Because it has been almost three decades since the AIDS pandemic first exploded into public consciousness, it may be hard for some to believe that there are still vast pockets of the country in which un- and under-treated people continue to suffer, and where public health experts and AIDS activists are not much closer to getting a handle on the problem than they were three decades ago.
Within Black communities, this doleful reality is becoming increasingly apparent, as people are alarmed to discover that Black women are the fastest-growing group of AIDS sufferers, representing 67 percent of all new HIV infections in the U.S. among women. Within Dallas County, there are currently 14,000 people living with HIV/AIDS, more than a third of whom are Black. Blacks are 48 percent of the newly-diagnosed (compared with 28 percent for whites and 23 percent for non-white Hispanics). 1 in 89 Black individuals in Dallas County are living with HIV/AIDS. *
And Dallas is no anomaly. Despite being just 13 percent of the U.S. population, African-Americans are 50 percent of all of those living with HIV.
Given the ways that the socioeconomic profile of the “typical” AIDS patient has evolved over time, experts everywhere are insisting on the need for new paradigms and, for Black communities especially, new urgency.
“We’re basically still looking at HIV as a disease that is driven by behavior, when we know that HIV is being driven by socioeconomics,” said AIDS activist Marsha Jones of The Afiya Center, an organization devoted to HIV education and reproductive justice. “We’re also not addressing the need to educate people who are younger. HIV should be a part of any school curriculum, because the bottom line is that children are getting infected younger.”
For Jones and other activists, the HIV/AIDS crisis has only served to sharpen pre-existing racial and socioeconomic disparities.
“Prior to HIV, we were able to make it appear that everybody had risen,” said Jones. “We had gone through the 60s and the 70s and the protests and the marches, and everyone was on a level playing field. That was never so. HIV brought the realization that racism and classism still exists.”
A crucial point about the HIV/AIDS crisis, frequently reiterated in this reporter’s talks with public health experts, is that each generation experiences the pandemic anew, so that a previous generation’s experience with the disease (for people above a certain age, for example, the 1991 announcement by NBA legend Earvin “Magic” Johnson that he tested positive for HIV), might not be applicable to a younger crowd.
“We’re seeing a younger population, who may not [remember] back that many years in terms of looking at the crisis and when it begun,” said Zachary Thompson of Dallas County Health and Human Services. “Like for example, when you talk about Magic Johnson, he was diagnosed almost 20 years ago. But when you talk about now, a different generation sees Magic Johnson today, and they may not take it as seriously as people took it back in the 1980’s.”
Phill Wilson of the Los Angeles-based Black AIDS Institute agrees. Diagnosed with HIV during the 1980s, he’s been living with full-blown AIDS for nearly two decades. He co-founded the Black AIDS Institute in 1999, made possible only when the new protease inhibitors—now a standard medical treatment for AIDS—helped him stay well enough to go back to work.
“The major lesson to learn is that new people come into their sexuality everyday, so they weren’t in the room during whatever lessons we were teaching yesterday. So the most important lesson is that you have to keep it up. You don’t get to stop doing it,” Wilson said.
“For Black communities, we have yet to invest the kind of energy that we need to invest to raise HIV science literacy in Black communities,” said Wilson. “Too many folks don’t understand the science of HIV. Too many folks are vulnerable to misinformation and conspiracy theories because they don’t understand how the virus works, and it becomes a barrier to prevention, a barrier to trusting, and a barrier to treatment.”
Wilson said that when he looked around, it soon became apparent that there needed to be an organization that focused on policy, information, training and capacity building from a Black point-of-view.
“Obviously, at the Black AIDS Institute we talk about the relationship between race, gender, class, sexual orientation and HIV all the time, and we think that’s an important part of the conversation for a whole bunch of reasons, chief among them that having an honest conversation about race, class and HIV helps people take responsibility and ownership of the epidemic,” said Wilson.
The national Greater Than AIDS campaign, which frequently works with state and local health departments to promote and mobilize HIV/AIDS resources, is one attempt at boosting HIV-literacy levels. The campaign is being harnessed by local activists to connect audiences with direct services on the ground. So far more than 1,200 outdoor advertisements (billboards, mall kiosks, interior bus ads) tagged with local HIV resources have sprung up in and around Dallas, Houston, and San Antonio.
