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Federal and private groups highlight HIV epidemic among African Americans
Nearly half of new infections are among blacks
The Centers for Disease Control and Prevention is joining AIDS service organizations (ASOs) and other groups in launching a new campaign to fight the epidemic in African American communities.
One effort will be the Test One Million campaign by the Black AIDS Institute of Los Angeles, CA. The institute is in collaboration with civil rights organizations across the United States. It will be launched on National HIV Testing Day in June.
"Our goal is to screen one million African Americans over the next year," says Phill Wilson, chief executive officer of the Black AIDS Institute.
"We're partnering with celebrities and will be promoting HIV testing and screening — normalizing HIV testing in our community," Wilson says. "We want to increase the number of people who know their status and increase the number who get into treatment."
The CDC is expanding its efforts to work with the African American community and others most affected by the epidemic, says Richard Wolitski, PhD, acting director for the division of HIV/AIDS prevention.
The CDC recently focused on one aspect of the epidemic's impact on African Americans with a report in the Morbidity & Mortality Weekly Report (MMWR) about the epidemic in Mississippi.
"With the MMWR report we're focusing specifically on the risk and experiences of young black men who have sex with men [MSM]," Wolitski says. "Those experiences and reflect some of the larger challenges we see in the African American community."
The MMWR report details HIV infection rates among young black, HIV-infected MSM in Jackson, MS, and it found that they readily engaged in high risk behaviors and had been unrealistically optimistic about their risk of infection.1
The report also noted that from 2001 to 2006, the number of HIV/AIDS cases increased by 93% among young black MSM in 33 states. And there were more new AIDS cases among black MSM in the South than in all of the other U.S. census regions combined.
"We conducted surveys with HIV-infected young black men who have sex with men, and we found 38% of them had not received HIV testing annually, as is recommended for MSM," says Alexandra Oster, MD, an epidemic intelligence service officer and lead author of the MMWR report on black MSM in Mississippi.
The epidemic has spread throughout the African American community partly due to the impact of a fairly insular sexual network.
Stigma spells silence
"Black MSM are more likely to have sex with other black MSM, who we know are more likely to be infected with HIV, and many don't know their HIV status," Oster says. "Homophobia and stigma about HIV play a role in this community and they can lead to difficulty in addressing issues related to HIV prevention and testing."
Also, socioeconomic issues, like poverty and lack of access to quality health care complicate HIV prevention efforts in the African American community, she adds.
To address those challenges, the CDC is trying to support community leaders to mobilize against HIV/AIDS, he adds.
"We've been working with more than 200 leaders in the African American community, including Julian Bond from the NAACP and Jesse Jackson, and we're working with the National Urban League leaders, and others to increase their awareness of HIV/AIDS in the black community and to promote testing, as well," Wolitski says.
"It's really critical that community members appreciate the impact that this epidemic is continuing to have in the United States and particularly among African Americans," he adds. "The burden of HIV among African American communities is staggering, and we cannot allow this crisis to continue."
CDC data show that 45% of new HIV infections in the United States are among African Americans, even though they represent only 12% of the population.
"Twenty-five thousand African Americans become infected with HIV each year, and the rate of new HIV infection among blacks is seven times higher than the rate among whites," Wolitski says.
The CDC's latest estimates of the lifetime risk of HIV infection among black Americans are astounding, he adds.
"One in 16 black men will be diagnosed with HIV during their lifetime, and for black women the CDC estimates that one in 30 will be diagnosed with HIV within their lifetime," Wolitski says. "There are hardly words to describe that sort of impact."
These statistics are particularly disturbing because the disease is preventable, and transmission risk can be greatly reduced if people know they are infected, Wolitski says.
"But we know that not everyone who is at risk is getting tested and not everyone who is at risk is being reached by HIV prevention services," he adds.
Early testing and prevention services are linked with another trend in the African American community of diagnosis during later stages of disease progression.
African Americans infected with HIV continue to be diagnosed late, often after they've developed comorbidities related either to their disease or their age, one long-time HIV physician and expert notes.
"The late entry, unfortunately, is still the case," says Ellen Tedaldi, MD, professor of medicine and director of the HIV program at Temple University in Philadelphia, PA.
"One of the challenges of HIV for African Americans is the multiple health-related and psychosocial-related issues," Tedaldi says. "Many of the patients — especially the older African American patients — have other medical diseases, including kidney disease, hypertension, and diabetes."
In Tedaldi's 25 years of working with HIV/AIDS patients, she has dealt with many of the obstacles to battling the epidemic in the African American community.
One of the bigger challenges is psychological, she says.
"The psychological challenges seem to be particularly difficult in terms of disclosure and support systems," Tedaldi says.
This challenge includes the disease's stigma within the community, which until recently has made it difficult to for HIV providers to forge partnerships with community organizations, she explains.
"Within the community where we practice there has been a first-time-ever connection made with the community agencies and churches," Tedaldi says. "There's a focus and real push to get tested and to know your status, and there seems to be some response to this."
Another hopeful sign has been President Barack Obama's public words and focus on the domestic HIV/AIDS epidemic, which could help to lift the disease's stigma, she adds.
For these and additional reasons, the CDC and other groups are renewing efforts to promote HIV testing among African Americans.
The CDC recently added two new interventions for African American women, two new interventions for minority youth, and one new intervention for black MSM to its arsenal of evidenced-based HIV prevention interventions.
Also, the CDC has expanded the Take Charge - Take the Test campaign, which is designed to increase HIV testing among African American women. In a pilot study of the campaign, it demonstrated an increase in HIV testing in this population of nearly 70%, according to CDC data.
And the CDC implemented last year a new testing initiative that allocates $70 million to state and local health departments to increase testing opportunities for African Americans.
The CDC's initiatives and the Black AIDS Institute's Test One Million campaign are not groundbreaking campaigns, but advocates and others say they are optimistic that the public policy is at a turning point, and the epidemic's destructive course can be reversed.
"I definitely think we have reached the point where we have the potential to change the trajectory of the AIDS epidemic in this country," Wilson says. "We could talk about ending it — not eradicating the virus — but ending the epidemic as we know it in the next five to 10 years."