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On the Frontline of the HIV/AIDS Epidemic

On the Frontline of the HIV/AIDS Epidemic
With infection rates still escalating among African Americans, researchers, scholars and activists wonder if the battle is a losing one

By B. Denise Hawkins

Most days, Cynthia Davis is an exasperated trooper who can always be found teaching and preaching from the frontline of the AIDS epidemic in Los Angeles. The very disease that’s crippling and killing those she’s trying to save with prevention, education and intervention is also what fuels her resolve to return day after day to a place where burnout is high, death is an almost everyday event and where the community’s concerns about HIV/AIDS often get lost in the daily struggle to survive.

Still this community services administrator and assistant professor at Charles R. Drew University of Medicine and Science in Los Angeles keeps on pushing for clinical care for those living with HIV/AIDS.

 “One person can only do so much,” says Davis, adding she could work 24-7 and still not keep up with the requests she receives to speak on HIV/AIDS. She’s been coordinating HIV/AIDS efforts at Drew, one of four predominantly minority medical schools in the nation, since 1983, and she says her resolve is still high.

But Davis and other veterans of the AIDS war are starting to wonder. With infection rates still escalating among the homosexual community and increasingly among African-American females, especially those living in the South, is the battle a losing one?

When the global epidemic got its start in the early 1980s, little was understood about how social behaviors and socioeconomic conditions gave rise to the spread of HIV/AIDS among Blacks. It became the work of Black health care providers, scholars and researchers. Drs. Mindy and Robert Fullilove of Columbia University were among those immediately pressed into service to respond to a menacing disease that few understood at the time. In fact, Mindy was one of the first Black researchers to investigate the roots of the epidemic.

The 1990s were marked by a disproportionate rise in HIV/AIDS among African Americans, and the pioneers in the Black public health community had to step up their pace dramatically in order to keep up with the spread of the scourge. But despite all their efforts, the prevalence of HIV infection among Blacks has doubled while remaining stable among Whites, according to the federal government’s National Health and Nutrition Examination Survey released in February.

According to the survey, the HIV infection rate among Blacks ages 18 to 59 was 1.1 percent in 1991, or about five times higher than that found in Whites. By 2001, the rate was 2.14 percent, or 13 times greater than the rate seen in Whites. Currently, African Americans account for more AIDS diagnoses — both those living with the disease and HIV-related deaths — than any other racial or ethnic minority group, as related in a report of the survey findings issued by the Kaiser Family Foundation.

Noting that the increased spending on intervention and prevention seem to have had little impact, Davis says, “You would think that after 20 years and after all of those efforts, the prevalence rates would decrease and behaviors would change.”

Lingering Attitudes
The survey indicating that HIV infection rates have doubled in Blacks in the last decade was only one of two sobering reports on HIV/AIDS issued during Black History Month. The second report, published in the Journal of Acquired Immune Deficiency Syndromes, concluded that a significant proportion of African Americans continue to believe that government scientists are responsible for creating HIV, the virus that causes AIDS, and are using the virus to control the Black population.

Men were more likely than women to believe HIV/AIDS-related conspiracy theories, but were also less likely to use condoms to protect themselves from transmitting the virus, according to the study, which was funded by the National Institute of Child Health and Human Development and conducted by RAND Corp. and Oregon State University.

Davis wasn’t surprised by the findings. “I see it and hear it everyday,” she says, among Drew’s client base in South Central Los Angeles. “Since the Tuskegee Experiment, Blacks are still distrustful of government-sponsored research. Those feelings and beliefs aren’t going to be erased from our collective consciousness. We have a long way to go in changing attitudes about the origin and transmission of the disease.”

But while the HIV/AIDS service community admits such beliefs are widely held and reflect a tortured past, they also say they shouldn’t be used as an excuse to engage in risky behaviors such as not using condoms.

Crisis Within a Crisis
Black women are among those with the most to lose if they and the men they are involved with don’t change their behaviors, says Dr. Celia Maxwell, an infectious disease specialist and director of the Women’s Health Institute based at Howard University Hospital in Washington, D.C. Indeed, African-American women accounted for 67 percent of new AIDS cases among women in 2003, but that news is hardly a blip on the national agenda — as a recent event demonstrated.

During the vice presidential debate on Oct. 5, 2004, PBS news correspondent and debate moderator Gwen Ifill said to Vice President Cheney, “I want to talk to you about AIDS, and not about AIDS in China or Africa, but AIDS right here in this country, where Black women between the ages of 25 and 44 are 13 times more likely to die of the disease than their [White] counterparts.”

When asked what the U.S. government should do about the problem, Cheney said he was “not aware” of the statistics.

The lack of awareness is nothing new, according to Dr. Vincent C. Bond, who along with his research team at Morehouse School of Medicine in Atlanta, conducted two large AIDS studies in the 1990s. His team’s findings accurately predicted the devastation HIV/AIDS was about to wreak, but there was little interest and no funding from the Centers for Disease Control and Prevention (CDC).

“It was clear from our findings that the disease was spreading the fastest among Black women and disproportionately affecting minorities,” says Bond, whose findings on this aspect of the disease were considered among the first, appearing in the Journal of Infectious Diseases and in at least three other journals during the late 1990s. “What we theorized then is now being borne out.”

Indeed, the numbers are catastrophic, says Maxwell, who also serves as assistant vice president of health sciences at Howard. And she reluctantly cites the much-hyped “brother on the down low” phenomenon — in which gay men, often refusing to admit their homosexuality, engage in sex with other men while maintaining public relationships with women.

