National Black AIDS Awareness Day, February 7, was established in 1999 in response to the HIV and AIDS epidemic in African-American communities. More than fifteen years later, the Centers for Disease Control and Prevention reports that while the number of new HIV diagnoses in the general population fell 20 percent between 2005 and 2014, the prevalence of HIV among African Americans remains significantly higher than it is for other racial/ethnic groups, while the rate of new diagnoses among young black men is rising.
Earlier this month, PND spoke with Gregorio Millett, vice president and director of public policy of amfar, the Foundation for AIDS Research, about the impact of HIV/AIDS on the African-American community and ongoing efforts to address it.
Philanthropy News Digest: What is the most striking finding in the 2014 HIV Surveillance Report, as well as the finding that surprised you the least? And what do current trends in the HIV data mean for the African-American community?
Gregorio Millett: What surprised me the least was the fact that the number of new HIV diagnoses is falling among injection drug users; that's something we've known for quite some time, and it's incredibly encouraging to see that trend continue nationally. And there were two things that surprised me: The first was the 42 percent decline in HIV diagnoses among African-American women nationally between 2005 and 2014; we knew that diagnoses were decreasing, but we didn't realize they were falling that rapidly. The other interesting thing is that, in the last five years, diagnoses have remained stable, for the most part, for African-American men who have sex with men — though for the ten-year period it actually increased — while the number of diagnoses has been increasing for Latino men who have sex with men. So the fact that we really need to start focusing more on Latino MSM was interesting.
That said, the overall prevalence of HIV is greater among African Americans compared to all other racial and ethnic groups; we've had a higher prevalence in the black community since the mid-1990s. The good news is that for most African Americans, HIV rates are declining at a rapid rate. The bad news is that rates are not declining among gay and bisexual men, who comprise most of the new infections in the black community. Another issue for the African-American community is that even though HIV rates are declining, African Americans overall are still more likely to die from HIV/AIDS compared to whites or Latinos, even though we now have very effective medications that enable people with HIV to live a normal lifespan.
PND: What are the key factors behind the persistently higher rates of HIV prevalence among African Americans?
GM: There are several. The first is that HIV prevalence is just higher in black and Latino communities, particularly among gay men, and when you have more people living with HIV, it means there are more opportunities to transmit HIV, so higher prevalence begets a greater number of diagnoses. Another huge issue is healthcare access; we know that whites are more likely to have access to health care in the United States compared to Latinos or African Americans, and if you don't have access to health care and you're HIV-positive, you're less likely to be on medication or virally suppressed, and therefore you're more likely to transmit HIV to your partners.
A third issue is that, quite frankly, we haven't focused on where HIV is really hitting the black and Latino communities. When you take a look at the cumulative dollars for research, for care, for prevention, they're going primarily to heterosexual communities and injection-drug-using communities. Unfortunately, from the very earliest days of the epidemic, that's not necessarily where HIV has hit hardest. A lot of that has to do with our society not being able to talk about HIV, which has been concentrated among gay and bisexual men, honestly, because our politics didn't allow us to talk honestly about gay and bisexual men. Instead, we say that everybody is at risk for HIV, which just isn't true; some groups are at far higher risk. So, from a historical perspective, there has been less money to address HIV among Latino and black gay men, and there has been less press and attention from black and Latino leaders. And you see that in the rates of HIV infection for those groups. In the African-American community, for instance, the overall infection rate is about 2 percent; among black gay men, it's about 30 percent. In other words, one in three black gay men is living with HIV. And if you look at the campaigns and initiatives led by black leaders, members of Congress, celebrities, and so on, they're doing wonderful work but they're talking about HIV among women or babies — U.S. populations where there is actually very little HIV. What we need is a realignment of those efforts to focus on dealing with HIV where it is still a problem in the black community.