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The Forgotten Epidemic

Part of Left Behind: Black America -- A Neglected Priority in the Global AIDS Epidemic

August 2008

The widespread belief that AIDS is a foe that has been vanquished in the U.S. reflects something more -- the astonishing invisibility of the continuing AIDS in Black America.
Soon after the emergence of Highly Active Antiretroviral Therapy (HAART) in the mid-1990s, one of America's leading political commentators, himself HIV-positive, wrote an influential commentary in the New York Times Magazine heralding "the end of AIDS."1 Ten years later, as the world marked the 25th anniversary of the AIDS epidemic, this sentiment that therapeutic advances had effectively conquered the disease in the United States had become accepted wisdom in many circles. As one HIV clinician put it, "[O]nce treatment was available, the challenge seemed to be elsewhere."2

Over the last 10-12 years, America's opinion leaders, policy-makers and news media have come to believe that the AIDS challenge is indeed "elsewhere" -- that America's AIDS problem has been solved thanks to a proliferating array of effective medications. The unquestioning belief in the capacity of science to eradicate the most intractable of problems is quintessentially American. Yet the widespread belief that AIDS is a foe that has been vanquished in the U.S. reflects something more -- the astonishing invisibility of the continuing AIDS crisis in Black America.

AIDS in America is a Black disease. Although Black people represent only about one in eight Americans, one in every two people living with HIV in the U.S. is Black. Despite extraordinary improvements in HIV treatment, AIDS remains the leading cause of death among Black women between 25-34 years and the second leading cause of death in Black men between 35-44 years of age.3

AIDS illustrates the degree to which there are "two Americas" -- one white,4 wealthy and healthy, and the other Black, poor and unhealthy. These unconscionable socioeconomic disparities are matched by the world's apathy regarding the continuing AIDS emergency in Black America. As America rightly devotes billions of dollars to address global health disparities, it tolerates growing racial differences between basic health indicators within its own borders.

In reality, HIV-related health disparities between whites and Blacks have actually widened as medical advances have made HIV treatable. More than a decade since the emergence of HAART, HIV-positive Blacks in New York City have an age-adjusted death rate that is 2.5 times higher than white New Yorkers living with HIV. Meanwhile, Blacks are eight times more likely than whites to become newly infected with HIV.

This report argues that the prevailing understanding of two epidemics -- one global, another domestic -- presents a false dichotomy. AIDS today is better understood as a global problem divided along color lines -- one white, the other Black.

In fact, the epidemic in Black America is an important part of the global epidemic and merits a commensurate political response and financial commitment. Many of the challenges confronting the global AIDS response are the same that impede more effective HIV prevention and treatment in Black America. Moreover, America's failure to respond to its own epidemic among its Black citizens undermines its credibility in addressing the AIDS epidemic in Africa and across the African diaspora. By developing and implementing more effective AIDS-fighting strategies in Black America, we can learn important lessons that will benefit countries and communities worldwide. And by recognizing Black America's place in the world as a whole, the U.S. can similarly gain insights into how to improve the response to AIDS among Black people in America. In particular, lessons learned in countries that are addressing generalized epidemics may have particular applicability in combating AIDS in Black America.

With sufficient financing, political leadership and community engagement, dramatic progress can be achieved against AIDS in Black America. A strong foundation exists on which to build a more robust AIDS response, thanks to the presence of a vibrant civil society infrastructure in the Black community. Civil rights organizations, churches, Black elected officials, the media and other community institutions and thought leaders have a potentially vital role to play in fighting AIDS in Black America, but efforts to mobilize them have been critically under-resourced.

For the U.S. to be a global AIDS leader, it must put its own house in order. AIDS in Black America must be tackled with the same zeal currently being mobilized to such extraordinary effect in scaling up AIDS responses in other regions. This report aims to advance progress toward this goal.





  
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This article was provided by Black AIDS Institute. Visit Black AIDS Institute's website to find out more about their activities and publications.
 

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