The Final Call

“HIV/AIDS and the African- American Community 2018: a Decade Call to Action,” a new paper published in the Journal of Racial and Ethnic Health Disparities, showed that at the end of 2014, there were 471,500 Blacks living with HIV.

“We really need to have an all hands on deck approach in terms of HIV/AIDS and the crisis in the Black community, and we must mobilize as a community to really work to address this, because left as it is, I don’t think this is going to improve greatly,” said Dr. Cato T. Laurencin, lead author, Van Dusen Distinguished Professor of Orthopedic Surgery at UCONN Health, which oversees clinical care, advanced biomedical research, and academic education in medicine at the University of Connecticut.

Blacks represent 17,528 of the estimated 39,782 newly-diagnosed infections, according to the 2016 HIV Surveillance Report by the Centers for Disease Control and Rehabilitation. Fifty-eight percent, or 10,223 incidents of Blacks diagnosed with HIV, were men having sex with men.

Combating HIV/AIDS must include focusing on prevention for Black men, argued Dr. Cleo Manago, founder of Black Men’s Xchange. Most prevention conferences that focus on HIV/AIDS target Black women, he said.

“I feel it’s very important to focus on Black women, but Black women are getting HIV from Black men,” Dr. Manago added.

He feels only focusing on women leads to risks for Black women and Black men and isn’t wise.

Blacks need to embrace an indigenous African sense of self and culture, and not focus on issues around sexuality, including prostitution and homosexuality, to stop HIV/AIDS, he said.

In February 2018, the Black AIDS Institute opened three clinics in Los Angeles. One focuses on prevention and treatment, a second specializes in Black men’s health, HIV, Hepatitis, STDs, prostate cancer, diabetes, family medicine, dental, and mental health, and a third on Black women and children.

Since last year, the organization has tested over 1,000 people and they’ve found alarming HIV positive rates ranging from three percent to eight percent, according to Phill Wilson, president and CEO of the Black AIDS Institute.

Graphic: link.springer.com

Resources to fight HIV and AIDS are drying up, and there is a lack of media attention, he said. “Many people believe that the epidemic is over, so they don’t have to worry about it so much,” Mr. Wilson stated.

He urged Blacks to focus on ways to reach young people and engage people where they are.

“I believe that there is a light at the end of the tunnel, but it requires us to take action. It requires us, no matter who we are, no matter what we’re doing, no matter what we’ve been doing, to look to see if there’s something that we are not doing that we need to be doing,” Mr. Wilson stated.

He added, “An important thing to remember always is that each number represents a person and each person is a part of a family, and families are what make up communities, and so the numbers aren’t really important, but the people and the families and the communities are important, and those are the stories that we need to tell. Those are the folks that we need to fight for, and those are the folks that we need to be for.”

Gary Bell, CEO of Philadelphia- based BEBASHI Transition To Hope, said it’s true that Blacks are disproportionately affected by HIV. Mr. Bell is a licensed clinical social worker.

“One of the biggest determinants is poverty. Black people are disproportionately impoverished and there is a whole host of what we call social determinants of health such as homelessness, substance abuse, domestic violence incarceration, a number of things that make us more vulnerable to any type of major health problems,” he said.

“Another factor has to do with location. Black folk dating back to when we fled the South were pushed into certain neighborhoods creating high density. One is more likely to become infected because the area where you live has a higher rate of HIV. So it has more to do with where you live and who you interact with than risk behaviors. Risk behaviors we know are what infects people but studies have shown Black people are not riskier than other folks. We are just more likely to come in contact with someone who is HIV because we are all pigeonholed in these low income neighborhoods where HIV is more prevalent. In Philadelphia about 67 percent of people living with HIV are African Americans.”

BEBASHI used to stand for Blacks Educating Blacks About Sexual Health Issues and was created in 1985. The group says it was the “first minority-based, AIDS service organization in the United States.”

