September 22, 2010
This is the third in a four-part series examining the strategy's impact on Black communities. This article is cross-posted from the Sept. 21 edition of Black AIDS Weekly, the newsletter of the Black AIDS Institute.
When the Obama administration unveiled its new National HIV/AIDS Strategy in July, New York City-based Housing Works challenged the strategy's second goal of increasing access to care as overly ambitious. Now the same group describes the third component of the strategy -- reducing HIV-related disparities -- as "quite limited."
By 2015 the administration hopes to increase by 20 percent the proportion of people from the following groups who have been diagnosed as having HIV yet have an undetectable viral load:
Read more to learn how it plans to achieve these objectives.
To cut the mortality rate among high-risk groups, the strategy first focuses on trimming HIV/AIDS health disparities. Black Americans are eight times more likely to be diagnosed with HIV than Whites, and AIDS-related deaths and AIDS death rates are highest (pdf) among Blacks. One important reason: African Americans are estimated to make up 56 percent of all "late testers" -- people diagnosed with AIDS within one year of an HIV diagnosis.
Late testers have less chance to benefit from lifesaving anti-AIDS drugs. They're also more likely to spread the virus to others -- both because people who know their HIV-positive status take precautions not to infect others and because those on antiretroviral meds typically lower their viral load. The strategy states a need to reduce the community viral load, the total amount of virus that is circulating in the community.
Gay and bisexual men have experienced tremendous health disparities, with young Black MSM particularly at risk. The plan explicitly states that new infections must be curtailed among MSM. What's the plan for other groups? "Women are touched upon, but there is not a specific section that speaks to Black women," says Dázon Dixon Diallo, the founder of Atlanta-based SisterLove, the first women's HIV/AIDS service organization in the Southeast.
According to data from the Kaiser Family Foundation, new infections among Black women are 16 times that of white women. "Symptoms are often much different among women," Diallo adds. "Black women respond differently to some medications, and there are concerns around sexual and reproductive health. It's a very notable oversight."
Transgender women were also not mentioned. "That is a key at-risk group, especially Black and Latino transgender women," says David J. Malebranche, M.D., M.P.H., assistant professor of medicine at Emory University. A recent analysis by the Centers for Disease Control and Prevention estimated that about 28 percent of male-to-female trans women were HIV positive.
The second step in reducing HIV-related health disparities is adopting community-based approaches. "Neighborhood and community solutions are key, but that section lacks specificity," says Bambi W. Gaddist, Dr.P.H., founder and executive director of the South Carolina HIV/AIDS Council. "Compare this with the specific prevention or treatment goals in the strategy."
Vanessa Johnson, executive vice president of the National Association of People with AIDS, is "encouraged" by the community input into making the strategy but admits "there are significant structural and economic barriers" facing people living with HIV/AIDS (PLWHA) in the inner cities and rural areas.
"We're talking about cycles of poverty and decades of neglect. One six-week intervention is just not going to change a person's life significantly. We have to improve neighborhoods block by block, build new schools and clinics, increase employment ... we need to view wellness as national priority," Johnson adds. "I'm excited there is finally a national strategy. But much of the talk and these same phrases have been used over the 20 years that I've been diagnosed with HIV."
Reducing the shame and prejudice experienced by PLWHA is the third step. "Much of the stigma started around homophobia," says Dr. Malebranche. "Many people want to single out the 'Black church' ... but it's a lot of churches. Plus television, media, government, schools ... many people have helped spread fear and misinformation. And criminalization laws only exacerbate the problem."
The United States and Canada lead the world when it comes to prosecuting people who infect or expose others to HIV, a surprising new study reveals. At least 21 states have HIV-criminalization statutes. Black men have been disproportionately targeted, which both reflects and increases HIV/AIDS stigma.
HIV advocates have commended the National HIV/AIDS Strategy for explicitly stating that "state legislatures should consider reviewing HIV-specific criminal statutes." It also challenges communities to support and promote PLWHA into leadership.
"We have to look at this strategy as a guideline and not a solution," says Dr. Malebranche. "There is only a certain amount of power the White House and president have. They can't force states to change their HIV-criminalization laws. But they can direct policy and spark change at the local and grassroots level. Hopefully that will happen."
Rod McCullom, a writer and television-news producer, blogs on Black gay, lesbian, bisexual and transgender news and pop culture at rod20.com.