Black America: A neglected ­priority in Global AIDS epidemic

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In December 2011, the Centers for Disease Control and Prevention (CDC) published these statistics about HIV/AIDS in America:

• 1.2 million people are living with HIV in the U.S.

• Nearly one in five people living with HIV (about 240,000) don’t know they are infected.

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• In 2009, there were an estimated 48,100 new HIV infections, with most (61 percent) occurring in gay and bisexual men.

African Americans have not been spared from the spread of HIV/AIDS. The CDC estimates that the rate of new HIV infection for Black men is more than six and a half times as high as that of White men; and for Black women, 15 times as high as that of White women. In its 2008 report, Left Behind, Black America: A Neglected Priority in the Global AIDS Epidemic, the Black AIDS Institute offered this unflinching assessment of AIDS in the African American community: “Widespread belief that AIDS is a foe that has been vanquished in the U.S. reflects something more—the astonishing invisibility of the continuing AIDS crisis in Black America…. HIV-related health disparities between Whites and Blacks have actually widened as medical advances have made HIV treatable.”

Disparities in the incidence and prevalence of HIV/AIDS in Allegheny County echo national trends. Deborah McMahon, MD, associate professor of medicine in the Division of Infectious Diseases and clinical director of its HIV/AIDS program, notes, “Allegheny County has not escaped the HIV/AIDS epidemic. African Americans represent roughly 13 percent of the county population but over 35 percent of county residents living with HIV/AIDS.”

Pat McGlone, MSW, a senior social worker with UPMC’s Pittsburgh AIDS Center for Treatment (PACT) and a close colleague of McMahon’s, has spent most of her career grappling with HIV/AIDS in the African American community and has seen the impact of these disparities firsthand. She says, “Since the introduction of ‘cocktail’ drugs in the mid-’90s, AIDS is no longer a death sentence. But, the flip side of living longer with AIDS has been greater opportunities for the disease to spread. Now AIDS, like so many other chronic public health problems, is affecting communities struggling with poverty, lack of education, mental health issues and substance abuse.” McGlone’s comments reflect an emerging understanding of the epidemic because HIV-positive people who are not taking antiretroviral drugs are especially efficient transmitters of new infections. Our ability to prevent the spread of AIDS depends on finding HIV-positive people and helping them get into care.

Although all African Americans have been disproportionately affected by the rise in new HIV infections over the last two decades, McGlone focuses on two groups: African American women and young men and women. From 1980 to 2005 in Allegheny County, the female proportion of AIDS cases rose from 12 to 21 percent, and the majority of women living with HIV/AIDS are African Americans who contracted the disease through heterosexual transmission. “For many of the younger women, they first learn they are HIV-positive through prenatal screening when they are already pregnant,” McGlone said. “We have systems in place to support them during their pregnancy, but after the baby is delivered, things often fall apart. Dealing with a serious and chronic illness on top of caring for a new baby, and often variable and inadequate family support is a crushing load, not to mention the stigma of having AIDS itself. Our biggest challenge is keeping these women engaged in their care, for their sake as well as for their families.” The University of Pittsburgh’s HIV Early Intervention Project, which includes PACT, was awarded Ryan White Part D funds in 2001 to improve and standardize HIV counseling, testing and treatment for women receiving prenatal care in Allegheny County. The program has been successful in testing women for HIV, providing intensive support during pregnancy and virtually eliminating mother-infant transmission of HIV in the county.

African American young men and women ages 18-24 are the other group with a disturbing upward trend in new cases of HIV/AIDS. Of new youths seeking care at UPMC/PACT from 2005-2007, 65 percent were African American. Advances in HIV/AIDS treatment have diminished fear of HIV, but lack of comprehensive sex education and homophobia leave youths unprepared for the risks associated with sexual intercourse and increase isolation for those attracted to the same sex. “All the fear and stigma associated with having HIV/AIDS are doubled for our young people,” McGlone said. “You’re afraid to come into the building, to get on the elevator, to sit in the waiting room because you might run into someone you know. Your mother may not know you are HIV-positive or that you are homosexual. These are the kinds of barriers we face caring for youths with HIV/AIDS.” To address these issues, PACT providers focus on individualized care and phone support as much as possible to enable youths with HIV/AIDS to understand, care for themselves and effectively cope with their diagnosis.

The Black AIDS Institute report recommended seven action steps for addressing the HIV/AIDS epidemic among African Americans, including strengthening grassroots organizations and leadership in the African American community to mobilize against HIV/AIDS; conducting comprehensive community-wide HIV education through extensive social marketing and targeted outreach; and promoting community programs such as the Pittsburgh Needle Exchange Program that support and empower African Americans stigmatized by HIV/AIDS, sexual orientation or substance abuse. McMahon concludes, “Raising HIV awareness and having strong leadership that addresses stigma could significantly change this health disparity among African Americans living in this region. There are numerous programs offering HIV counseling and testing, which should be a routine part of an annual medical physical.”

The University of Pittsburgh is internationally recognized for HIV research. Pitt researchers want to do a better job partnering with the community to make sure that new HIV infections become rare in Pittsburgh.

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