“We provide a continuum of care around sexual health ranging from education to HIV, STD and pregnancy counseling and testing. We also provide case management for HIV positive individuals, and offer specialized case management working with women, older adults (50-plus years), African immigrants, and ex-offenders,” he said.

According to Mr. Bell, his group is the only AIDS service organization working with all 27 state prisons to provide discharge planning for inmates six months prior to release. The group also offers housing counseling, care outreach, support groups, a food cupboard, and is involved in a national research project with the Centers for Disease Control and Prevention called the Black Men’s Health Survey. “We gather information on the prevalence and incidence rates of HIV-infection in the Black MSM (men having sex with men) population,” Mr. Bell explained. “We serve over 15,000 each year and collaborate with over 80 social service organizations in the area to further enhance our services. All services are free of charge.”

Black women were 60 percent (139,058) of the total population of women living with diagnosed HIV at the end of 2014.

From 2005 to 2014, new HIV diagnoses among Black women fell 42 percent, but are still significantly higher compared to other races and ethnicities.

Whites were 26 percent of new HIV cases in 2016, Hispanics 25 percent, Asians two percent, and American Indian/Alaska Natives one percent.

Other multiple races were two percent.

Of the 38 U.S. children under age 13 who received new AIDS diagnoses, 25 were Black, indicating that Black children are three times more likely to be diagnosed with AIDS than the total population, researchers reported.

“We have to make sure that the Black community has a high awareness of the issue of HIV/ AIDS and that everyone over age 13 should be tested for HIV, have themselves tested to know what their HIV status is. It’s just that important, because one in every seven in our community don’t know our HIV status. Just by knowing would be a step in going a long way,” said Dr. Laurencin.

A second solution is to work to eradicate Sexually Transmitted Diseases, which can make one more prone to getting HIV/ AIDS, he said.

The CDC did not reply to a Final Call inquiry about funding and allocations for the Black community, but indicated there has been progress in prevention in recent years.

Blacks don’t engage in risky behaviors more often than other races or ethnicities, the federal agency said. Other factors may increase the risk of HIV infection among Blacks, including lack of access to health care, poverty, high rates of incarceration among Black men, stigma, and homophobia, the CDC and HIV/AIDS activists said.

The CDC has created a strategy to reduce the incidence of HIV/AIDS through 2020, but the paper’s authors said even stronger measures are needed to reduce the number of new HIV cases in the Black community.

The authors recommend a five step action plan for community leaders, including policymakers, public health practitioners, and others. Get active in Black communities and participate in free or reduced cost HIV/ AIDS testing in local areas, they urged.

Their plan calls for eliminating prejudice and unconscious bias in treating patients, knowledge and understanding of new approaches to treatment, nuances in medications, and other issues related to HIV/AIDs, they said.

Awareness of the epidemic and its impact on the Black community must also be increased, they said.

“I don’t believe that the level of attention and the level of discourse that should be taking place has been taking place,” said Dr. Laurencin.

The plan calls in part for the recruitment of advocates and activists to eradicate secondary factors such as incarceration rates, poverty, and STDs, that increase the chances of contracting HIV.

“I think if we’re waiting for some governmental organization to make the change for us, then we’re going to be disappointed, because it really has to be the community itself coming together and saying these numbers are not acceptable and that we will make this a major priority for change,” said Dr. Laurencin. “It’s got to be from the community center, from the churches, to the mosques, to across the neighborhoods.”

The National Medical Association, which represents Black physicians, has been promoting prevention and educating and engaging health care providers to develop expertise to provide HIV medications to patients and educate their patients on PrEP (Pre-Exposure Prophylaxis), offered as one-pill-a-day to prevent HIV infection.

“The average costs of HIV treatment medications total $12,000 annually, and people just can’t afford that. Also, young, Black men are less likely to be exposed to the health care system compared to other populations,” said Dr. Virginia Caine, infectious disease specialist and principal investigator of the National Medical Association’s PACT (Partnering and Communicating Together) Initiative project.

