Statement of Anthony S. Fauci, M.D., on National Black HIV/AIDS Awareness and Information Day

The grossly disproportionate impact of HIV/AIDS on African Americans is a public health crisis that we at the National Institutes of Health (NIH) and as a nation must address boldly. Nearly 27 years into the AIDS epidemic, approximately half of the new HIV infections that occur each year in the United States are among African Americans, even though they represent only 13 percent of the U.S. population.¹ The virus plagues every segment of the African American community: in 2005, black women accounted for two-thirds of newly diagnosed HIV/AIDS cases among U.S. women, and black men accounted for half of new diagnoses among U.S. men.² A recent study in five large U.S. cities found that 46 percent of black men who have sex with men were infected with HIV.³ Only dramatic action will reverse this calamity.

Today, on the eighth annual National Black HIV/AIDS Awareness and Information Day, I call upon public health officials and leaders in the African American community to jointly marshal their efforts against the AIDS epidemic. In particular, black leaders -- religious, secular and political -- have a key role to play in reducing the stigma often associated with HIV/AIDS and influencing African Americans to get tested, counseled and treated.

The national toll of HIV/AIDS among African Americans is shocking, and nowhere is that more evident than in our nation's capital. African Americans make up 57 percent of the population of Washington, D.C., yet they accounted for more than 80 percent of recent HIV/AIDS cases in that city.⁴ One in 20 Washingtonians is living with HIV infection; one in 50 has AIDS. These statistics are staggering and unacceptable in a modern society.

The National Institute of Allergy and Infectious Diseases (NIAID), part of the NIH, strongly endorses testing for HIV during routine medical care for adolescents, adults and pregnant women, as the Centers for Disease Control and Prevention recommends. An estimated one-quarter of Americans who are infected with HIV do not know it, and a disproportionate number of those people are African Americans. In fact, a recent study found that 64 percent of HIV-infected black gay men did not know they were HIV-infected.³ That means a significant number of African Americans with HIV are not receiving proper counseling and care, placing them at risk for becoming extremely sick and for spreading the virus further.

But HIV testing alone is not enough to win the battle against HIV/AIDS in the African American community, because many lack ready access to basic health care services. Recent studies have found that many HIV-infected African Americans are first diagnosed with HIV late in the course of their disease, often when they are hospitalized with serious HIV-related illness.⁵ This is unacceptable in our society, where antiretroviral drugs for controlling the virus and prolonging life are widely available and best used earlier in the course of disease. A delay in getting tested or starting treatment also may increase the risk of ongoing transmission, as untreated patients with high levels of the virus are more likely than treated patients to infect others.

To curb the HIV/AIDS epidemic among African Americans, we need to bring basic health care services that include HIV testing and timely treatment into the communities where African Americans live.

All of us at NIAID are committed to basic and clinical research on HIV/AIDS to help people of all races live healthier, longer lives. Our research has led to extraordinary advances in understanding the biology of HIV/AIDS, creating HIV therapies and treatment guidelines, advancing the development of AIDS vaccines, and developing strategies to prevent HIV transmission. We continue to strongly encourage African Americans to participate in clinical research on HIV/AIDS.

Despite significant scientific progress, the deplorably high rates of HIV/AIDS in the African American community loom large. We as a nation must act immediately and decisively to end the HIV/AIDS crisis among black Americans. History will judge us harshly if we fail in this mission.

Information about National Black HIV/AIDS Awareness and Information Day is available at http://blackaidsday.org/. Visit AIDS.gov for comprehensive government-wide information on HIV/AIDS. Information about prevention, treatment and clinical trials is available at www.aidsinfo.nih.gov/.

Dr. Fauci is director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health in Bethesda, Maryland.

References

1. CDC. 2007. Fact Sheet: HIV/AIDS among African Americans.
2. CDC. 2007. MMWR 56(09): 189-193. Table 1.
3. CDC. 2005. MMWR 54(24): 597-601.
4. Government of the District of Columbia Department of Health. 2007. District of Columbia HIV/AIDS Epidemiology Annual Report 2007. Page 2.
5. Examples of recent discussions of late diagnosis of HIV infection:
   • Keruly JC and Moore RD. 2007. Immune status at presentation to care did not improve among antiretroviral-naive persons from 1990 to 2006. Clinical Infectious Diseases 45(10):1369-1374.
   • Valdiserri RO. 2007. Late HIV diagnosis: bad medicine and worse public health. PLoS Medicine 4(6):e200.
   • Schwarcz S et al. 2006. Late diagnosis of HIV infection: trends, prevalence, and characteristics of persons whose HIV diagnosis occurred within 12 months of developing AIDS. Journal of Acquired Immune Deficiency Syndromes 43(4):491-494.