HIV/AIDS IN THE BLACK
COMMUNITY:
A SOCIAL DETERMINANT
ANALYSIS AND POLICY RECOMMENDATIONS
Jay Carrington Chunn, Ph.D
Policy
Monograph
August,
2008
Published
by the National Center
for Health Behavioral Change e-Press©
Location:
Urban Medical Institute /Morgan
State University
2600
Liberty Heights Avenue
Baltimore, MD 21215
www.nchbc.org
Funding
for this monograph provided by the Joint
Center for Political and
Economic Studies, Washington,
DC: Subcontract number
P0093824-694-6012
CONTENTS
Introduction
pg 3
HIV/AIDS in Black America
pg 4
Existing National
Policy
pg 5
Proposed National
Policy
pg 15
Social
Determinants of HIV/AIDS Policy for African Americans pg 19
Policy
Recommendations
pg 26
Conclusion pg
36
Bibliography &
Notes
pg 39
About the Author:
Consult www.nchbc.org for bio under about
us
INTRODUCTION
On June 5, 2006, the public health community
recognized a difficult 25th anniversary. On that date in 1981, a
rare form of pneumonia cystitis was diagnosed and discovered in a handful of
white homosexual men in San Francisco,
California. Shortly after this
discovery, the victims succumbed to the symptoms of the condition that is known
as Acquired Immune Deficiency Syndrome (AIDS). This puzzled the medical and
scientific communities, who used their resources to determine that AIDS was not
just a variation of a common disease, but a unique and deadly epidemic that had
the potential to wreak havoc on populations and communities. This disease was a
slow-moving virus that attacked the immune system of its victims until they
were left vulnerable and powerless to fight off opportunistic infections that
would eventually kill them. The growing epidemic was identified as similar to a
disease that had been the cause of death for many in Africa
as early as the 1950s. Scientists discovered that this disease was spread
through contact with body fluids of infected individuals. This contact included
sexual transmission and the receipt of infected blood through transfusions.
They also found that Human Immunodeficiency Virus (HIV) was the initial
condition that eventually progressed to AIDS. Those who found that they were
infected with the disease were aware that their life would soon end. That fear
was compounded by the prejudice, harassment, and scorn that were heaped upon
them by biased people who did not understand the disease.
What started as a disease affecting
a handful of gay men turned into a pandemic of epic proportions and soon began
to infect both homosexuals and heterosexuals. It was clear that HIV/AIDS had
the potential to spiral out of control if it was not stopped and/or contained.
However, the United States
government was slow to respond to the growing AIDS problem. Lawmakers had to be
convinced to enact policies to study and prevent this disease. Little attention
was paid to this disease in the 1980s, when it was first recognized. That lack
of attention allowed the disease to progress to the point that it is today.
As
the affected population changes, it is necessary to reassess policies, re-engage
policymakers, and enact prevention as well as treatment programs. To that end,
this monograph examines current HIV/AIDS policies and proposed policy
initiatives. It then identifies the social determinants that should drive
HIV/AIDS policymaking for the African American community, including politics,
economics, gender, age, and geography. Finally, it concludes with
recommendations for new policies and directions that will better serve African
Americans.
HIV/AIDS IN BLACK AMERICA
African
Americans are disproportionately affected by HIV/AIDS infection. They have an
AIDS diagnosis rate nearly 10 times higher than that of whites.[i]
In 2004, they made up 12.2 percent of the U.S. population, but 49.3 percent
of the AIDS cases estimated to be diagnosed that year.[ii]
For black adults, the AIDS rate (the number of people
living with AIDS per 100,000 population) was 72.1, while it was only 17.1 for
the total U.S.
population.[iii] The rate at which black women were
diagnosed with AIDS in 2004 was 23 times the rate for white women, while the
rate for black men was eight times that of white men.[iv]
HIV
infection among African Americans due to intravenous drug use is especially
common. In Baltimore
City, for example,
statistical analysis suggests that as high as 75 percent of all new cases are
related to drug abuse.[v]
Many of these drug users are identified as heroin addicts as well as
intravenous drug users who use crack and/or cocaine. Drug addicts spread the
disease to their partners primarily through sexual contact and needle-sharing.
Female addicts acquire and spread the disease because they often prostitute
themselves in exchange for drugs. The issue of drugs and HIV/AIDS is not
exclusive to the African American community, but it is a crucial factor that
affects the spread of the disease among this population. Indeed, the lack of
sufficient substance abuse treatment programs and the very low number of
prevention programs have been cited as reasons for the spread of HIV/AIDS among
African Americans.[vi]
By 2003, there was widespread
recognition of the changing face and demographics of HIV/AIDS. That year, the
Ryan White CARE Act appropriated $104 million to be spent by the Centers for
Disease Control and Prevention (CDC) to study the disparity between people of
color and whites. However, the following year, despite the fact that no
conclusive evidence had been obtained to explain and address the racial/ethnic
disparity, there was no increase to the CDC to continue this study.[vii]
In this way, the foremost organization for researching disease and prevention
was prohibited from increasing its efforts to generate research that would help
prevent HIV/AIDS in African Americans and other people of color. In addition to
the need for further such research on the issues surrounding HIV/AIDS
disparities between people of color and whites, national policies pertaining to
the disease need to be assessed to determine their impact on African Americans.
We now turn to an examination of these policies.