AIDS is Racial?

There is a screaming gap in this article, which is in today’s (or tomorrow’s) Wall Street Journal. They don’t discuss the “why” factor. What is it? More exposure to African or Haitian immigrants, who tend to have high rates of infection? Greater likelihood of risky behaviors? Some combination thereof? Perhaps even the greater incidence of incarceration combined with the above?

At the very end they say “we don’t know,” but that is a cop out, given that we’re very well aware of how this is spread. If they don’t provide a viable explanation, people will draw their own conclusions, and behave accordingly (they will anyway actually).

I’ve never thought of AIDS in terms of race before – geography, but not race. What do the medical professionals think about this?


The Changing Face
Of AIDS in the U.S.

by Michael Waldholz

Increase Among Blacks Raises Questions
About How to Better Fight the Disease
The changing demographics of HIV/AIDS in the U.S. are stirring a host of discomfiting race-related concerns about the best way to fight the deadly disease these days.

The latest statistics show that African-Americans account for 54% of the 43,000 or so new cases of HIV infection in the U.S. last year, up from 35% of new cases in 1993, according to data from the Centers for Disease Control and Prevention. Most troubling, in 2001 AIDS became the leading cause of death for African-Americans between 25 and 44 years of age.

That AIDS disproportionately has affected African-Americans is not new; in 1998, the number of African-Americans living with AIDS surpassed that of whites for the first time. But the trend is deepening with each passing year. As the disease enters its third decade in this country, many activists say the government is not being imaginative enough in how it deals with this burgeoning racial disparity.

The problem, say pubic health officials, is exacerbated by a sense among many Americans that the disease is now mostly a problem in Africa and other poor nations, and no longer the major U.S. health concern it was in the 1980s and early 1990s.

“AIDS is not a primary issue in this country anymore, period,” says Phill Wilson, a longtime AIDS activist and founder of the Black AIDS Institute, a non-profit in Los Angeles created in 1999 to raise awareness of the disease’s impact on the African-American community. “But the fact is this: The epidemic has not let up in black America.”

Jennifer Kates, an HIV policy analyst at Kaiser Family Foundation, agrees, noting that the racial character of AIDS contributes to an increasingly passive concern among Americans about the disease. This, in turn, has reduced public pressure on government health officials and politicians to make fighting HIV/AIDS as imperative as it would likely be if it were raging through general white or even gay white populations. (See a recent Kaiser report http://www.kff.org/content/2003/6089/ on the topic.)

Preventing and treating AIDS among blacks “requires an approach and leadership that is distinctly different in its emphasis from what the government is doing now or has been doing for years,” Mr. Wilson says.
This past spring, the CDC announced a major policy shift that appears to be driven, at least in part, by the changing face of AIDS. With the new plan, called the Advancing HIV Prevention Initiative, the CDC hopes to sharply increase public health efforts designed to prevent people infected with the virus from spreading it to others. This tack differs from previous policy that mostly concentrated on preventing new infections by educating all Americans about avoiding high-risk behaviors such as unprotected sex or the sharing of needles by IV drug users.
The new plan is designed, for instance, to fund programs to encourage doctors and other health providers, particularly staffers in government-supported community-based health centers that serve many African-Americans, to aggressively dissuade HIV-infected patients from exposing others to their virus. The initiative will also increase funding for HIV testing as a way to help health practitioners identify those people who may unknowingly be at risk of spreading the virus, says Harold Jaffe, who runs the CDC’s National Center for HIV, STD and TB Prevention.

The CDC won’t formally say this new policy is focused on African-Americans or other minorities. But Dr. Jaffe says that in providing new funds to the community-based centers, many in poor and urban settings, the CDC is addressing the disease’s growing racial disparity.

Mr. Wilson maintains the approach is far short of what’s needed. He says the CDC and others shouldn’t shift funding away from programs designed to prevent people from getting infected in the first place. He says this is especially important because the infection rate is rising so swiftly among adolescent blacks who “clearly aren’t hearing the message that certain behaviors put them at very high risk of getting infected, and that once infected, they have a very serious health problem.”

