AIDS workers aim to lift black community's shroud of silence
The effort to stop HIV’s spread among blacks is a battle against racism and poverty, distrust and homophobiaBY: CARY DARLING
Star-Telegram.com
Monday, August 4, 2008
When New York rapper Jim Jones sat down with the hosts of Black Entertainment Television’s 106 & Park last year, he ended up doing more than just hyping his latest hip-hop project.
The man known for his beefs with the likes of Jay-Z and whose albums sport such street-tough titles as Harlem’s American Gangster had tears welling in his eyes, a catch in his throat, and a story to tell. "My father and all his brothers, they passed away due to the HIV epidemic," he said. Struggling to keep emotions in check, he admitted later that he’s "petrified" of the disease.
For a guy whose public image is that of public enemy, such a moment of sensitive introspection shocked many in the hip-hop world. It was a crack in the facade of an African-American youth culture that, some say, hasn’t fully grasped the threat that HIV and AIDS pose to the black community:
While 13 percent of the U.S. population is African-American, the Centers for Disease Control and Prevention reports that 49 percent of Americans with HIV and AIDS are black.
For those under the age of 25, the numbers are even more dire: 61 percent of those diagnosed between 2001 and 2004 were black.
"The rate of AIDS diagnoses for black women was nearly 23 times the rate for white women" in 2005, according to the CDC.
Observers say the reasons that HIV/AIDS is hitting the black community harder than others are multilayered. They point to: a history of racism and poverty that has led to a distrust of medical institutions; lack of knowledge; delayed treatment; silence on the issue from major black organizations such as churches; reluctance to acknowledge homosexuality; and the high rate of incarceration among young men.
"The thing about African-Americans is they don’t want to know," said the Rev. John Reed, seated in a conference room at the AIDS Outreach Center in Fort Worth, where he volunteers. "They feel like if they don’t know, it ain’t going to hurt them. And when they do find out, they don’t want to talk about it. If we could just break the silence, I think that we can prevent a lot of HIV and AIDS in the African-American community."
Across the Metroplex at the UT Southwestern clinic in Dallas’ Oak Cliff neighborhood, Anne Freeman — assistant professor at UT Southwestern’s Allied Health Sciences School and director of the Community Prevention and Intervention Unit — points to poverty as a prime cause. "People in situations are going to not have access to the information they need or the healthcare they need," she explained. "They’re doing things for survival that they might not do if they weren’t in such dire circumstances."
A history of silence
Among African-Americans there’s been little echo of the national "silence equals death" mantra that arose in the gay community in the ’80s in response to the first wave of the AIDS crisis. But there may be a culturally specific reason that African-Americans are reticent.
"There was a time when a woman was expected to have sex with the master of the house and the master’s son, and her husband could do nothing for her," says Steven Wakefield, director of the HIV Vaccine Trials Network Legacy Project in Seattle. "That silence is historic, and people not talking about what happens in terms of sexual relationships has been handed down through generations."
That’s compounded by a wariness of the medical establishment, a sense that any cure may be worse than the disease. The infamous Tuskegee Experiment — in which 399 black men enrolled in a U.S. Public Health Service study of syphilis from 1932 to 1972 went untreated so that researchers could see how the disease kills — is often pointed to as proof.
"We’re still living the legacy of the Tuskegee study," said Dr. Cato Laurencin, a University of Virginia professor and chairman of the board of directors of the W. Montague Cobb/National Medical Association Health Institute, an organization designed to address health disparities among African-Americans.
"And you also have to remember there’s clearly the continued racism that’s still pervasive. There was a recent study in the New England Journal of Medicine on implicit bias that takes place among physicians treating African-American versus non-African-American patients in terms of the types of treatments that are provided," said Laurencin, who recently co-authored HIV/AIDS and the African-American Community: A State of Emergency in the Journal of the National Medical Association.
Conspiracy theories
Related to these are conspiracy theories suggesting that HIV/AIDS was created in a lab and deliberately introduced into the black community.
"My research team documented in the early ’90s and published our results showing that the most conservative African-Americans we surveyed — church congregations — that 30 percent of them believed that HIV was a man-made virus unleashed on the black community," said Stephen Thomas, head of the Center for Minority Health at the University of Pittsburgh. "The fact that the theme resonates today is a serious problem and is contributing to the spread."
Thomas said homophobia within the black community also assists the disease. "We have allowed . . . our problems with addressing the issue of homosexuality to blind us to the results of what it means to have people closeted, what it means to have men marry because the homophobia is so devastating. Therefore, they engage in same-sex behavior with men and come home to the woman."
