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"Our Own House Is on Fire": Thoughts on HIV/AIDS Spending in the U.S.

By Gary Bell

July 22, 2010

"Charity begins at home." A cliché? Certainly! But with dwindling resources for everything and a raging HIV Epidemic in Black people in the United States, should we concentrate more of our efforts here?

This question, which has created an ongoing tension for many HIV/AIDS advocates in the U.S., was the proverbial "elephant in the room" during a breakfast meeting I attended with billionaire philanthropist Sheila Johnson this morning. Ms Johnson acknowledged coming to the same conclusion through her international work with CARE upon learning of the devastation that HIV was causing in Washington DC. For years, we (Black U.S. HIV advocates) have witnessed the constant flow of wealthy celebrities overseas, often to Africa, to attempt to make some small impact in the epidemic. We have struggled with the dichotomy of two virtual epidemics: one here and the other overseas. If we are truly our brother's keepers, how can we begrudge anyone helping our brothers and sisters in the "motherland"? No one will discount the devastation of HIV in Africa.

As I travel throughout the conference and look into the many faces of its participants, it is clear that most, if not all, are very, very passionate about the impact of HIV in their respective countries and/or, for the constituents they represent: women, transgender, MSM (men having sex with men), sex workers, etc. Few seem to advocate for resources to be sent elsewhere. Therefore, is it selfish for those in the U.S. who have more resources and clearly have an edge in terms of access to life sustaining antiretroviral therapy, to place most of our emphasis on home?

While no one would argue that we have more in the U.S., for black people, we clearly do not have enough. Moreover, we now recognize that HIV rates in some areas of the U.S.: parts of the rural south, the Bronx, North Philadelphia and of course Washington DC, rival countries in Sub Saharan Africa. Therefore, do we now have the justification to advocate more vociferously for more of our resources to remain at home? Did we ever need "justification"? And if we don't advocate, what will the consequence be?

Well, ladies and gentleman, we are living the consequences of not just diverted resources, but our own ignorance and apathy. We have very little margin for error. While we certainly have no right to tell Oprah or Alicia Keys how to spend their money, we can and we must continue to educate them and others (including those of more moderate means) that our own house is on fire and that if we run down the street to help our neighbors then we just might not have a home to come back to. It is a difficult conversation to have. But I'm ready. Let's talk about it!

Goodbye from Vienna. Will be in touch tomorrow!

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