New HIV statistics indicate increasing toll of AIDS on African American community

The country's leading African-American lawmakers, civil rights leaders and medical experts today called on the federal government to adopt and implement a new blueprint to address the HIV/AIDS crisis in the African-American community.

The plan is outlined in a new report, African-Americans, Health Disparities and HIV/AIDS: Recommendations for Confronting the Epidemic in Black America, written by Robert E. Fullilove, EdD, associate dean for Community and Minority Affairs and professor of Clinical Sociomedical Sciences at Columbia University's Mailman School of Public Health. The report was released by the National Minority AIDS Council (NMAC) in advance of World AIDS Day (December 1).

Since the beginning of the HIV/AIDS epidemic 25 years ago, African-Americans have been overrepresented among those living with and dying from AIDS. The disease continues to affect African-Americans more than any other racial/ethnic group in the United States. Today, African Americans comprise only 13% of the U.S. population but account for over half of all new HIV/AIDS diagnoses. Over 200,000 African-Americans have died of AIDS, half a million are now living with HIV and blacks are 10 times more likely than whites to have AIDS. Confronting this national health disparity is a paramount concern.

NMAC's report, written by Dr. Fullilove, is a comprehensive analysis of the complex social, economic and personal factors that underpin the black AIDS epidemic. Its recommendations are endorsed by a blue-ribbon expert advisory panel of some 30 African-American leaders that includes, among others, Julian Bond (chairman, NAACP), Dr. Louis Sullivan (former Secretary of Health and Human Services), Dr. David Satcher (former U.S. Surgeon General), Marian Wright Edelman (president, Children's Defense Fund) and Marc Morial (president, National Urban League).

"At this time each year, the U.S. Centers for Disease Control and Prevention releases new national HIV statistics and we see an ever-increasing toll of AIDS on the African-American community," said Dr. Fullilove. "And each year we ask why AIDS is hitting black Americans hardest. Our analysis identifies the forces that drive the epidemic in black America, and recommends proven, practical and affordable strategies that government must implement without delay to protect the health of African Americans."

"It is a national tragedy that the AIDS crisis has continued unabated in the African-American community for so many years," said Beny Primm, M.D., NMAC's chair emeritus. "There is a danger that we view AIDS as a problem that only affects Africa when it remains a real and growing danger in our own backyard. That kind of complacency is killing people and it has to stop. This plan of action shows us the path forward to reversing this national disparity."

"The U.S. government is showing leadership in addressing the global pandemic, but we are failing to confront AIDS here at home," said Congresswoman Donna M. Christensen (D-U.S. Virgin Islands), Chair of the Congressional Black Caucus' Health Braintrust. "Are we willing to sacrifice another half-million African-American lives to this entirely preventable disease? It is up to the members of the newly elected 110th Congress to answer this question."

Report Recommendations

African-Americans, Health Disparities and HIV/AIDS: Recommendations for Confronting the Epidemic in Black America presents five policy solutions that address the increasingly disproportionate impact HIV/AIDS is having on the African-American community:

• Eliminate marginalization of, and stigma and discrimination against, black gay and other men who have sex with men (MSM). African-American MSM is the population hardest hit by HIV, with diagnosis rates twice that among white MSM. Yet currently there is only one HIV prevention program that has been specifically designed for black MSM. Investing in research to implement interventions for black MSM is essential to reversing the epidemic in this population. Promoting leadership among black MSM and sustained capacity-building investments in the organizations that serve them is critical. Efforts to address homophobia and related stigma, discrimination and violence – all of which increase HIV risk among black MSM – are also needed.
• Reduce impact of incarceration as driver of new HIV infections. – AIDS cases among incarcerated persons are more than three times that of the general population, and African- Americans are disproportionately represented in U.S. prisons. Outdated and inconsistently implemented HIV prevention policies have failed to reduce risk behaviors among prisoners while incarcerated and after their release. Providing routine, voluntary HIV testing for prisoners upon entry and release; making condoms available in correctional facilities; expanding re-entry programs to help prisoners transition back into society; and ensuring that their HIV prevention, substance abuse, mental health and housing needs are met prior to release are key to stopping HIV's spread in the African-American community.
• Reduce role of injection drug use in sustaining the AIDS epidemic. – Among blacks, one in five (19%) new HIV infections is attributed to the sharing of contaminated needles through injection drug use. Reducing the role of injection drug use in the spread of HIV will require an increased investment in education and substance abuse programs designed to prevent people from using injection drugs in the first place and help current users to quit, and establishing needle-exchange programs to minimize the risk of infection from sharing needles.
• Expand proven HIV prevention, diagnosis and care programs. – Far too many African Americans lack accurate information about how HIV is transmitted, prevented and treated. Approximately 250,000 Americans – many of them African American – are unaware that they have HIV. These individuals are not receiving life-saving medical care and may unknowingly transmit HIV to sex- and needle-sharing partners. In addition, African-Americans are diagnosed at later stages in the disease more often than other racial/ethnic groups, diminishing medications' effectiveness. Many African-Americans also distrust the medical establishment, which only adds to the problem. Establishing and expanding corps of community health workers is a proven, effective and critical bridge between physicians and patients where mistrust of the health care system exists.
• Stabilize communities by increasing affordable housing. – The scarcity of affordable housing faced by many African-Americans is at the center of a web of interconnected socioeconomic problems affecting the black community, such as residential segregation, school failure for children and a lack of access to health care, including HIV prevention, diagnosis and treatment services. Stabilizing black communities by expanding federal housing programs, such as Housing Opportunities for Persons with AIDS (HOPWA), is central to stemming the African-American AIDS epidemic.

The National Minority AIDS Council (NMAC) was founded in 1987 to develop leadership within communities of color to address challenges of HIV/AIDS. Today, NMAC is an association of AIDS service organizations providing valuable information to community-based organizations, hospitals, clinics and other groups assisting people and families living with and affected by the AIDS epidemic. African-Americans, Health Disparities and HIV/AIDS: Recommendations for Confronting the Epidemic in Black America is available at www.nmac.org and has been endorsed by a number of organizations, including AIDS Project Los Angeles, Community HIV/AIDS Mobilization Project, Lambda Legal, the National Black Leadership Commission on AIDS, the Harm Reduction Coalition and others.

NMAC's report complements a series of publications from the Black AIDS Institute exploring the African-American HIV/AIDS epidemic. Black AIDS Institute reports and policy recommendations are available at www.blackaids.org.

About HIV/AIDS in the United States

2006 marks the 25th anniversary of the start of the AIDS epidemic. The first cases of HIV/AIDS were reported by the U.S. Centers for Disease Control and Prevention (CDC) in the June 5, 1981 issue of the Morbidity and Mortality Weekly Report (MMWR). Today, the CDC estimates that 1.1 million Americans are infected with HIV, the virus that causes AIDS. Of these, nearly half (47%) are African- American. Since the beginning of the epidemic, African-Americans have accounted for 379,278 (40%) of the estimated 944,306 AIDS cases diagnosed. Through December 2004, an estimated 201,045 African-Americans have died of AIDS.

About the Mailman School of Public Health

The only accredited school of public health in New York City, and among the first in the nation Columbia University's Mailman School of Public Health provides instruction and research opportunities to more than 900 graduate students in pursuit of masters and doctoral degrees. Its students and more than 270 multi-disciplinary faculty engage in research and service in the city, nation, and around the world, concentrating on biostatistics, environmental health sciences, epidemiology, health policy and management, population and family health, and sociomedical sciences. www.mailman.hs.columbia.edu