Reversing the HIV Epidemic in Black America: An Action Agenda

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

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.

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.

Researchers

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.