The Community Mobilization for Testing

Black America has long taken HIV testing seriously. Op-ed commentaries in the Black media have focused on the importance of testing, and HIV awareness and testing promotion activities are held each year in association with National Black HIV/AIDS Awareness Day.

Oasis Spearheads Physician-Based HIV Screening Dr. Wilbert Jordan Recognizing the HIV/AIDS crisis in Black America, in 2006, the board of directors of the National Medical Association adopted a resolution calling for the creation of an outreach program that would help to identify 95% of HIV-positive African Americans not in care through three basic activities: Physician-based model: Asking all Black physicians and all physicians who treat Black patients to provide HIV screening to all their patients twice a year. Zip code-based model: Work with local health departments and AIDS service organizations in key cities to identify zip codes with the highest rates of HIV, STD and teenage pregnancy and offer community-wide HIV screening in those zip codes. Focused intervention model: Recruit patients currently in HIV care and treatment to bring in their friends and associates to be screened for HIV. Dr. Wilbert Jordan, from the Oasis Clinic in South Los Angeles, is working with local and state NMA presidents, and the Association of Black Women Physicians, on a pilot for the physician-based model. In the first year of the pilot, 903 physicians were recruited. One hundred and four cases of HIV were diagnosed. 20 per cent had CD4 counts less than 350. Twenty four hundred were recruited in the second year. And, 4,400 were recruited in the third year.

These and other efforts have achieved results. Notwithstanding early perceptions that AIDS was a "white gay disease," HIV testing rates among Black Americans steadily rose during the 1990s. Today, reports by Blacks indicate they are significantly more likely than whites or Hispanics to have been tested.

Still, the community mobilization has often been scattered and episodic, focused on one-shot efforts to promote testing. To achieve the levels of HIV testing required to save Black America from AIDS, the call for HIV testing must become a constant drumbeat in Black communities. Just as with public policy, Black America must know that it has a "generalized" epidemic, reaching broadly across Black communities. Therefore, nothing short of a broad-based, commonly shared community norm that every Black American should know his or her HIV status will suffice to turn the tide against AIDS.

A History of Testing Awareness in Black America

Popular understanding of the AIDS threat in Black communities came into sharp focus in November 1991, when Earvin "Magic" Johnson announced to the world that he had tested HIV-positive. The effect of Johnson's announcement on Black people's willingness to be tested was immediate. Even though Johnson's announcement occurred during the holiday season, when testing utilization is typically low, one study found a 52 percent increase in the number of Black women who were tested in the six weeks following the announcement. A smaller, yet substantial, increase in testing was also reported among Black men.

In the following years, Black leaders took up the AIDS cause, with particular efforts focusing on the promotion of HIV testing. Black leaders -- ranging from the Rev. Jesse L. Jackson and NAACP Chairman Julian Bond to Bishop T.D. Jakes and President Barack Obama -- took public HIV tests, in an effort to encourage their constituents to do the same. In 1999, five CDC-funded organizations joined together to launch the first National Black HIV/AIDS Awareness Day. Leading Black organizations -- such as The Balm in Gilead and the National Black Leadership Commission on HIV/AIDS -- have helped mobilize Black clergy to promote HIV testing. The Black AIDS Institute has mobilized hip-hop artists and other Black celebrities to promote HIV testing by taking HIV tests themselves.

Mom's Status Opens Daughter's Eyes Alyssa I'm only 18, but it's funny how your life can suddenly change. My mom was diagnosed with HIV a few years back. Before her diagnosis, I didn't know anything about HIV or AIDS. I never knew a lot of people had it. If my mom didn't have it, then I wouldn't know or even care. Even though things have been rough, my mom's diagnosis brought the family together. My sister and I can talk to her about anything now. The media only shows sick people. They don't show everyday people. But you can't tell who has HIV. They are normal people. I get tested all the time, and now I know a lot. I talk to my friends about it. It is especially important for Black women to get tested because they are the fastest growing population of those affected. I know because I help with my mom's organization, Open Hearts, to help spread the word about HIV/AIDS.

In part as a result of these initiatives, the percentage of Black Americans who have been tested for HIV is significantly higher than the share of whites or Latinos who have done so. Yet, as discussed above, the share of Blacks who report having been tested has not risen since 1997, and the percentage of Blacks who have heard a lot about AIDS in the past year has sharply declined.

With 48 percent of African Americans indicating they have never been tested for HIV, the limitations of episodic, if courageous, efforts to promote HIV testing are clear. There is an urgent need for a dramatically scaled-up campaign that uses state-of-the-art advertising and social marketing techniques to promote HIV testing as a social norm in Black America.

To be effective, such a campaign will require major new resources. Yet the first step -- even before resources are mobilized -- is for the Black community to take action on its own. Black Americans need to talk to each other about AIDS -- openly, loudly and repeatedly. That costs nothing, and is the necessary beginning of a revolution.

