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Reversing the HIV Epidemic in Black America: An Action Agenda

August 2008

Where national AIDS responses have succeeded, communities have mobilized to fight stigma, overcome prejudice, and promote solidarity in the fight against the epidemic.
It is clear that the AIDS epidemic in Black America shares key features of the AIDS challenge in low- and middle-income countries. It is equally plain, given the magnitude and severity of the epidemic among Blacks, that progress in fighting AIDS in Black America will greatly contribute to advancing the global AIDS response.

No single actor or constituency can alone reverse such a legacy of neglect. Rather, diverse stakeholders and communities must join together to give AIDS in Black America the attention it deserves.

Black Communities

In developing countries where national AIDS epidemics have been reversed, strong political leadership has combined with the active and fearless engagement of diverse people from all walks of life, including religious leaders, media, celebrities and opinion leaders, business and industry, affected communities, and people living with HIV.186 Where national AIDS responses have succeeded, communities have mobilized to fight stigma, overcome prejudice and promote solidarity in the fight against the epidemic. This was especially the case in Uganda, Thailand and Brazil, where courageous national leadership forged working partnerships with civil society to wage an effective national campaign against the epidemic.187

Although much has been learned about how to stimulate effective community responses and indigenous leadership on AIDS, these lessons are often not put to use in the U.S. While leading Black organizations, publications and constituencies are placing increasing priority on the fight against AIDS, they are typically doing so without the support of the U.S. government. Lacking sufficient resources, the efforts of these groups have yet to achieve maximum impact.

The U.S.-Based Public and Private Sectors

Support for the scale-up of essential HIV prevention, treatment and care services in Black America should be significantly increased. As the epidemic's burden in Black America has intensified over the last decade, targeted funding for AIDS initiatives in Black communities has stalled. Funding for the Minority HIV/AIDS Initiative has remained flat for the last three fiscal years, and President Bush has proposed a cut in the program for FY2009. Meanwhile, support for Ryan White treatment and care services, HIV prevention and substance abuse services has generally failed to keep pace with inflation.188

Official neglect of HIV prevention is especially striking. Under the President's FY2009 budget request, HIV prevention would account for only 4% of all HIV-related expenditures in the upcoming fiscal year.189 Given that lifetime costs for treatment of a case of HIV infection in the U.S. now exceeds $618,000,190 the paltry sums currently spent to support HIV prevention are unconscionable on both humanitarian and fiscal grounds.

An Action Agenda


We must build a new sense of urgency in Black America, so that no one accepts the idea that the presence of HIV and AIDS is inevitable.


The AIDS story in America is mostly one of a failure to lead. Black leaders -- from traditional Black ministers and civil rights leaders to hip hop artists and Hollywood celebrities -- must join in a collective national call to action and declaration of commitment to end the AIDS epidemic in Black America.


Black America must get informed about the science and facts about AIDS. Knowledge is a powerful weapon in the war against AIDS.


Black Americans must get tested and find out their HIV status. Half of HIV positive Black people in the U.S don't know they are infected -- and people who don't know they're infected are less likely to protect their partners and completely unable to receive treatment. Knowing your HIV status early can save your life.


The federal ban on funding for needle exchange programs should be lifted. Risk reduction programs should be developed and implemented in Black communities. Comprehensive, age-appropriate, culturally competent AIDS prevention efforts -- with messages inclusive of abstinence, delayed sexual activity, sexual responsibility, proper condom use and negotiated safety -- that give young people the tools to protect themselves should be expanded.


A massive effort to address the disproportionate impact this epidemic is having on Black youth, women, injecting drug users, and men who have sex with men must be embarked upon.


AIDS is not just a health issue. It is a human rights issue. It is an urban renewal issue. It is an economic justice issue. The fight against HIV and AIDS is actually a broader fight against an environment in which poverty; homelessness, unemployment, incarceration, marginalization, homophobia and violence exacerbate the risk Black people face daily, including their risk for HIV and AIDS. The only way to end the AIDS epidemic in Black America is to build a broad base mass mobilization.

In the final analysis, this epidemic isn't terribly complicated: When we allow politics, subjective notions of morality and profit-driven health economics to reign over public health, the most vulnerable in our society are left behind. When we make a genuine commitment to meet people where they are, with the resources they need to chart a healthy path and stay on it, we find success. When we have the courage to act we make progress; when we don't we lose ground.

Financing of HIV/AIDS activities by U.S.-based philanthropic and corporate entities increased by 8% in 2006. However, both the magnitude and share of such funding directed toward domestic AIDS programs fell in 2006. In 2006, only 9% of HIV-related contributions by the US private sector focused on domestic programs.191

In an era when America's reputation in the world continues to suffer, the leadership of American foundations and corporations in contributing to the AIDS response serves as a potent reminder of the generosity and goodwill of the American people. It is essential that America's engagement in the global AIDS response continue and grow even further. Yet it is equally imperative that funders recognize that the epidemic in Black America is a critical component of the global epidemic.

In Black America, the U.S. is losing its own fight against AIDS. U.S. funders should do more to ensure that effective HIV prevention, treatment and care services are brought to scale here at home.

International Agencies

In the advocacy by the leading international and multilateral organizations, Black America is a forgotten component of the AIDS response. Few global AIDS leaders even acknowledge the seriousness of the epidemic in Black America or refer to it as an important element of the global AIDS crisis. Unfortunately, the U.S. government contributed to this oversight in 2008 by being one of the few countries to fail to submit a report to UNAIDS on progress in implementing the 2001 Declaration of Commitment on HIV/AIDS.192

Global AIDS leaders should break the silence on AIDS in Black America. In 2004, even as Thailand was hosting the International AIDS Conference in Bangkok, the United Nations Development Program issued a highly critical report on the country's failure to sustain its commitment to HIV prevention.193 Similarly, Black America needs the leaders of the global AIDS movement to speak honestly about America's failure to address the serious epidemic within its own borders.


Funders should prioritize research on HIV-related issues that Black America shares in common with other countries. As this report has described, Black America lacks key tools needed to ensure a successful response to AIDS. The range of validated prevention strategies for key Black populations is too limited, and proven interventions are needed to address the factors that increase HIV vulnerability and contribute to the continuing burden in Black communities. Efforts to improve treatment outcomes for HIV-positive Blacks would benefit from a stronger evidence base, including effective strategies to encourage knowledge of serostatus, promote access to care, and increase treatment adherence. Government and non-government funders should step forward with greater resources to fill the gaps in the evidence base for effective AIDS action.

The discussion above reveals that these gaps not only impede effective action to fight AIDS in Black America, but also slow progress in the global AIDS response. Funders and technical agencies should establish meaningful mechanisms for the timely sharing of information and perspectives between Black America and other countries and communities throughout the world.

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