“For Dallas in particular, the campaign has posted more than 450 outdoor advertisements tagged with local resources,” said Nicole Saunders of the Kaiser Family Foundation, one of the main organizers of the event. “Dallas County Health and Human Services (DCHHS) is working to heighten efforts to increase awareness, through events like the Testing Tour that was held at four Dallas area colleges this past Monday and Tuesday, and through outreach at Kwanzaafest and other events.”
“I think what we need to focus on in terms of discussing AIDS are two areas that oftentimes get overlooked [when] we try to typecast the disease into a certain race or class,” said Zackary Thompson of DCHHS. “What should be focused on is that we realize no one is exempt from this and we have to do prevention and treatment; and we have to get the message out there that if you’re involved in risky behavior, then that’s really what [we should] be focused on.”
In the course of trying to increase awareness, activists soon discover that broaching the subject of AIDS, because it overlaps the treacherous terrain of sexuality, intimacy, and African-Americans’ tortured relationship with the medical establishment, is never a simple conversation.
“There are definite barriers there, because as a community of people, we don’t always like to talk about those things that hurt our community most,” Jones noted. “We have historically decided that we would prefer to deal with those things within the confines of our community.”
And within the confines of the community, certain folk wisdoms develop—such as the “down low” phenomenon or the belief that the emergence of AIDS among Blacks is part of a government conspiracy—that can complicate efforts to disseminate accurate, up-to-date information.
“To get into the Black community and talk about those things that drive HIV—specifically as it relates to same-gender sex or women selling sex to survive—these are things that we don’t like to talk about in our community. We don’t want to make it appear that there’s a crack in our foundation, when it’s more than a crack,” Jones insists.
And then there’s the role played by some religious leaders, whose traditional conservatism and influence over Black congregations can pose challenges for those trying to initiate frank discussion.
When asked whether he thinks Black churches have been a force for inertia on HIV/AIDS awareness, Phill Wilson responds: “I think that that’s probably a fair analysis. The caveat that I would add is that there’s no such thing as ‘the Black church,’ and I think that to the degree HIV advocates often think of Black faith communities as a single entity, they contribute to the problem.”
Another sensitive subject is the widespread belief that one of the main vectors of disease transmission is closeted gay and bisexual Black men—said to be on the “down-low”—transmitting the disease to their unsuspecting Black female partners. Despite the amount of ink and airtime devoted to the subject, there are those who argue that the phenomenon is overblown. What’s more, some worry that the currency of the down-low explanation only breathes new life into old stereotypes about Black male sexual profligacy and recklessness, as well as homophobia.
“Two things are problematic about it, about how it’s currently characterized in the media,” said Jones. “One is that it’s a uniquely Black phenomenon. White gay men on the down-low are simply ‘in the closet,’ while Black men in the closet are on the down-low. It carries with it a demonization and a characterization that Black men are amoral predators which I think is destructive.”
“The second thing is that there is no evidence that the phenomenon, no matter how broad or narrow it is, is the major engine of the spread of HIV in Black communities. That’s why it’s important to look at the science,” Jones adds.
Jones is adamant that providing service to AIDS patients, though still vital, must be buttressed by efforts at influencing policy and bringing about wider cultural shifts. Though skeptical of the “down-low” issue, Jones thinks some good may come of it if catalyzes a changing of norms within Black communities that results in greater acceptance, even embracing, of the full range of sexual identities.
“While direct service is extremely important, direct service alone is not going to end the AIDS epidemic,” said Jones. “We need to build a model that is inclusive of caring for people with AIDS, as well as prevention, as well as addressing social determinants and changing the cultural norms within our communities.”
But at this point a paradox is confronted. The more activists attempt to bring up fundamental paradigm shifts, the more they can’t help being aware of the structural challenges that they’re up against. Marsha Jones states it plainly:
“Black people have less access to affordable, accessible, quality healthcare, housing and education. All of these things create vulnerabilities; they create the risk for a certain population to become affected by this disease that’s driven by socioeconomics. HIV has mirrored this, it’s magnified it, and it has really clearly shown the great divide here.”
*Statistics provided by Blanca Cantu of Dallas County Health and Human Services
© Dallas Examiner. All rights reserved.
© Dallas Examiner. All rights reserved.
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