HIV/AIDs is still as deadly for Blacks today due to some basic, social determinants, where they live, work, play, said Cynthia Davis, assistant professor in the Colleges of Medicine and Science and Health at Charles Drew University of Medicine and Science.

“It’s all of the things that are impacting us in our community in terms of being under stress, the trauma that we’re faced with, not having access to health care, not knowing what the clinical signs and symptoms are of these STDs, so not seeking out medical care immediately when you have a health condition, not thinking that it can happen to you, thinking that still 40 years into the epidemic that it’s a gay disease,” Prof. Davis told The Final Call.

She and longtime health advocates say infection rates should still matter, because currently in the U.S., there’s an epidemic of STDs, especially syphilis. Data has proven that someone with an STD, who comes in contact with someone who is HIV infected, is 3-5 times more likely to contract HIV if they are having unprotected sex.

Prof. Davis said all of those factors take on a synergistic effect in terms of why these numbers are still so high after almost 40 years in the Black community, and why Blacks are still getting sick, still suffering, and still dying.

The HIV/AIDS crisis still matters, but the CDC funding has been cut back in primary prevention areas and more is being poured into PrEP promotion and education, said Prof. Davis.

“They think that that’s the panacea and that’s what’s going to bring these numbers down in our community, but the CDC just came out with a report, one, two months ago, where they’ve been analyzing and doing assessments on how effective have they been in promoting PrEP and our people opting to get access to PrEP and the findings show that the majority of people on PrEP in the United States—and they’re only a little over 70,000-80,000 of them, high-risk negatives, are Caucasian people,” she said. Blacks have not responded to this outreach campaign to go on PrEP for some reason, she said.

Blacks were 44 percent of those infected with the HIV virus, though only 12 percent of the U.S. population.

Dr. Ava Muhammad, national spokesperson for the Honorable Minister Louis Farrakhan, noted that HIV/AIDS has been controversial since first identified in 1981. She said the statistics of HIV/AIDS in the Black community is indicative of its decline on the societal ladder.

“AIDS is just simply one of a plethora of issues that we not only have not seemed to overcome, and other ethnic groups and races and segments of the population have gained control over with the exception for us, but all of those things are impacted by our living conditions more than anything,” Dr. Muhammad stated.

She cited the increase of Black male incarceration, as one factor. The probability of contracting the virus increases, because the close quarters and inability to be mobile in an all-male population does not decrease the sex drive, she said.

“As the Honorable Minister Louis Farrakhan has stated, we’re tested for these things going into the prison population, but we’re not tested coming out of the prison population,” Dr. Muhammad stated.

“The policies and the various forms of genocide that are in effect in the United States, in my view, are what combine together to feed the increase in this problem,” said the Nation of Islam student minister, attorney, author, and talk radio host.

She argued the same could be said for increased rates in any type of illnesses in Blacks, whether it’s breast cancer, obesity, diabetes, homicides, or infant mortality rates, much less rates warranting children as young as 13 be tested for HIV.

“I find it appalling, the same way as I’m seeing toddlers going to (immigration) court and our youth going to funerals and protests in the wake of death, and flowers and teddy bears in the front yards and on the curb where someone 12 or 15 or 18 or 22 died! To me it’s the same thing, to have to add this to the list of traumatizing experiences,” Dr. Muhammad stated.

She understands the view point of medical professionals and activists in wanting to stem the tide of infections, but said it is putting a band aid on a gunshot wound.

“Obviously, as long as we’re afflicted with this situation, we do need to do what we can to try to stem it, but what does it do to a 12 and 13 year old that they have to be subjected to this at that young age?” she asked.

“It just speaks to the Minister’s tweet in Part 38 of ‘The Time and What Must Be Done,’ the Caucasians are totally disagreeable to live with. And the longer we stay in and among them, the harder it is for Black people to accept that truth, but we can choose between the larger truth and bite the bullet and make the move or we can continue to splash water on a four-alarm fire,” she said.

(Michael Z. Muhammad contributed to this report from Philadelphia.)