The "poster child" for HIV/AIDS has changed throughout the years. First the media focused on White gay men who became infected through sex; then came the five H's: Haitians, homosexuals, heroin addicts, hookers and hemophiliacs. Recently, emphasis has been placed on Black women infected heterosexually, ostensibly by "down-low" brothers. But though the risk posed to by heroin addiction has been clear from early on, the media rarely cover the role that injection drug use (IDU) has played in driving up Black HIV rates.
Injection drug use is the second leading cause of HIV infection for African American women and the third leading cause for African American men, according to the Centers for Disease Control and Prevention (CDC). The CDC also estimates that IDU directly -- through actual contact with contaminated needles -- and indirectly, through sex with HIV-positive partners infected from IDU, accounts for more than one-third of AIDS cases in the United States.
But talking about injection drug use is not as sexy as discussing DL Black men. And those addicted to heroin, cocaine or other injection drugs are not in a position to advocate for themselves. So Black America remains ignorant about, and powerless against, this missing link to high HIV rates in our communities.
The Cause We Don't Talk About
"So much emphasis has incorrectly blamed the down low that there's been a lack of focus on one of the real issues of why HIV is disproportionately affecting African Americans," says Mary Beth Levin, director of programs and services at PreventionWorks! the District of Columbia's largest program focused on protecting IDUs (injection drug users). Levin notes that it's far easier (and cheaper) to speculate about a "mythological person" than to fund education, testing and treatment for STDs such as HIV, comprehensive mental health and drug treatment, and overdose prevention and needle exchange.
One of the most controversial but effective HIV-prevention methods -- needle, or syringe, exchange (pdf) -- consists of a structured process in which trained workers collect used needles from drug users, dispose of them safely (pdf) and then provide sterile needles to replace them (pdf). A large body of research exists about these programs, including a 1997 National Institutes of Health survey that found that needle-exchange programs (NEPs) reduce HIV transmission by 30 percent. In 2005, NEPs removed more than 22 million dirty syringes from communities.
Still, detractors falsely depict NEPs as programs that irresponsibly hand out needles next to playgrounds and/or promote or condone drug use. These and other "moral arguments" have prevented needle exchange from being seriously considered as a public-health strategy.
"We didn't make it universally known that syringe exchange would help to keep HIV infections to a minimum," says Beny Primm, M.D., (pdf) chair of the Addiction Resource and Treatment Corporation and the Urban Resource Institute, both non-profits that have treated drug addiction in New York City since the late 1960s, when many Black men returned from the Vietnam War addicted to heroin. Shunned by their families, communities and houses of worship, many were incarcerated, did not receive education about HIV and eventually became HIV-positive.
Injection drug use coexists with other high-risk behaviors -- exchanging sex for drugs, prostitution and having sexual relationships with IDUs, for example. So in places like Washington, D.C., and Harlem, N.Y., where heroin use thrives but public health interventions have failed, AIDS rates have reached pandemic levels.
Blood on the Hands of Congress
"The United States is the only country in the developed world that has not reduced new HIV infections," asserts Levin. Yet in many parts of the world, NEPs help prevent blood-borne disease (pdf), including HIV. For example, in southern Australia, where 55 NEPs serve about 1.2 million IDUs, no new HIV infections occurred for three consecutive years.
Washington, D.C., where Levin's program is based, has the highest rate of new AIDS cases in the United States. An estimated one in 20 residents, most of them Black, live with HIV, versus one in 50 Blacks and one in 200 Whites nationally.
Congress has controlled D.C.'s entire budget for 22 years, refusing to fund syringe exchange, even as other cities -- some in the home states of representatives who opposed NEP in D.C. -- exchanged needles. Adding insult to injury, Congress banned the D.C. government from using its own dollars for needle exchange until 2007 -- interference that many activists say places blood on federal legislators' hands.
Toward a More Compassionate Approach
Under the Obama administration, Congress has approved money for Washington, D.C., to support needle exchange. Levin says she is "absolutely" sure that D.C.'s infection rate will go down. Dr. Primm agrees: "I think we may see some difference in the numbers."
And in the face of a growing body of scientific evidence and the support of major public figures -- from former surgeon generals C. Everett Koop and David Satcher to California governor Arnold Schwarzenegger -- a slow shift has been taking place nationwide.
The question remains, though: How long will it take for our nation to develop comprehensive policies to prevent injection drug use from fueling HIV's spread? And equally important, what actions will Black people take to bring it about, and what price will Black communities pay?
Contact your federal, state and local representatives to let them know where you stand.
Angela Bronner Helm is a Harlem, N.Y.-based editor at Uptown magazine. She is also a board member of the Black AIDS Institute.