyond simply encouraging teenagers to abstain from sex—a message many young people fail to embrace. "We need to also teach them, If you do choose to do it, do it responsibly and understand that having sex can change your life," she states. "This is basic, and it should start with preteens." —Bob Adams
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Strip Away the Stigma
AIDS is hitting African-Americans disproportionately hard, says Helene Gayle, MD, director of the National Center for HIV, STD, and TB Prevention, a division of the Centers for Disease Control and Prevention.
CDC figures show that while African-Americans make up about 13% of the U.S. population, they account for 37% of all U.S. AIDS cases reported through 1998. Researchers estimate that as many as 325,000 African-Americans are infected with HIV. AIDS also ranks as the nation's number 1 killer of blacks ages 25 to 44.
While shocking to some, these statistics are not unexpected to doctors and researchers familiar with minorities' health care issues. Chronic illness rates are typically higher in populations of people of color than whites, particularly among African-Americans, Gayle says. The same long-standing issues of poverty, poor education, racism, and unequal access to information and medical care that contribute to these higher infection levels are also very much at play when it comes to HIV and AIDS.
But African-Americans also have been slow to acknowledge that AIDS poses a serious threat to their communities, Gayle says. Much of this lag can be attributed to a reluctance to talk openly about the disease and its risk factors, including IV drug use and unprotected sex—because of the stigma associated with such behaviors.
"When you think of a community already stigmatized because of racism and poverty—and you add on the further stigmatizing issue of disease—it's not surprising that there are those that simply don't want to deal with it," Gayle notes. "But we cannot afford as a community to make judgments about people's behavior that would deny them services to keep them alive."
Stripping away the stigma through frank and open dialogue is everyone's responsibility, Gayle says. But, she insists, respected business, religious, and political leaders should step up to be pioneers in breaking the silence. "They need to carry the message that it's OK to talk about these things to every place people congregate: in churches, barber shops, fraternities, sororities, bars, out and about, person to person," she says.
Gayle also suggests that high-profile AIDS activists and leaders nationwide should be willing to make room at the table for new voices that speak for their communities' specific needs. "This is all about us sharing equally in the process, and having a desire for true diversity and true partnership will help the process keep moving forward," she says. "This is still everyone's epidemic, and we need everyone's response to end it." —Bob Adams |
Never Forget
About Our Youths
Adolescents and young adults are poised to be the next wave of infections in the AIDS epidemic, says Lisa Henry-Reid, MD, chair of the adolescent division at Cook County Hospital in Chicago. She says an estimated 50% of all new U.S. HIV infections will occur in people under age 25, and a majority of those will be among young people of color.
"The same trends in the adult population are being seen in terms of infections among youth," she explains. "As of December 56% of HIV cases in the 13-to-19 age group were African-American."
The percentage is so staggeringly large due in part to a failure of HIV prevention information to make an impact with adolescents, mostly because the messages are tailored for adults or other specific at-risk groups such as gay men, Henry-Reid says. For teen-focused prevention programs to work, especially those that address youth of color, they must speak to adolescents on their level, in their language, and—in keeping with an increasingly media-oriented world—in ways to catch and keep their attention.
Teenagers also need to be treated with an adult level of dignity and respect by AIDS educators and caregivers, Henry-Reid says. This is particularly true of those struggling with the notion of seeking out HIV testing, counseling, or treatment.
"It's very, very important to dedicate some thought and effort to all activities for adolescents so that they are friendly, respectful, and far-reaching," she says. "We need to make them feel safe and comfortable if we want them to keep using the services available to them. If we fail to do that, we'll have young people continuing to be infected and failing to get the treatment that can keep them alive." —Bob Adams
Return to the Grass Roots
African-Americans need to wage a battle against AIDS with the same sense of urgency that framed the hard-won civil rights victories of the 1960s, says Debra Fraser-Howze, president and CEO of the New York-based National Black Leadership Commission on AIDS, an umbrella organization providing education, public policy, and fund-raising support to community-based AIDS groups.
"It's time to move from ACT UP to 'Black UP,'" Fraser-Howze says, referring to the community-based activist groups that sprang up in the '80s under the umbrella name AIDS Coalition to Unleash Power. "We must have the same sort of civil disobedience that we know worked in the civil rights movement to now focus on HIV and AIDS. To do anything less is suicide."
Fraser-Howze is also adamant in her belief that African-Americans must force politicians—particularly presidential candidates George W. Bush and Al Gore—to recognize that the public health care system has failed black citizens.
"The African-American community is under siege," she says. "We have a higher rate of death from chronic illnesses than all other minorities combined. Every hour seven Americans are infected with HIV, and three of those are African-American. We must make our elected officials see these issues with a sense of alarm."
Black leaders can help this cause by taking a lesson from the tactics used by gay men in the '80s to raise widespread awareness of AIDS' impact on them, Fraser-Howze says.
"We must have mothers come out and become open voices in speaking about HIV," she notes. "We have to work with people in the various industries, like the entertainment industry, where African-Americans spend billions of dollars. We have to go into the schools and churches and beauty shops and every place African-Americans can be found and talk openly and urgently about this. And every black organization, not just black AIDS groups, needs to demand that black health issueas become a national priority." —Bob Adams |
Prisoners Must Not Be Ignored
AIDS rates in U.S. prisons are about six times higher than among the U.S. populace at large, according to estimates by the National Commission on Correctional Healthcare. But HIV infection among inmates often goes undetected and untreated, says Cassandra Newkirk, MD, a correctional psychiatrist and board member of the National Alliance of Minority Correctional Health Care Providers.
With African-Americans accounting for about 46% of inmates serving sentences of a year or more in prisons, according to Justice Department statistics, the issue becomes a serious one for black Americans.
Ironically, obtaining HIV tests and medication is not usually a problem for prisoners, Newkirk says. Instead, the roadblock is in identifying inmates who need services. "They often don't want to be identified," she explains. Any medical condition can be seen by other inmates as a weakness, leading HIV-positive prisoners to shun testing and treatment.
"There's also a perception that AIDS is a gay-male disorder," Newkirk notes. "Male inmates of color might have difficulty in seeking out help because they don't want to be seen as being gay."
For those who are treated, a whole new set of problems can crop up once they are released. Access to free or affordable health care is often unavailable to former inmates, placing them at greater risk of developing AIDS and its associated illnesses.
But many former prisoners with access to medical care don't seek it, worrying that a public acknowledgment of being HIV-positive will add to the stigma of having been imprisoned, Newkirk says. "We need to reach out to these people and talk with them about their concerns and fears so that they can be active participants in their treatment," she suggests. "HIV doesn't care who you are or whether you've been in prison. It crosses all societal, ethnic, and racial barriers, and we need to talk openly about it."
—Bob Adams
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