Communities of color seek reform in HIV funding

CDC takes hard look at allocation of resources

Two recent summits on the devastating impact of AIDS on communities of color have helped promote a new agenda for how federal HIV prevention dollars are spent in this country. Health officials at the Centers for Disease Control and Prevention are responding by looking at how HIV prevention resources need to be reallocated in light of the demographic shifts in the epidemic.

Two months ago, a two-day summit held in Atlanta gave black leaders a forum to voice their concerns to federal health officials. In late March, religious, medical, and academic leaders met in Boston for a briefing on the AIDS crisis among African-Americans.

"The first thing that was clear was that the group wanted a statement to be made that a state of emergency must be declared in the African-American community regarding the HIV/AIDS epidemic," says Rev. Edwin Sanders, a CDC consultant and pastor of Metropolitan Interdenomi national Church in Nashville, TN, who attended the Atlanta summit. "There was a tremendous level of alarm with respect to the fact that the community planning process has not been effective in terms of capturing the needs that exist within the African-American community."

Government statistics show that AIDS kills more African-Americans under the age of 45 than cancer, homicide, and heart disease. Although African-Americans make up only 12% of the U.S. population, 35% of existing AIDS cases and 43% of all new AIDS are among African-Americans.

Given those alarming figures, leaders at the summit called on Secretary of Health Donna Shalala and Surgeon General David Satcher, MD, to pressure the Clinton Administration to convene an emergency meeting of health leaders to respond to the crisis.

A similar appeal was heard at the Boston meeting, sponsored by the Leading for Life Campaign and held at the W.E.B. Du Bois Institute for African-American Studies.

"Although the decline in overall AIDS deaths has been widely reported, AIDS is absolutely not over for African-Americans," said Henry Louis Gates, PhD, director of the institute and professor of African-American studies at Harvard University. "We must take strong and immediate action to turn the tide on the AIDS epidemic before it decimates our communities."

A new national survey released by The Kaiser Family Foundation in Menlo Park, CA, found that one in two African-Americans are strongly concerned about becoming infected with HIV - a level twice as high as the general population. Also, 58% said AIDS was a more urgent problem today than in the past.

An African-American movement like ACT-UP?

Despite these concerns, African-American have failed to muster the level of community support and activism against AIDS found in the gay community. Indeed, there was talk at the Atlanta summit of the need for an African American movement similar to ACT-UP - what was called "Blacked-Up," Sanders says.

"The tone of frustration was reflected in the fact that most folks said that for too long we just accepted the vehicles that have been available through the CDC in order to make our response to this issue instead of saying it was time to step out of that scheme of operations," he recently told a CDC advisory committee.

Responding to the fact that the CDC's HIV prevention portfolio grew out of the early-days focus on the gay community, Helene Gayle, MD, MPH, director of the CDC's National Center for HIV, STD, and TB, told the committee that the CDC is taking a close look "at what we do and whether the approaches we are using make sense for these communities, and if not, what we should be doing differently."

One issue on which many African-Americans agree is that the government should change its position on funding needle-exchange programs. The Kaiser survey revealed that a majority (58%) of African-Americans favor programs that offer clean needles to IV drug users in exchange for used ones.

"We must confront community complacency and governmental roadblocks to practices like needle exchange," said Mario Cooper, founder of Leading for Life. "We are in the midst of a public health crisis that demands immediate action."