The War on AIDS Is Not Over

The AIDS epidemic in America is still far too real. And the risk factors have taken on a new face: race and poverty.
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An AIDS activist lights a group of candles placed in the shape of a red ribbon during an event marking World Aids Day in Manila on December 1, 2012. Discrimination against homosexuals and people infected with HIV is contributing to the rapid rise of the incurable disease in the Philippines, officials and health activists said. AFP PHOTO/TED ALJIBE (Photo credit should read TED ALJIBE/AFP/Getty Images)
An AIDS activist lights a group of candles placed in the shape of a red ribbon during an event marking World Aids Day in Manila on December 1, 2012. Discrimination against homosexuals and people infected with HIV is contributing to the rapid rise of the incurable disease in the Philippines, officials and health activists said. AFP PHOTO/TED ALJIBE (Photo credit should read TED ALJIBE/AFP/Getty Images)

Sometimes, it feels as if the AIDS epidemic must somehow be over. The cause is not as trendy as it once was. There doesn't seem to be the same scale of rallies and demonstrations. We don't hear about in the news: FOX News, CNN, and MSNBC evening news had a combined 19 stories on HIV/AIDS for 2013, and this year there were only two from January through March (FOX News had none). Magic Johnson, who seemingly received a death sentence when diagnosed with HIV in 1991, now looks like he's healthy and could even stand to lose a few pounds (much like myself).

And indeed, there has been progress. People with HIV/AIDS are not quickly dying like they used to. In 2012, for the first time since 1983 it wasn't one of the top 10 causes of death in New York City. Even more encouraging, there are about 16 people declared "functionally cured," though you're probably unaware owing to scant coverage in mainstream news media.

However, the AIDS epidemic in America is still far too real. And the risk factors have taken on a new face: race and poverty.

Although this has been repeated time and time again, AIDS is not just a gay person's disease. While it is true that men who have sex with men (MSM) have the highest risk, nevertheless they are a slim majority (57 percent) of people over 13 in America who are HIV positive, according to the most recent Centers for Disease Control statistics. If we don't include MSM who also used injection drugs, this majority shrinks to just under 52 percent.

A tragic reality is that HIV/AIDS has now become an epidemic among people of color. Although in many circles AIDS may be seen as a "white person's disease," in fact African-Americans are now a plurality of new HIV diagnoses. Of the 49,273 people newly diagnosed with HIV in 2011, 23,168 were black, 10,159 were Latinos of any race, and 13,846 were white. Specific communities of color have also been hit hard: by one estimate, an alarming 1 in 4 African-American men in Harlem are HIV positive, the same prevalence as among Africans in Johannesburg.

And the evolution of the epidemic was not that it started among white gay men and more recently spread to blacks. While the first documented cases of AIDS in 1981 Morbidity and Mortality Weekly Report were five white men, the next two cases were black men. But you wouldn't know it from the early media coverage that generally only showed white men. Tragically, this slanted coverage of the crisis helped perpetuate a sense among blacks that it didn't affect them.

Latinos are also at a higher risk for HIV/AIDS. Latino men are about three times as likely as white men to be diagnosed with HIV; for Latina women, four times as likely as white women.

The HIV/AIDS epidemic in communities of color goes a long way to explain another reality ignored by the media: although the disease might feel like a New York/California phenomenon, as of 2009 the highest number of adults and adolescents with AIDS is actually in the south, concentrated in poor urban areas with high minority populations. The result is that the rate of persons in California 18-64 who are HIV positive is now lower than those of Louisiana, Florida, Georgia, and South Carolina.

And while the epidemic is disproportionately affecting people of color, there is an even greater risk factor: poverty. A CDC sampling of selected high poverty areas in the U.S. found that HIV prevalence among heterosexuals was over 20 times more than the overall population, 2.1 percent compared to .1 percent. To put this in perspective, an epidemic is defined as a rate of at least 1 percent. In fact, poverty is such a huge risk factor that there is no statistically significant difference in prevalence rate among different races. Even worse, there is an inverse relationship between income and HIV prevalence, with the rate of among people with an annual income less than $10,000 at 2.8 percent, a rate greater than that of Haiti.

There are a number of factors that explain the high rates of HIV/AIDS in impoverished neighborhoods and communities of color. For one, these communities often suffer from a lack of adequate medical care, both for treatment and prevention. And what few health care facilities that do exist may not provide language access for Latinos. Moreover, people who can barely afford necessities won't be able to afford the thousands of dollars for pharmaceuticals and other treatment costs.