Erik Parker, content director at the popular hip-hop site SOHH.com, says the fear of being labeled gay runs through hip-hop culture like a fault line. Hip-hop has a lot of anti-gay themes, he said, and that plays into how HIV/AIDS is perceived. "There’s a stigma attached to it so people don’t come out and admit they have it. A lot of people don’t realize how real it is in their own neighborhoods."
"At some earlier stages in this epidemic, it was lack of a perceived risk," said Curtis Jackson, a UT Southwestern senior research associate who is responsible for implementing intervention techniques to change risky behavior. "They saw it as a white, gay male disease. . . . So the behaviors that put people at risk — unprotected sex and sharing needles with people who were infected — didn’t apply to them from their own perspective."
There’s not only a fear of a personal stigma but one of a broader insinuation. It’s understandable, says Thomas.
"Black leadership in the early days said, 'We cannot own HIV/AIDS, because it will be used to denigrate us,’ " he said, noting that, during those years, the reputations of groups with the disease, such as gays and Haitians, "were trashed."
Laurencin also blames the high rate of incarceration among black men, noting that from 1984 to 1997 it rose from 1 in 30 to 1 in 15. "One fourth of the people living with HIV in the United States in one study have been incarcerated at some point," he said.
"A man [who] may have been in jail for a considerable time, and then leaves that environment, may move to heterosexual companionship but may move in a situation which the adequate support system in terms of education and treatment aren’t there in terms of HIV. So it’s a complex situation with poverty, racism, and incarceration also becoming part of the paradigm in terms of HIV spread."
Africa vs. America
There’s been much more public support for efforts to eradicate HIV/AIDS in Africa. Legacy Project director Steven Wakefield recalls the vice presidential debates four years ago when John Edwards and Dick Cheney were asked about HIV/AIDS in the United States and responded by talking about its devastating effects in Africa.
Last month, the Senate voted to expand PEPFAR, the President’s Emergency Plan for AIDS Relief, which will spend $48 billion over the next five years to fight HIV/AIDS, malaria and tuberculosis in Africa.
Outside the political realm, there’ve been all-star concerts and projects to raise consciousness about AIDS in Africa. Singer Alicia Keys’ involvement in African AIDS relief is even the subject of a documentary, Alicia in Africa: Journey to the Motherland.
This imbalance irks some.
"President Bush has this wonderful program outside the U.S., but Washington, D.C., has infection rates higher than most of the places that PEPFAR dollars go," says Wakefield. "But in the U.S., we don’t have a national AIDS plan. We don’t have continuing growth of resources as the number of new infections and the number of people living longer with HIV grow in this country."
When you look at HIV/AIDS in Africa, you see the direct results, entire villages ravaged and children fatherless and motherless because of the virus, SOHH.com’s Parker said.
"In the African-American community, you hear the statistics but you don’t see the results," he said. "When it’s happening at home, really up close, you can’t see the forest for the trees. . . . People aren’t talking about it. People aren’t broadcasting it, making it a major issue."
Reason for hope?
Yet there are signs that the shroud of silence is being lifted in the black community as the issue moves into the cultural ethos. This Feb. 7 marked the eighth year of National Black HIV/AIDS Awareness Day. In March, Howard University in Washington, D.C., was the site of the third Hip-Hop and Higher Education Symposium, which threw the spotlight on HIV/AIDS within the hip-hop community and featured rapper Jones as a panelist at a town-hall meeting.
Black Entertainment Television, through its Rap-It-Up campaign, has reportedly tested nearly 12,000 people for HIV infection and put together community forums for teens.
In addition to his volunteer work, Reed is a youth pastor at the New Harvest Missionary Baptist Church in Fort Worth’s Stop Six neighborhood.
He says he’s seeing reluctance from area churches begin to evaporate. "Now, we’ve got some good churches out there who are rolling up their sleeves and fighting," he said.
According to Laurencin’s HIV/AIDS and the African-American Community: A State of Emergency, "during the time period 2001-2004, HIV diagnosis rates among black males and females declined by 4.4 percent and 6.8 percent respectively" while "results from a 2007 study reported similar declines among African-Americans in the state of Florida."
Thomas is heartened by the number of philanthropic and governmental organizations that are now focusing on the issue and putting it in perspective among other ailments in the black community.
"It’s promising that we’re moving away from being disease-specific — AIDS over here, heart disease over there — and talking more broadly about health disparities and addressing the common risk factors," he said. "And that means you must address the issue of poverty and health literacy.
"If you take AIDS out the isolated box and put it in a broader context of other racial and ethnic health disparities — cardiovascular disease, diabetes, infant mortality — it destigmatizes it in some ways."
Wakefield is actually optimistic.
"I go back and look at the kinds of things that happened in the Civil Rights movement," he said. "It wasn’t a well-funded movement and people were under pressure, but they understood what was happening, and these were times they could thrive and find hope."
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