What do you focus on in your own HIV/AIDS advocacy work? What are the biggest obstacles you encounter?
I'm strongly for prevention efforts -- that's the key: "Don't get it." As a psychiatrist, I'm also interested in some of the psychological dimensions. I think a lot of people in the black community feel hopeless about a lot of things. When you get into that mood, you engage in more reckless behavior. That frequently goes along with people struggling with feelings of self-esteem, with "What's the future got to hold for me anyway?"
Some of the resistance to HIV/AIDS education and to protected sex is a kind of risk-taking attitude. Black life has been so devalued in America for centuries that a lot of black people, I feel, devalue their own life -- and then they're going to devalue their health. And that's been part of the culture, that black life is not worth as much. It has been acted out through slavery and lynchings, even now, and a disproportionate number of death penalties, incarcerations. It just came out around Katrina: "You just didn't give a damn about us, and you won't give us money to rebuild our homes."
The other obstacle is getting treatment. Blacks have more difficulty, for a variety of reasons, getting access to treatment, getting good follow-up and support services compared to whites. And also the affordability of drugs. It's something that needs major attention.
Where do you find the most support?
Sometimes I gauge support by how many people are inviting me to talk specifically about HIV/AIDS. The media frequently does not want to call me to talk about AIDS in the black community, but they'll call to talk about the black reaction to, say, Katrina. On the speaking circuit, even among black groups, I get a lot of invitations to talk on black mental health problems -- but not about AIDS. People are still embarrassed about that.
Suppose they invited me to a predominantly white campus, and it's black history month, and the talk is "AIDS in the Black Community." Well, blacks would be embarrassed. It's "Lets focus on something positive instead." But that type of thinking prevents education.
You have to talk about HIV/AIDS, and throw in obesity and diabetes -- the things that are killing blacks.
What is the most critical AIDS issue facing the African-American community?
The continuing rise in HIV infections. When black AIDS workers come and talk anywhere, the black communities seem shocked by the statistics. They don't know.
I think also we have a young population with AIDS, and AIDS in the age group from 25 to 44 is, I think, the leading cause of death. There's been a lot of silence about it, and the media hasn't covered it adequately. And we don't know why. It happens to blacks, so they're kind of indifferent.
How does attention to HIV/AIDS differ in white and black communities?
It gets much more attention in the white community, particularly among white gay men. They represented a powerful block and were able to mobilize because they had many supporters -- especially many people in their own community who could support their effort.
A lot of the groups that they started did not reach out to the black community. Some of the organizations were nearly all white. Black gays complained to me about what they thought was racism in the white gay community. So there was some neglect and silence there until blacks began to mobilize.
On the other hand, in 1996 we sponsored a conference [Leading for Life] here at Harvard to look at HIV/AIDS among African Americans, and some of the major black civil rights organizations didn't send representatives or sent very low-level people. Later they began to cooperate.
What role does the media play in educating black communities about HIV/AIDS?
Some people in the regular media told me that they were reluctant to write about HIV/AIDS in the black community because they felt it was such a negative: "All this negative news all the time about the black community -- crime, poverty, AIDS." They felt that blacks would feel the media was blaming blacks. I don't think that was a wise decision. It just kept up the barrier, the wall of silence.
Then there was -- and remains -- the problem that a lot of blacks get HIV from needles, drugs. And there was enormous opposition to needle exchanges -- both from the federal government and from the black church and other leaders in the black community. They associated that with drug addiction. That remains still a major means of transmission in the black community.
And some people have complained that the public health schools in the country are more concerned about AIDS in Africa -- which you have to be concerned about. But everyone's talking about AIDS in Africa and AIDS in Asia -- but not AIDS in African Americans.
So AIDS education on all fronts is just essential. And the media has to play a role in that.
Where is the most progress being made in combating the epidemic in the black community?
The churches were very silent about it. But Balm in Gilead has been doing more and has been expanding. And the formation of the Black AIDS Institute made a big difference. They were even able to mobilize on historically black college campuses, where HIV was increasing, giving training workshops, making people leaders in their own community.
Some progress has been made particularly in going after the women, and saying, "You have to be more assertive in demanding condoms." There's an issue of male dominance, and women having trouble dealing with that issue. Black women now account for the vast majority of HIV/AIDS cases among women every year. And they have to say no. They're catching it from men -- not who caught it on the down low, whatever the heck that means, but who are injecting drugs.
Even on The Cosby Show years ago [for which Dr. Poussaint was a script consultant], we had a scene with a guy wanting to make out with Cosby's cousin, and she kind of said, "If you expect to get next to me, you're going to have to wear this." And she handed him a condom, which was very controversial at the time.
And we know that HIV spreads among incarcerated men who may be situationally homosexual. A lot of jails won't pass out condoms. They come back out, and they're primarily heterosexual, and then they transmit it to women.
What are the top myths about HIV you encounter in the African-American community?
People thinking HIV/AIDS was a conspiracy against blacks. I never figured out where that came from -- initially, people infected were mostly white. A fear and suspicion about how even now it's disproportionately affecting the black community.
We're up against the young people being influenced by the media -- the glamour and the excitement of engaging in sex. So you have younger and younger kids doing it, but the public health message isn't there, including, foremost, of course, AIDS, but also the other sexually transmitted diseases. So we have a public-awareness challenge of enormous proportions.
In what ways is the HIV epidemic different in the black community from other communities?
It's an extreme threat to the black community, and to other people in society, where there is a situation where the public health measures are not ameliorating the situation. That means problems for children, sick parents, orphans -- you know, the works. The major issue then is prevention, and how to do that when a lot of people are reluctant and embarrassed about discussing AIDS.
Do you think too much has been made of the "down low"?
The New York Times Magazine article and that book [J.L. King's On the Down Low] got enormous publicity, and it was all absolutely overblown. A lot of people in the black community still associate AIDS, even though women are getting it, with homosexuality, and that's stigmatizing.
Can you recommend one action everyone can take to end the epidemic?
I would say condoms. Either abstain from sex, work at keeping your relationship monogamous if you're negative, or always practice safer sex.
About Dr. Alvin Poussaint
Dr. Poussaint is one of the nation's leading psychiatrists. He is director of the media center of the Judge Baker Children's Center in Boston, a professor of psychiatry and faculty associate dean for student affairs at Harvard Medical School, and an expert on race relations in America and the dynamics of prejudice. He has pioneered the view that violent racism is a form of mental illness. After getting his medical degree in psychiatry, he served as the southern field director of the Medical Committee for Human Rights in Jackson, Mississippi, providing medical care to civil rights workers and helping desegregate southern health facilities. In 1996, when Mario Cooper, a black PWA lawyer who chaired AIDS Action Council, founded Leading for Life at Harvard University to mobilize then-scarce black leaders to speak out about HIV/AIDS in the African-American community, Dr. Poussaint was one of the first to sign on to the effort. Leading for Life has since morphed into the Harvard AIDS Institute, a multimillion-dollar public-health organization that promotes research, education and leadership to end the AIDS epidemic.