From the Board Chair: What If Black America Was a Country Unto Itself?

Jesse Milan, Jr., J.D.

Welcome to Left Behind, the latest in a series of reports on the state of AIDS in Black America by the Black AIDS Institute.

While the world wasn't looking, the AIDS epidemic in the United States refused to go away. In fact, the domestic AIDS epidemic in the U.S. is much more serious than previously believed. According to analyses of epidemiological data by the Centers for Disease Control and Prevention, the annual rate of new HIV infections is nearly 50% higher than previously believed.

And as America lost interest in its own epidemic over the last decade, the disease became even more firmly implanted in Black America. Nearly 600,000 Black Americans are living with HIV, and as many as 30,000 become newly infected each year. In New York City, Blacks living with HIV have an age-adjusted death rate that is two and a half times higher than for HIV-infected whites.

According to public opinion surveys, Blacks regard AIDS as the country's most serious health threat. America's opinion leaders and policy makers apparently don't share this view. In recent years, domestic AIDS issues have virtually disappeared from the front pages of the nation's daily newspapers and from the evening news. And funding from governmental agencies and most foundations for essential programs to prevent new infections and treat people living with HIV in the U.S. has declined in real terms in recent years.

For much of the AIDS epidemic, an impediment to progress in Black America has been the shortage of Black leadership, activism and mobilization to address the disease. This is no longer the case. Black leaders, political organizations, civil rights groups, churches and community groups across the U.S. are mobilizing to wage battle against this most serious of health problems facing Black America.

So what's missing?

In this report, we point out that Black America is lacking a partner in the federal government when it comes to fighting AIDS, and in many ways has been left behind by most foundations and almost all global health agencies. As America goes to the polls in 2008 to decide the country's future, this report argues that official neglect of the epidemic in Black America must become a thing of the past.

This report underscores the ironies in the U.S. government's failure to take AIDS in Black America seriously by juxtaposing the federal response to the domestic epidemic in recent years with its pioneering leadership on global AIDS issues. This isn't meant to suggest that U.S. leadership on the global epidemic is misplaced. On the contrary, helping lead the global response to AIDS is one of the most important actions the U.S. has taken in the international arena in decades. It might even be the one shining example in an otherwise dismal foreign policy agenda. The point of this report, rather, is that the same zeal, wisdom and courage our government is now showing on global issues must be brought to bear in the fight against AIDS at home.

If Black America was a country, its AIDS epidemic would be nearly the size of the AIDS epidemic in Côte d'Ivoire.

By comparing AIDS in Black America with other parts of the world, this report also isn't meant to imply that the breadth and severity of the epidemic in the U.S. are equivalent to AIDS in the countries that have been most heavily affected by the disease in southern Africa. That would be like comparing apples with oranges. And yet while, for example, we would never suggest that the recent floods in the American Midwest were identical in their human impact to the 2004 Asian tsunami or to this year's cyclone in Myanmar, no reasonable person would suggest that the differences should mean that communities in Iowa, Missouri or Wisconsin shouldn't receive the support they need to recover from this year's disaster.

In fact, looking at AIDS in Black America in the context of the global epidemic yields important insights. The number of people living with HIV in Black America exceeds the HIV populations in seven of the 15 focus countries of the U.S. government's PEPFAR initiative. Many of the factors that make HIV so challenging in other countries are the same ones that drive the epidemic in Black America.

Were Black America a country on its own, it would undoubtedly attract the concern and strategic focus of the U.S. government. It is both a tragedy and an outrage that it has failed to do so simply because its AIDS epidemic occurs within the borders of the U.S.

For the U.S. government to have credibility as a genuine leader in the global AIDS response, it needs to lead the response to AIDS at home. If we are to have any hope of achieving the goal of a world without AIDS, Black America cannot be left behind. It is toward this goal that this report is dedicated.

Jesse Milan, Jr., J.D.
Chairman of the Board
Black AIDS Institute