Mr. Wilson believes the federal government should be waging a much more explicit attack on the disease among African-Americans, one that is designed, for example, to counter the profound stigma of AIDS and homosexual behavior in the black community. “We should be saying, this is the problem, here is research showing how to address it and here is a plan of attack and the money to back it,” says Mr. Wilson.

Even so, Mr. Wilson acknowledges that addressing AIDS among blacks and other minorities is not an easy task. For one, “the American black community itself has been very slow to acknowledge the problem,” Mr. Wilson says. For example, homosexual and bisexual behaviors are not openly discussed among blacks as they were among white homosexuals when the epidemic first surfaced in America.
One critical first step, some activists argue, is to help African-Americans deal with the disease themselves in a more forthright manner. Besides lobbying the government, the Black AIDS Institute has been aggressively pressing the black media, religious groups, African-American health providers, and, most recently, black civil rights groups, to make AIDS a priority in their public discourse and in their varied activities.

One result is that during Black History Month in February, a number of magazines targeted to African-Americans put HIV/AIDS on their covers. In August, the National Association of Black Journalists held its first HIV screening program at its annual convention.

“For too long, important parts of the black community have acted as if the problem didn’t exist, or shouldn’t be discussed,” Mr. Wilson says. “If we want the nation to pay attention we have to make this, just like gay activists did in the 80s, our major concern.” Mr. Wilson and other activists say they are certain that if blacks begin to openly talk about HIV/AIDS, it will be possible to be change dangerous behaviors.

Dr. Jaffe of the CDC concedes that the reasons for virus’s rising toll among African-Americans is something “we still don’t fully understand,” noting that his department is supporting research efforts to investigate the problem and develop new strategies. Hopefully, their efforts will help reverse this disturbing trend soon.


ABOUT MICHAEL WALDHOLZ

Michael Waldholz is news editor for health and science for The Wall Street Journal. Mr. Waldholz joined the Journal in 1980 as a reporter covering medicine and the health-care and pharmaceutical industries. He was named a senior special writer in March 1994, became a news editor for the science, technology and health group in May 1995 and was named deputy editor for health and science in January 1996, and editor for science and health in 2000.

In 1997, Mr. Waldholz led a team of Wall Street Journal reporters that was awarded a Pulitzer Prize for chronicling the development and effects of new AIDS therapies. He’s been nominated for and won many other awards, including a Pulitzer nomination as part of a team of writers for a series on genetics. Mr. Waldholz is the author of “Curing Cancer,” published by Simon & Schuster in 1997. He is a co-author of “Genome,” about the hunt for human genes, published by Simon & Schuster in 1990. Mr. Waldholz writes a bimonthly column for the Journal’s Personal Journal section called “Prescriptions.” He also appears each Monday on CNBC’s “Power Lunch” and also throughout the week reporting about health and biotechnology.

Born in Newark, N.J., Mr. Waldholz received a bachelor’s degree in English and a master’s degree from the University of Pittsburgh. He has a daughter, Rachel, and son, Daniel, and he lives in Bloomfield, N.J.

America was very lucky as far as how Aids was spread here. I hate to say that, but it was originally hitting the gay population first, and by the time it really started hitting the general population many people have changed their lifestyles to slow it’s progression.

The biggest reason it spread so well in the gay population was two fold. Gay men tended to be very promiscuous, and the necessity of protection was not seen in the gay population because there was no risk of getting anyone pregnant. When you add the fact that you can be infected with HIV for years before knowing you have AIDS, and you have one person infect a hundred others.

Now the fear seems to have subsided. The fear now is not what it use to be. Aids is having a resurgence among high school students. Also minorities in low income areas. The article didn’t want to mention this for PC reasons, but this is a matter of people caught in a cycle where adult males die young, or leave, and children are left with only a mother who they never see because she works two jobs to support her kids. These kids grow up on the street and end up turning into the same type of person their fathers were.