Black Organizations Lead the Charge

For years, the growing health crisis in Black America remained largely hidden from public consciousness, eliciting only the most minimal public health response. In the absence of clear public health warnings, the Black community itself was also slow to recognize the severity of the epidemic.

In recent years, that has begun to change. In 2009, Black Americans are 11 times as likely as whites to regard HIV/AIDS as the single most urgent health problem, according to a Henry J. Kaiser Family Foundation survey. And, according to the same national survey, Blacks are four times as likely as whites to tell pollsters that AIDS has become a more serious problem in recent years.75 Black Americans are also notably more likely than whites or Latinos to have ever donated to an HIV-related charity.⁷⁶

Actors Henry Simmons and Vanessa Williams, along with Producer and Casting Director Robi Reed, take an HIV test on June 25, 2007 at a Test 1 Million event held in connection with the Screen Actors Guild and the American Federation of Television and Radio Artists.

In 2006, the Black AIDS Institute, in concert with The Balm in Gilead, the National Black Leadership Commission on AIDS and the Magic Johnson Foundation, launched the National Black AIDS Mobilization. Under the umbrella of the campaign -- and with the technical support of the Black AIDS Institute -- 14 of the most prominent national Black organizations and four historically Black colleges and universities have for the first time developed and begun to implement strategic national AIDS action plans. Promoting HIV testing is a core component of most of the strategic plans developed by these leading Black organizations. (See Making Change Real: The State of AIDS in Black America, 2009 for a detailed update on the Mobilization.)

With the launch of its Act Against AIDS Leadership Initiative in 2009, the CDC has begun to provide financial support to aid these organizations in translating their plans into action. The initiative offers 14 Black organizations funding for a full-time staff person to direct AIDS programming. As a part of CDC's Act Against AIDS campaign, the Act Against AIDS Leadership Initiative is explicitly designed to build the capacity of traditional Black organizations. It is a visionary step by the CDC with the potential to help Black organizations with the resources they need to bring AIDS "out of the closet" and to forge a new social norm in favor of HIV testing. To ensure its long-term success, this initiative should be accompanied by additional supportive steps, including major funding for Black-focused HIV testing promotion campaigns and the active engagement of diverse opinion leaders and community sectors in the AIDS response.

Political Action by Black Leaders

A milestone in the Black response to AIDS occurred during the second term of President Bill Clinton, when members of the Congressional Black Caucus spearheaded passage of the Minority AIDS Initiative. This initiative aimed to strengthen HIV testing, prevention and treatment programs in heavily affected communities of color through targeted funding.

Unfortunately, under President George W. Bush's subsequent administration, funding for the Minority AIDS Initiative declined in real terms. Black Congressional leaders are now working to reverse this recent history of neglect. Under the leadership of California Rep. Maxine Waters, 79 members of Congress wrote the House Appropriations Committee requesting $610 million for the Minority AIDS Initiative in FY2010, or an almost 50 percent increase in funding over FY2009.

Then Illinois Senator Barack Obama and his wife Michelle take HIV test in a special van in Kisumu, Kenya, August 26, 2006. Photo: Sayyid Azim/AP.

Black political leaders are taking additional steps to promote knowledge of HIV status in Black communities. In 2007, Rep. Waters introduced the Stop AIDS in Prison Act, which requires the Federal Bureau of Prisons to test all prison inmates for HIV unless inmates specifically decline a test. The bill also requires comprehensive HIV prevention and treatment for all inmates. The legislation passed the House of Representatives in 2007 but was not endorsed by the Senate prior to the adjournment of the 110th Congress. In 2009, Rep. Waters reintroduced the legislation, along with a bipartisan group of co-sponsors.

In April 2009, New York Rep. Charles Rangel introduced the National Black Clergy for the Elimination of HIV/AIDS Act. Endorsed by a bipartisan group of co-sponsors, the bill would authorize different parts of the Department of Health and Human Services to make grants to public health agencies and faith-based organizations to conduct HIV testing and other HIV-related activities. Among the bill's provisions is authorization for intensified capacity-building support for Black communities to respond to AIDS and for a national media outreach campaign to encourage sexually active individuals to be tested for HIV.

These visionary initiatives deserve far broader support and visibility than they have thus far received. President Obama and congressional leaders should embrace them and work for their swift approval.

In summary, the evidence from community groups, traditional Black institutions, and Black political leaders indicates that much of Black America is ready to respond to the AIDS crisis. However, Black America has to date lacked the resources, infrastructure and broad-based commitment to convert such episodic actions into a high-level, coordinated national campaign that can be sustained over time and can make knowledge of HIV status a social norm in Black communities. If the AIDS epidemic in Black America is to be reversed, this must change.

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