The Hidden Epidemic

African-American community hit hard by HIV/AIDS

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“He has cancer.” “He has hepatitis.” “House In Virginia”. “Hi-Five. (Hi-V)” “The virus.” Society today has developed many euphemisms to not say HIV. HIV is ravaging the African-American community nationwide, and no one is listening. It’s a problem from within the African-American community, especially when the lifetime risk for HIV is 1 in 2 for African-American men who have sex with men compared to 1 in 99 for all Americans. These men face an unacceptably high risk for HIV.

Another disparaging factor impacting the African-American community is living in the South. Forty-four percent of all Americans living with HIV live in the South, while 37 percent of American live in the South. Diagnosis rates for people in the South are higher than the rate for Americans overall. Eight of the 10 states with the highest rates of new HIV diagnoses are in the South, as are the 10 metropolitan statistical areas (MSAs) with the highest rates. African-Americans are severely impacted in the South and nationwide, accounting for 54 percent of individuals living with HIV. African-American men who have sex with men account for 60 percent of all African-Americans living with HIV. African-American women face an equally disproportionate burden of the disease, accounting for 69 percent of all HIV diagnoses among women in the South.

Thanks to the success of antiretroviral medications pioneered more than 30 years ago and education, HIV positive patients can lead full, healthy lives. HIV new case rates have plummeted in recent years overall and are now down to about 36,000 new cases annually. However, in certain communities in this country, HIV is ravaging the population.

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Early HIV research and literature did not include the African-American community and especially African-American men who have sex with men and could have made an impact on the understanding of the origins of HIV along with earlier outreach and prevention. The early success of the HIV advocacy and the financial power of the LGBT community, did not include the African-American community which was and is burdened with poverty and an inadequate healthcare infrastructure.

Pre-exposure prophylaxis (PrEP), Post-exposure prophylaxis (PEP) and Treatment as Prevention (TasP) have positively impacted the rate of new cases and the health of those living with HIV. An undetectable viral load is the new negative with little or no chance of passing the virus on during a possible exposure. Truvada, the only medication currently approved for the prevention of HIV is > 99 percent effective. Yet less than 10 percent of “at risk African-Americans” are taking Truvada. Most African-Americans either can’t afford it or don’t know about it. The negative attitude of rural health care settings also plays a role.

History should never forget the  “Tuskegee Study of Untreated Syphilis in the Negro Male,” which was started in 1932 and was projected to run for six months and ended up running for 40 years. The study only ended in 1972 when the situation was exposed by an Associated Press story. These men were told they had “dirty blood” and were being treated for various ailments, but were not given effective treatment. According to records, the American Medical Association was aware of the study and did not interview. It is no wonder the African-American community has a general distrust of the practice of medicine and the cultural misbelief that HIV was created to kill African-Americans.

Can we turn things around for the community? In the current political climate, there is not the leadership, money and political will to effect change. One of the greatest success stories for HIV/AIDS is the 2003 President’s Emergency Plan for Relief (PEPFAR) which provided $15 billion internationally but none for America, over a five-year plan. There are pockets in America which have experienced the same and higher rates than Africa for HIV while funding remained flat or declined.

During the 1990s the U.S. government spent billions of dollars on abstinence until marriage sex education. Effective sex education and condom use were discouraged and agencies who attempted to provide science-based, effective sex education were harassed with federal audits. It is no surprise that the rates of new HIV cases rose sharply during this anti-science campaign. Ignorant ideology made effective HIV prevention nearly impossible for some of our most vulnerable Americans.

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Research indicates that African-Americans are not having condomless sex at higher rates than others. It is a numbers games. If HIV has hit the African-American population harder and more African-Americans are positive and either don’t know it or are not linked in care and taking their medications, then those detectable viral loads are driving the epidemic.

The nation and society have failed the African-American community. The African-American community must take care of itself. And it must start with the homophobia and transphobia mentality that permeates much of the African-American community. Until it is acceptable for a African-American man to love a African-American man, the epidemic will decimate the African-American community. General discomfort with public sexual discussion is more widespread in the South. The African-American community has long turned to its houses of worship for guidance. Sexual discussions, reducing stigma and a willingness to be tested for HIV, must start in the pulpit.

I am a white male with privilege who has had the honor of being welcomed in to the African-American community. My patients have helped me recognize my privilege that has not been afforded to the African-American community. My African-American brothers and sisters are suffering. Words have power. These words have power. We need to help. What can I do to help?

info: J. Wesley Thompson, MHS, PA-C, AAHIVS, DFAAPA, is the medical director for Ballantyne Family Medicine.

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