I would believe that if they divided their stats up between low income and middle income African Americans they would see a jump in the low income, and the middle income would drop to about average for the rest of the country.

Wow!..interesting topic here…
The topic of Aids throws a wet blanket on cavalier and gratuitous sex talk…even on this here magazine I suspect…

I agree with the Mage in that it would be interesting to see an economic breakdown as well as a racial one. That might answer some more questions.

I’d also like to offer my version of something the Mage said. It is not gay men that are promiscuous, but men in general.

Mage –

Very intersting observation on the economics of AIDS.

One thing that you seemed to gloss over a bit in your analysis of why AIDS spread more quickly in the homosexual population: anal sex is more risky than vaginal, and receiving anal sex is the riskiest of all. At least that is what I have read. The quick ranking of riskiness (associated with AIDS specifically) supposedly goes like this (from riskiest to least risky): receiving anal (likely blood contact – very absorbant tissue and/or blood in contact with seminal fluid); giving anal (likely blood contact); receiving vaginal; giving oral (especially with semen in the mouth); giving vaginal; and receiving oral.

This leads to the idea I posited in the end of my first post (before the article): Do you think that the rate of incarceration, and, given what we know about prisons, anal sex in prison, is related to the prevalence of AIDS in the African American community? Scary thought…

what the article doesn’t mention is that the fastest growing population with HIV infection is middle aged women, 45-65

I don’t have an economic breakdown, but I’m guessing lower middle class and down

when I was taught this stat, no mention of race was made, which is interesting in itself

–Bill

Actually, that brings up another bit of statistical chicanery I see all the time. Newspapers and politicians like to focus on the “fastest growing” segment of the population w/r/t new infections. This tends to be misleading. The reason is that if you start with a very small rate of infection, a small jump in that rate is a huge percentage jump in the rate of infection.

For a very simple example, assume you had 5 heterosexual women with AIDS, and then you got 5 new cases, whereas you had 1000 homosexual male cases, and got 100 new cases. The growth rate in the rate of infection is 100% for the heterosexual women and 10% for the homosexual males. I think originally they focused on that stat to give some sort of backing to the claim that AIDS wasn’t just a gay disease, which it very well was for a long time in the United States. Now, unfortunately, it seems to be spreading to certain other populations.

Jared NFS: Yes, it is men that are more promiscuous. It is the women that keep men from having as much sex as they want. Being gay circumvents this because each partner being male is more likely to be promiscuous.

BostonBarrister: Yes, I did gloss over it. Butt fucking, uh… I mean anal sex, is more damaging to tissue, and does increase the chances of infection. (Due to contact with blood.) But there is also the fact that in hetero relationships, men tend to be the ones who are giving out bodily fluids, so the infection is more likely to travel in one direction then the other, while both gay men in a relationship get the bodily fluids.

I didn’t get into crime, assuming it would be understood. When you are 15, and poor, and your neighbor is making a few grand a week selling crack on the street, it becomes very motivating to go in that direction. Especially for a young boy. Suddenly you have pockets full of cash, and women who will sleep with you for the drugs.

If the kid does not get AIDS from the crack whores, then the cops catch him, give him a couple whacks, (especially if he squeezes the cops balls, ;^> ) and throw him in jail where he becomes Buba’s bitch.

So yes I believe crime, and being in prison increases your chances of getting and spreading AIDS.

And as far as numbers go, there is a classic book called “Lying with Statistics”. Ok, I haven’t actually read the book, though I have read some excerpts. But it is easy to make numbers say anything you want them to. Unfortunately many reporters don’t even go as far as looking at the statistics. Sometimes it is decided that if a number sounds good then just use it. This is done very often with numbers that are hard to quantify. Like the total world population watching the Super Bowl. When asked about this number (years ago that is,) they had to admit that since they have no way of tracking what people watch in many countries, they just made it up.

Also the number of homeless in America has been exaggerated (on purpose) for a long time. Then others hear these numbers, and accept them without question.