The high prevalence of drugs also fuels the epidemic in poor communities. Even though intravenous drug use accounts for a relatively small percentage of new HIV infections, those infected can go on to transmit the virus to others through sexual contact. Non-IV drugs like crack also exacerbate the problem by clouding people's judgment and encouraging disinhibited behavior. Someone in poverty suffering from drug addiction might make dangerous choices to afford the habit, such as reusing needles or, particularly for women, trading sexual favors or becoming a sex worker.

Communities of color must also grapple with a greater stigma over homosexuality and HIV/AIDS. Religious institutions are often bedrocks of black and Latino communities, and many still preach homophobia. Even heterosexual black men may be afraid of facing the stigma, owing to the news media's baseless claims of a phenomenon of otherwise straight black men who have sex with men "on the down low." Black clergy were also reluctant at first to be leaders in the fight against HIV/AIDS, feeling that they already had enough issues on their plate, though many have stepped up since then.

However, despite all the grim statistics, a solution to the AIDS epidemic is very much in sight, if we only command the necessary resources, have the dedication, and cut through the ideological barriers.

For one, we must educate folks young and old. This includes facing the reality that some teenagers will engage in sex, and as such teaching them how to be safer if they do so. Instead, we have endured decades of conservative grandstanding in support of abstinence-only education while the AIDS deaths pile up.

The absurdity of abstinence-only education has been exposed more and more over time. A 2007 study commissioned by congress that took 10 years to complete found that young people who received abstinence-only education were just as likely to have sex, had a similar number of partners, and first engaged in sex at about the same age as those who did not receive such education. We've seen Meghan McCain and Bristol Palin acknowledge that abstinence-only education is unrealistic, despite their father and mother respectively running on a presidential ticket supporting it. And when even Pope Benedict has said condoms could be useful to prevent the spread of AIDS, you know that something is out of whack with folks refusing to teach it.

And education on HIV/AIDS does not stop after the school years; it must be a lifelong process. This includes the mainstream media doing its part by covering some of the little-known trends I've brought up in this article, instead of sensationalized stereotyping. And if the media won't publicize the realities of today's AIDS epidemic, including the fact that it still exists, then we'll have to do it ourselves.

We must also end the ideological barrier preventing the funding of needle exchange programs. This life saving tool gets dirty needles off the streets, and research repeatedly shows it does not increase drug use. All it takes is thinking about it for a few seconds to realize the ludicrousness of a scenario where it encourages drug use. Columbia professor Robert Fullilove does a good job describing what would have to go through the head of a non-drug user: "Oh, my God, here's a clean syringe; let's go find some heroin so that we can shoot it up." If anything, these programs can help reduce drug use, since drug users are coming before community activists who can then refer them to help for substance abuse.

Eliminating poverty is another key tactic in the fight to end AIDS. That means we must have a decent safety net, including healthcare facilities in poor neighborhoods, so that folks in high poverty areas can afford treatment along with food and rent. One good step in New York State was passage of the rent cap this year so that low income individuals with HIV/AIDS only have to spend at most 30% of their meager incomes toward rent, instead of potentially 70% or more. But there must be affordable housing and other services for all people in poverty, not just those who have contracted the virus. Otherwise there can be a perverse incentive to become HIV positive. As an op-ed in the Amsterdam News put it, "Is contracting HIV a cure to homelessness?"

Passing the Early Treatment for HIV/AIDS Act (ETHA) would also reduce the cost of living for those in poverty with HIV/AIDS. The act would allow low income HIV positive individuals who are asymptomatic to qualify for Medicaid. Currently, people only qualify if they are eligible for SSI, meaning they must be debilitated by full-blown AIDS. Passing ETHA would actually save taxpayer dollars because it would fund preventative treatment to keep the disease from progressing and causing expensive complications. Preventative care would also keep peoples' viral loads low, reducing the chances the virus will spread to others.

Tackling the epidemic will also require the community outreach and education. Such grassroots initiatives, which should receive government funding, would help further educate people; combat stigma; promote safer sex and testing; help improve language access; and foster leadership. This will require coalition building among various stakeholders, including community based organizations, non-profits, businesses, and clergy. Celebrities must also help raise awareness, including people of color with whom younger people identify. One celebrity of color who stepped up is Alicia Keyes, who is more relevant to this generation.

Finally, it's going to take all of us being outspoken leaders to end the epidemic. All the funding in the world won't matter if we don't step up to the plate. As Dr. Martin Luther King said, "Our lives begin to end the day we become silent about things that matter." Activist Rosa von Praunheim put it even more succinctly: "Silence = Death."

There's been too much silence for far too long. Instead, let's be loud and win the War on AIDS.

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