Maxwell worries that Black men, who already are suffering the consequences of low education, low-paying jobs and a lack of housing, are finding themselves again under fire for fueling new HIV/AIDS infections among Black women. 

But it takes two, she adds, explaining that many Black women fail to protect themselves. Some are engaging in unprotected sex from a feeling that they have fewer relationship choices or from a simple inability to negotiate safer sex relationships. Others put themselves at risk because they are ignorant about how the disease is transmitted. Still others believe that they won’t get the disease because they are married.

In fact, “Most Black women are infected largely by heterosexual transmission,” says Maxwell, “from their husbands and boyfriends. That’s some heavy stuff. It’s scary.”
But if the spiraling rate of infection among Black women is ever to slow, Maxwell says, Black men have to be a part of the solution.

The HBCU Connection
Indeed, one could argue further that if the rates of HIV/AIDS infection are ever to be brought under control, historically Black colleges and universities will have to be at the forefront. And despite shrinking federal dollars for disease prevention and testing, many institutions and organizations are looking eagerly for alternative funding sources and creative strategies for reaching HBCU students and their surrounding communities.

Bond, a virologist, has spent years trying to discover a way to defeat HIV. These days he’s working on finding “a way to shut the virus (HIV) down in order to eliminate the disease.” And he’s getting help from members of the AIDS group at Morehouse, a formal collective of physicians, researchers and administrators that has grown from about four scholars devoted to AIDS work in the 1990s, when Bond arrived on campus, to about 15 today.

“Morehouse is on the cutting edge, conducting studies and research that you don’t see happening anywhere else,” says Bond, citing as an example the work of Dr. Elleen M. Yancey, director of the Prevention Research Center at Morehouse, who’s looking at reducing HIV/AIDS risks in sexually active Black heterosexuals.

In addition, a new CDC-sponsored study, The “Knowledge, Attitudes and Behaviors Study,” is assessing the risk behaviors of HBCU students and cataloguing what HIV/AIDS counseling and testing services are available to them on campus. As part of that effort, the United Negro College Fund’s HOPE Program will survey 26 HBCUs in 14 states in the Southeastern region, says Darlene Saunders, director of the UNCF’s Health and Community Development Division. The survey will include questions about general HIV knowledge, attitudes about condom use and sexual behaviors.

Strategies for protecting students at some Atlanta-based HBCUs is the focus of a new working group formed on the heels of the highly publicized AIDS outbreak among college students in North Carolina in 2003. The group, commonly referred to as the John Lewis Group, is named for its founder, U.S. Rep. John Lewis, D-Ga. The group is chaired by Dr. David Satcher, interim president of Morehouse School of Medicine and the chief executives of the member institutions in the Atlanta University Center as well as student leaders, corporate and pharmaceutical representatives, and AIDS experts, says Dr. Steve Owens, an AIDS expert at the National Association for Equal Opportunity and a member of the group.

Getting the Word Out
For Chris Cathcart, getting the word out is the most important part of the effort. The Howard University graduate and former student activist is using a new magazine to shake students up about HIV/AIDS. A year ago Cathcart chose Howard’s Homecoming to unveil the premier issue of Ledge, which he describes as “a student-driven HIV/AIDS awareness magazine and the perfect tool to mobilize Black college students in the fight against the epidemic.”

Cathcart, the owner of a public relations firm in Los Angeles, knew that a publication heavy with statistics and AIDS experts wasn’t the way to attract his target age group. So the premier issue of Ledge included features like “62 ways to fight AIDS” as well as the poetry of singer Jill Scott. In addition, the magazine explored questions about love and AIDS, offered feedback from Howard students participating in a roundtable discussion on the epidemic and presented a candid discussion about sex and trust on today’s college campus.

“I didn’t want students to deal with the stigma that’s often associated with picking up or reading brochures and pamphlets about AIDS,” Cathcart says. “When students pick up Ledge, I want them to think of it like they do any other lifestyle or entertainment magazine, I want it to be like reading Vibe or Essence.”

“Don’t Fall Off” is the tag line for the magazine sponsored by the Los Angeles-based Black AIDS Institute.

Billed as a magazine for Black college students by Black college students, Ledge is distributed to at least 80 HBCU campuses free of charge. Cathcart says plans are to reach all HBCUs. Hard at work on the second edition of Ledge, Cathcart and Freddie Allen, a Howard student and Ledge’s managing editor, say they are excited about the reception the magazine has received from campus officials and students. Requests for the magazine are even coming from outside the HBCU community, says Cathcart. Other colleges, student groups, churches and community-based AIDS organizations have sought the publication.

The second edition is expected to hit campuses in the fall. The magazine is part of a new national HIV/AIDS education and prevention campaign announced in February by the Black AIDS Institute and the Magic Johnson Foundation. L.I.F.E. AIDS, which stands for Leaders in the Fight to Eradicate AIDS, is aimed at mobilizing and educating Black college students. An estimated half of all new HIV infections occur among teenagers and young adults aged 25 years and younger. African-American youth accounted for 65 percent of new AIDS cases reported among teens in 2002, according to the Kaiser Family Foundation.
“AIDS in America is rapidly becoming a Black disease. Nowhere is that more apparent than among young African Americans,” said Phill Wilson, executive director of the Black AIDS Institute.”

Related Links:

The Charles R. Drew University of Medicine and Science in Los Angeles 

A study on “HIV Infection Among Minority Populations” 

The Journal of Infectious Diseases

Black AIDS Institute

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