2008 International AIDS Conference: Sunday
Abandoned, Yet Hopeful
By Institute Editorial
Revised CDC HIV Estimate Demonstrates the Federal Government had Deserted Black America
MEXICO CITY -- Saturday we listened attentively from the International AIDS Conference in Mexico City as the Centers for Disease Control and Prevention (CDC) announced to the media by teleconference that the HIV epidemic in the United States is worse than they previously thought. The CDC now states that their estimates of the number of new infections occurring in the United States each year were 40% too low. Instead of 40,000 new people becoming infected annually, the number exceeds 56,000.
On the one hand, these higher figures make me feel vindicated. For years, the Black AIDS Institute and other AIDS advocacy organizations have been telling the CDC that their figures were too low, as they insisted they were right. We knew they were wrong because we're the ones on the ground in the Black community. We're the ones getting the phone calls from Black young people who have just learned that they're positive and now realize that didn't really believe that they were at risk or that their lives were worth protecting. We're the ones taking the early-morning calls from Black mothers who lost a child overnight and are not only grieving but are also reeling with guilt because they never had the opportunity to reconcile their relationship, often after rejecting their child when they learned of their positive diagnosis. We're the ones who listen to Black people admit that they are more afraid of the stigma they'll face than they are of the disease. After receiving these and other phone calls, we knew that the epidemic was worse in our community than the official numbers were saying.
Yet on the other hand, the CDC's announcement makes me very angry. Had the government listened to the Black AIDS Institute and others—had they respected what we were telling them—there is a possibility that we would have been able to prevent some of these infections. The CDC's announcement underscores the allegations we made in our recent report titled "Left Behind," in which we examine what the AIDS epidemic would look like and how the U.S. government would respond if Black America were its own country. The United States of Black America would rank 9th on the U.S. government's list of the 15 countries with the worst AIDS epidemics in the world. While our government's AIDS policy focuses upon those nations abroad, the epidemic at home continues unabated. While Black folks comprise about 12 percent of the U.S. population, as previously reported by the institute and others, we account for nearly 50% of Americans living with HIV/AIDS. Forty percent of new cases among men are among Blacks, as are 60% of new cases among women and 70% of new cases among teens. In some Black neighborhoods the incidence of HIV infection is equivalent to nations in sub-Saharan Africa. The epidemic is so bad that the U.S. of Black America would qualify for the President's Emergency Plan for AIDS Relief (PEPFAR), the aid the U.S. government offers to countries with the worst AIDS epidemics. Yet the stringent requirements foreign governments must meet to receive PEPFAR aid, the U.S. government doesn't apply the same requirements at home.
When we wrote the "Left Behind" report we thought about titling it "Abandoned." For while the government demonstrates leadership in fighting AIDS abroad, it fails to prioritize the epidemic at home. This means our government has failed Black America. So have many major foundations and corporations. Yet, we settled on "Left Behind" because we didn't want to appear to be strident or hysterical. But this weekend's announcement shows that in the end, despite our cries for additional help, we really had been abandoned after all.
The CDC announcement has garnered considerable media coverage, as has our "Left Behind" report. I hope that now that the truth is out, the U.S. government will prioritize the epidemic at home as it does abroad.
As the acclaimed poet Maya Angelou says, "When you know better, you do better." Well, now we know better—the government, foundations, corporations and Black Americans. We all know better. Now, the Black AIDS Institute demands that all of us must do better.
2008 International AIDS Conference: Monday
U.S. Leadership Cannot Afford to Ignore HIV/AIDS
By Phill Wilson
Visit Blackaids' youtube page and blog.
In his address Monday to the Bill Clinton responded to the Centers for Disease Control and Prevention's (CDC) announcement that for over a decade it has underestimated the magnitude of the domestic HIV epidemic by 40 percent per year, by committing funds from his William J. Clinton Foundation to address the disease at home. President Clinton has long been a visionary in the international fight against AIDS by improving access to treatment through the Clinton Foundation. I think it's great that he is now going to demonstrate leadership at home. Then again, he should. When he looks out the window of his Harlem office, he must witness the impact of HIV on Black America—the people whom the government has most failed to protect from the devastation of this epidemic.
