Special Report: AIDS and Minorities

Director says risky behavior is increasing

Despite more than 15 years of HIV and AIDS prevention messages, young people — especially those in the African-American and Latino communities — continue to contract HIV at alarming rates.

The Centers for Disease Control and Preven tion in Atlanta has a variety of prevention programs, many aimed at minority communities, but critics claim these have not been well-funded and more money and effort are needed.

AIDS Alert asked Helene Gayle, MD, MPH, director of the National Center for HIV, STD, and TB Prevention at the CDC, to explain what the CDC is doing, what clinicians could do to help, and how well these prevention efforts are working:

Q: How have you personally been involved in collecting the data for this report and analyzing it, and what prompted you to take a look at the statistics relating to black and Latino gay men?

A: The CDC is responsible for disease surveillance in the United States, and our Center routinely collects information on HIV/AIDS and the individuals affected by this epidemic. We chose to publish this analysis on the increasing proportion of AIDS cases reported among black and Latino gay and bisexual men because they now represent more than half of the epidemic among gay men. Further, despite the severe and ongoing toll among gay men of color, the epidemic among gay and bisexual men has not been widely recognized or addressed in African-American and Latino communities. HIV prevention needs for these and other communities at risk are greater today than ever before.

Q: AIDS advocates have been saying for years that the federal money directed toward prevention efforts is far lower than what is needed. However, the CDC recently has funded a number of grants aimed at prevention efforts in minority communities. Should more federal money be shifted into the direction of prevention, and what else needs to be done to increase prevention efforts?

A: Yes, there are more prevention needs today than ever before. The communities in need of HIV prevention efforts are increasingly diverse, including a growing population of individuals already infected with the virus, racial and ethnic minorities with unique prevention needs, gay and bisexual men of all races, and a new generation of young people who are coming of age. In addition, we also must sustain HIV prevention efforts for all communities at risk and combat a new complacency about the need for HIV prevention. In an era of new HIV treatments, we have seen evidence that many individuals at high risk are less concerned about becoming infected and are engaging in increased risk behaviors. We must educate people about the limitations of treatment and convey that HIV remains a serious, lifelong disease that can and must be prevented.

Q: Would you give us an example of a CDC-funded prevention program aimed at a minority community that appears to be working, and explain whether this could be easily duplicated elsewhere?

A: One program that comes to mind is an annual event called the "B-Boy Blues Festival," which is funded through CDC’s community planning efforts. This festival, held in St. Louis, does not advertise or identify as an HIV/AIDS event and includes entertainment and cultural programs alongside HIV prevention workshops and HIV counseling and testing. The purpose is to create a setting where African-American men who may have sex with other men, but who do not self-identify as gay or bisexual, can feel comfortable while gathering information about HIV prevention. It has been an effective way to serve these usually hard-to-reach men.

Programs like this can be duplicated in other cities, the key being the involvement of the community itself and using innovative approaches to reach people where they are. Stopping the spread of HIV in any community isn’t easy. But gay and bisexual men of all races must recognize that they are at risk for HIV infection, and communities of color must create an environment where all men can access the HIV testing, treatment, and prevention services they need without the fear of estrangement.

Q: What can physicians and other clinicians do to reach and educate the youthful black and Latino men who are at risk for HIV?

A: I think they can start by simply raising the issue. Several studies have found that physicians are not talking with patients about HIV and STD prevention. Physicians can make an enormous difference in the lives of young men by just broaching the subject of HIV and other sexually transmitted diseases and openly discussing the risks of infection. It will also be important for physicians to create a nonjudgmental environment. Young gay and bisexual men must feel comfortable enough to discuss their risk behaviors.

Q: In the past year, black church organizations and other groups have become more actively involved in educating their communities about HIV and AIDS. Do you expect that these efforts will have a significant impact on HIV infection statistics among African-Americans over the next five years, and do you see any similar participation among churches and organizations that serve Latinos?

A: Faith-based organizations definitely have an important role to play in HIV prevention in communities of color, as they are such a central part of the culture of both African-American and Latino communities. Faith-based HIV prevention efforts have been increasing in both communities. How e ver, we have to recognize that churches cannot do it alone. It will take the combined efforts of public health agencies, community organizations, churches, schools, leaders, neighbors, and friends to stop the spread of HIV.