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Guest Editorial

Mario Cooper, Trustee
The International Association of Physicians in AIDS Care

January, 1997

As our nation continues to redefine healthcare delivery, we must keep uppermost on the agenda our obligations towards those most in need. This is especially true as African-American and Latino communities begin to bear the brunt of the AIDS epidemic. Communities of color are at risk because of a vulnerability that stems from poverty and racism.

In this issue of the Journal, Phill Wilson covers two meetings that specifically addressed HIV/AIDS within the African-American community. As his report notes, despite alarming rates of HIV/AIDS, African Americans have been reluctant to tackle AIDS prevention, care, and research issues.

As medical practitioners, it is vitally important to understand the social, cultural, and economic barriers placed before the black community in dealing with HIV/AIDS. We must understand the demonstrated impact of African Americans' (and Latinos') historic lack of access to healthcare. In communities of color, more often than not, medical care is provided in the emergency room. From New York City, to Miami, to San Antonio, to Chicago, and to Los Angeles, there are few, if any, community health clinics with the necessary resources to address the needs of their target populations.

Anecdotal stories of patients rejected by private sector physicians because of a lack of insurance, or because they are dependent on Medicaid, reflect the realities of life for the poor and disenfranchised. Prevention messages concerning smoking, heart disease, and safe sex rarely target these communities. Depression, drug use, and alcohol abuse-all cofactors in HIV disease progression-remain rampant within poor communities.

We must also acknowledge the high level of distrust these communities have towards the government in regard to health issues. The Tuskegee Syphilis Study, the Haitian HIV controversy, and the alleged CIA plot to infuse cocaine into Los Angeles nourish such distrust.

These are communities devastated by the historic reality of our nation's inability to provide healthcare to all, and by a lack of educational and economic opportunity. But we can improve the delivery of health services to millions of Americans who are currently falling through the cracks.

As physicians and others involved in healthcare research and delivery, you have insightful knowledge of the potential of good healthcare-and you also have a special obligation to provide services to all.

Get engaged in the healthcare debate. Testify before your state legislature, lobby for full access to treatments, write your local newspaper, challenge your health maintenance organization on cost limits, and reach out to those in need. An hour a month spent at an inner-city clinic, in a public school, or speaking before a civic organization can have a tremendous effect.

We simply cannot be a strong nation, unless we are a healthy nation. And for far too many Americans access to healthcare remains elusive.

©1997, Medical Publications Corporation

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