President Clinton's announcement raises the question of who has the courage and integrity to step up and lead, a question that is particularly important as we consider whom we will elect as the next president of the United States. We cannot afford to give either candidate a free pass. Especially in light of these higher CDC numbers, the stakes for Black Americans—for all Americans—are very, very high. The CDC now estimates that over 56,000 Americans are infected each year of which 45 percent, or almost 25,000, are Black. HIV rates in some Black neighborhoods approximate those of some sub-Saharan African nations, causing epidemiologists to worry that we've reached the point where the disease will spiral out of control.
On Sunday, Sens. John McCain (D-Az) and Barack Obama (D-Ill) both issued statements responding to the new CDC numbers. It's interesting to note the differences in their reactions. Sen. McCain supports the free market in reducing drug prices, but otherwise appears to have no specific goals or plans. Yet, the HIV epidemic is much more complicated than he understands or wants to acknowledge. What about education? What about prevention? Or reducing stigma and discrimination? What about developing and implementing a national HIV strategy as comprehensive and effective as the President's Emergency Plan for AIDS Relief (PEPFAR), as the Black AIDS Institute and our partners in the fight against AIDS now demand? We also call on the candidates to substantially increase monies allocated to the Minority AIDS Initiative; to support innovative screening, counseling and testing efforts; and to assist traditional Black institutions in their capacity-building and community-mobilization efforts.
Sadly, this apparent disinterest in the HIV/AIDS epidemic is not new for Sen. McCain. His record vacillates between total disengagement and reactionary sanctimony. Whether he doesn't care or whether he doesn't "get" it, it no longer matters why he's not on point. We must demand that he take this epidemic seriously and articulate meaningful proposals and make specific commitments for dealing with it.
Sen. Obama's statement is much more comprehensive than Sen. McCain's. He has repeated his pledge to draft and implement America's first national HIV/AIDS strategy. But we can't let him off the hook that easy. We need to make sure he's committed to putting his AIDS plan in place.
We cannot afford to elect another president who does not understand AIDS' devastating effect upon Black Americans. For years now the government has been stepping on Black America's neck. Now we want it to lift its foot off of us and give us a hand in getting upon our feet before the epidemic spins further out of control.
2008 International AIDS Conference-- Friday
Looking Back at Mexico City and Ahead to Vienna
By Phill Wilson
Visit Blackaids' youtube page and blog.
For the past week, a delegation composed of 37 community leaders, politicians, and journalists representing the Black AIDS Institute have attended the 17th biennial International AIDS Conference held in Mexico City. We've been treated wonderfully here—by our conference hosts, by our colleagues from around the world, by the many volunteers who have come here from all over the globe, and by Mexico City residents. We thank and congratulate our hosts for successfully executing such an ambitious convention, the first International AIDS Conference held in Latin America, an occurrence we believe is critically important; it exposed regional residents to this amazing experience and makes the global effort to end the HIV/AIDS epidemic local.
We are grateful as well to our peers from all nations for graciously hearing and supporting our report Left Behind: Black America: A Neglected Priority in the Global AIDS Epidemic; for celebrating the fact that we finally seem to be penetrating the wall around "powers that be" at home, as the struggles of Black Americans face appear to be getting heard; and for compassionately acknowledging the anger as well as the grief we feel that so many lives have been lost, hearts broken, families destroyed, and human productivity lost along the way. We look forward to your ongoing support as we challenge the American government, foundations and corporations to move from good words to good deeds.
Yet, in spite of these amazing occurrences, we wish that we had been more successful in building on the amount of content about or participation from the Black Diaspora, people of African descent who do not necessarily live on the African continent. There was very little content related to Blacks of the diaspora on the schedule. And if there's anything we've learned over the years, it's that no population can be left behind. The old paradigm that juxtaposes resource-rich countries against resource-poor countries and divides the world into the East, West, North and South is no longer applicable in this day and age. As the Left Behind report demonstrates, resource-poor communities can exist within resource-rich nations. The way we think about people should reflect the realities of their lives, not just the Gross National Product of the nation in which they live.
As we return home, Black participants from around the world will focus on: strengthening our networks with each other, pressuring our respective public and private sectors to pay attention to how the epidemic impacts us, improving our capacity to drive prevention and treatment messages home in our local communities.
So as we prepare for Austria, we believe it's critically important that we apply lessons learned here in Mexico City, as well as in Toronto, Bangkok and at previous conferences. We challenge our Vienna organizers to assist us in attracting to Austria all the people from diverse communities around the world that we've met along our journey together. We don't want to swap one group of participants for another; instead, let us endeavor to make our community of supporters grow.
