A Collaborative Response

A comprehensive response that addresses the HIV/AIDS crisis in African American communities requires the commitment and collaborative response of state and local health departments, federal agencies, policy makers, national non-governmental organizations and AIDS service organizations.

The Critical Role of State and Local Health Departments

State and local health departments play a critical role in the delivery of HIV/AIDS prevention, care, and treatment programs. State public health agencies are the central authorities of the nation's public health system. State and local health departments conduct a continuum of activities that address HIV/AIDS programs including: counseling, testing, and referral (CTR); disease surveillance, health education/risk reduction (HERR); primary health care and supportive services for the uninsured and indigent; delivery of antiretroviral medications; and prevention research and program evaluation.

State and local health departments provide leadership, resources, and assistance to meet citizens' HIV prevention and care needs, working in partnership with the federal government, other state and local agencies, and community-based organizations (CBOs). Along with significant state funding, health departments receive federal funding from agencies such as the CDC and the Health Resources and Services Administration (HRSA) to administer prevention and care activities.

In recent years, decreases in federal funding for HIV/AIDS programs have challenged how states address this ever-increasing epidemic, particularly within communities of color. According to the April 2005, National ADAP Monitoring Project Annual Report, 34 percent of clients served by state AIDS Drug Assistance Programs (ADAPs) in June 2004 were non-Hispanic Black/African American,¹⁶ yet African Americans represent more than half of the HIV/AIDS cases in the U.S.³ Additional resources are needed to support fiscally strained state ADAPs and other public payer programs in order to serve African Americans in proportion to the epidemic. Furthermore, national data must be enhanced to assess whether or not ADAPs and other public service programs are serving African Americans in proportion to their need.

It is urgent that state and local health departments address the disproportionate impact of HIV/AIDS on African American communities. NASTAD's monograph, HIV/AIDS: African American Perspectives and Recommendations for State and Local AIDS Directors and Health Departments, asserts "AIDS directors have a responsibility to take leadership and address the HIV/AIDS crisis in African American communities."⁹ Health departments must take a leadership role in shaping a governmental response to the HIV/AIDS crisis among African Americans. The response must account for the central role that health departments play in HIV/AIDS prevention, care, and service delivery. Indeed, state and local health departments are viewed as key partners in the fight against HIV/AIDS.

The Critical Role of Federal Agencies and Policy Makers

Recent events in our nation's history underscore the central role of core public health activities in ensuring public safety and promoting well-being. The threat of bioterrorism and the devastating impact of Hurricane Katrina both illustrate the importance of collaboration among federal, state, and local health and human service agencies. The alarming spread of HIV/AIDS represents a similar threat to our nation's health and security and requires a coordinated response from all levels of the public health system. Yet, even as the HIV/AIDS pandemic continues its explosive growth, budgets are being curtailed domestically for key programs and services, further challenging already strained health care safety-net programs.

Federal government health entities are integral to curbing the systemic effects of HIV/AIDS on at-risk populations, particularly African American communities. CDC, HRSA, The Office of Minoriy Health (OMH), the National Institutes of Health (NIH), the Centers for Medicare and Medicaid Services (CMS), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Department of Veteran Affairs (VA), and the Department of Housing and Urban Development (HUD) are increasingly challenged by, yet responsible for, the administration of a myriad of HIV/AIDS services and activities. These entities must integrate multidisciplinary programs of research, data collection and surveillance, technical assistance, housing, drug treatment, counseling and testing, prevention outreach, capacity building, care and treatment, and evaluation. Coordination among these agencies is also crucial in mounting an effective response to this crisis.

The federal Minority AIDS Initiative (MAI) has worked to address health disparities within communities of color in various federal programs across multiple agencies. This initiative has targeted the highest-risk and hardest- to-serve populations, which for the past two decades have eluded more traditional HIV/AIDS prevention, treatment, and education efforts. As African Americans continue to represent the majority of all new HIV infections nationwide, the disproportionate effects of this disease require a heightened response, and significant attention at all levels of government. Moreover, authorities responsible for the reauthorization of the Ryan White Care Act, Medicare and other care and treatment programs must recognize the effects that changes in these programs may have on African Americans. There must be an unprecedented collaboration and coordination among federal entities to effectively respond to the gravity of this disease among African Americans.

The Critical Role of National Non-Governmental and AIDS Service Organizations

National non-governmental organizations (NGOs) and AIDS Service Organizations (ASOs) that serve African American communities are vital to addressing the HIV epidemic. We must continue to strengthen the capacity of these organizations that are commited to fighting HIV/AIDS and engage other organizations whose mission and vision supports the work already begun in the fight against HIV/AIDS among African Americans. Many national African American organizations are committed to goals that eliminate health disparities, preserve the African American family unit, foster economic empowerment, and create powerful research and policy agendas. These issues are all critical to addressing HIV/AIDS in African American communities. These organizations must find ways to link HIV/AIDS to their current agendas, and make this involvement relevant and meaningful to the organizations and the specific African American populations they serve.

National African American organizations often possess the credibility in the community and the capacity to reach segments of the population unattainable by traditionally non- African American agencies. For example, The Balm in Gilead, an NGO dedicated to empowering churches, has recognized the powerful and influential role of the faith community to provide HIV/AIDS education and support to people living with and impacted by HIV/AIDS.

National African American organizations also exert political influence and shape policy discussions and responses. These organizations should participate in established initiatives, such as National Black HIV/AIDS Awareness & Information Day (NBHAAD), sponsor HIV/AIDS focused discussions at annual meetings and conferences, mobilize grassroots efforts, and develop their own HIV/AIDS initiatives. The broader HIV/AIDS community, particularly African American led ASOs, must support these non-traditional partners.

"African American leaders are united in their determination to wage war on behalf of the African American community. HIV/AIDS is the single greatest health crisis facing African Americans today. We stand ready and willing to work with every individual and organization committed to the health and well-being of the community to stop this epidemic. It is significant that NASTAD has produced this Call to Action because state HIV/AIDS programs have an important role to play in ensuring that increasingly scarce federal and state resources end up where they are needed most. NASTAD's Call to Action builds upon previous efforts by NBLCA to mobilize African American leadership, including our history-making Meeting of the Millennium in 2001, which continues to be the foundation for our affiliates across the country. The NBCLA stands prepared to work with NASTAD to help strengthen its African American-focused efforts and to partner with NASTAD in on-going efforts with African American leaders, organizations, and institutions in the battle against HIV." Deborah Frazier-Howze, The National Black Leadership Commision on AIDS (NBLCA)