• Eric P. Goosby, M.D.
  Key initiator of the creation of the Guidelines for the Treatment of HIV Disease.
  Former Chief Resident of San Francisco General.
  Now, the Director of the Office of AIDS Policy.

Dr. Goosby began his talk by recounting statistics detailing the disproportionate impact that HIV has had on the African American community:

Some of the more dramatic statistics he mentioned included:

• Although new infections have remained at around 50,000 per year, African Americans have grown from a minority of new infections to the majority;

• African Americans still refuse to see themselves or their sex partners as at risk for infection;

• African Americans seek medical treatment at a much later stage of HIV disease, with an opportunistic infection often preceding an HIV diagnosis; and,

• the African American community itself continues to deeply stigmatize HIV-positive people and discourages people from getting into and staying in proper care.

Dr. Goosby briefly highlighted some of the specific psychological and social challenges that keep many African Americans of all ages and economic levels from being motivated to act on their own or others' behalf in regards to health care. He noted that a pervasive, but sometimes invisible problem is that many African Americans do not feel entitled to health care, or that health care is seen as a last resort, not only among people living with HIV, but among all African Americans relating to all types of health conditions. The central question of his talk was "Why are [African Americans] as a people willing to remain still and endure?" Implicit in this question is another question: "What can be done about it?"

Although Dr. Goosby did not really answer the first question, he did discuss at some length what the Department of Health and Human Services (DHHS) has done to address what can be done about this inertia. Of massive importance was the discovery and acknowledgment by the DHHS that they would have to change in order to successfully impact and improve the delivery of services to HIV-positive African Americans. Specifically, programs were developed within the last couple of years with the goal of linking HIV prevention and treatment programs to create a safety net of services within specific geographic areas. This safety net would include HIV testing, treatment and other social services that may be needed to keep people in care, such as food and housing.

Upon issuing a series of requests for proposals (RFPs) targeted to organizations that serve HIV-positive African Americans, the DHHS found that many potential candidates for funding never found out about the RFPs. Others, although they learned of the RFPs, did not have the capacity or infrastructure to successfully complete their proposals or to compete for funding within the guidelines set out by the DHHS.

Thus, additional steps were taken to increase awareness of these funding opportunities among minority community-based organizations (CBOs) and to mobilize leadership within these communities to aid in the delivery of services. Further, because the DHHS hoped to demonstrate success in these communities and in order to open up new sources of federal funds for these kinds of programs, it became clear that support for infrastructure development and capacity building would also be needed.

Of particular relevance to service providers and clinicians was the acknowledgment by Dr. Goosby that government will have to change in order to finally make significant inroads toward erasing the disparities in health care among African Americans who are HIV positive. Government often moves slowly, or not at all. From a political standpoint, it is critical to have friends able to open doors, if only slightly, that will allow the activism of others to leverage more significant change.

In a talk later in the day, Dr. Fullilove, explained more fully some of the significant barriers that many African Americans face within and outside themselves, in their attempts to access appropriate care for HIV disease. Programs with a goal of erasing disparities in health care for HIV-positive African Americans will have to be built around a basic understanding of these barriers. Right now, most government programs do not adequately or appropriately fund such programs. Too often, minority community-based organizations are forced to accept whatever funding can be found, and adapt it as best as possible to meet the needs they encounter in the real world. Unfortunately, this leaves them, and thus their clients, to pay the price when they don't meet the original objectives of such funding. And we wonder why these organizations struggle? That Dr. Goosby and the DHHS are aware of their need to change is a very hopeful sign. It will take concerted advocacy to ensure that this change takes place.