Now, both Canada and Mexico—the United States' neighbors on our northern and southern borders—have hosted the International AIDS Conference. The U.S. government is finally lifting its ban on HIV-positive people entering the country. We hope that in the near future, our nation can rejoin the global AIDS community in fighting the pandemic of AIDS by hosting the International AIDS Conference in the United States.
So for now, Adios, a México! We look forward to seeing you again in two years.
Phill Wilson is the founder and the CEO of the Black AIDS Institute.
2008 International AIDS Conference-- Wednesday
Emphasis Has to Move Toward Prevention
By Phill Wilson
Visit Blackaids' youtube page and blog.
MEXICO CITY -- For years HIV/AIDS experts have hoped for a magic bullet—that easy, effective and universal approach to ending the epidemic. But with the recent failure of vaccine and microbicide clinical trials, it's time for us all to acknowledge that the calvary ain't coming—at least not anytime soon. Although several potentially effective treatment options are on the horizon, potentially including antiretroviral drugs for HIV prevention, many experts believe that we are at least 20 years away from developing an HIV/AIDS vaccine. In the meantime, approximately 2.5 million new people become infected with the virus every year. That's approximately 56,000 annually in the United States, including about 25,000 African Americans. The spread of this virus has got to stop. Treatment has a very important place, but it alone can't stop the virus from spreading.
Fortunately, we know that prevention works, as several influential groups of experts informed attendees at the 17th International AIDS Conference. On Tuesday, the Global Prevention Working Group (GPWG), an international panel of over 50 leading HIV/AIDS experts convened by the Bill & Melinda Gates Foundation and the Henry J. Kaiser Family Foundation, issued a comprehensive report, titled Behavior Change and HIV Prevention: (Re)Considerations for the 21st Century, and called upon global leaders to expand HIV-prevention programs targeting high-risk behaviors, including unsafe sex and drug use. The GPWG reminds us that behavior-based strategies have been associated with between 50 and 90 percent declines in HIV infections in key populations, such as Uganda, Thailand, Australia and Brazil. This is significant for Black Americans, in part because the epidemic in our community behaves very similarly to epidemics in the developing world. Additionally, the British medical journal The Lancet published a special prevention issue, emphasizing that evidence-based approaches should be moved to the forefront of our HIV/AIDS agenda.
Because over the years so much focus has been placed upon clinical approaches, proponents admit that we don't know enough about prevention—and that some critics are skeptical about its results, while others cherry-pick among its strategies to further their ideological or political purposes. Yet, the GPWG, Lancet researchers and others, all described the need for multi-pronged approaches, including biomedical, behavioral and structural interventions; game plans focusing on individual behaviors alone will not work, they say. Rather, we need to offer multiple options so that diverse people living in diverse epidemics have different choices during the different stages of their lives.
There's much that we do know about prevention—first of all, that it works. And it's long past time for us to put that knowledge in action, particularly in the Black community, where we must rely on ourselves because the government continues to fail us. The Black AIDS Institute calls upon public and private entities as well as the Black community in the United States to act upon the following recommendations:
• Set and meet ambitious national AIDS reduction goals through measurable, sustained increases in access to effective HIV prevention and treatment.
• Implement prevention strategies that contain biomedical, behavioral and structural components. Prevention should also be comprehensive—our government's obsession w/ abstinence only to the exclusion of comprehensive prevention is criminal. Abstinence only, even in light of scientific evidence proving it ineffective. Prevention should be tied to science; it is unacceptable for ideology to trump empirical evidence.
• Invest at least $1.3 billion per year, as identified by Federal AIDS Policy Partnership, to implement a comprehensive national prevention strategy to include sexual risk reduction including abstinence, negotiated safety, and proper condom usage; risk reduction for IV drug users including needle exchange and other harm reduction measures, and access to substitution therapy and drug treatment; and access to preventative healthcare for all Americans.
• Support efforts such as “Test 1 Million,” a national campaign to raise awareness about the importance of HIV screening and utilization of treatment by providing voluntary testing and counseling to 1 million people at elevated risk for infection who do not know their HIV status.
• Support traditional Black institutions to develop their capacity to make AIDS a top priority and a central component of their work.
So there is no silver bullet and the calvary isn't coming. We still can win because real prevention does work.
Phill Wilson is the founder and CEO of the Black AIDS Institute.