By David Brown
Washington Post Staff Writer
Wednesday, July 30, 2008
A prominent AIDS organization accused the federal government yesterday of doing too little to fight AIDS among black Americans, in whom the size and scope of the epidemic resembles that seen in many African nations.
In a 55-page report, the Black AIDS Institute argued that the disease should be viewed as a threat to the entire black population, and not just specific high-risk groups. Unlike in white Americans -- and in the citizens of most industrialized nations -- HIV in American blacks is increasingly transmitted heterosexually through "networks" where men especially have many sex partners at the same time, the report noted.
The report's authors asserted that the black AIDS epidemic here is being overlooked as the United States is allocating unprecedented resources to fighting the disease in sub-Saharan Africa.
African Americans with HIV -- at least 500,000 -- are more numerous than in seven of the 15 "target countries" in the Bush administration's global AIDS initiative, which has spent about $19 billion overseas in the past five years.
President Bush is scheduled to sign a bill today that will extend the program and authorize the spending of $48 billion for the next five years. The target countries consist of 12 in Africa and three others: Guyana, Haiti and Vietnam.
The report noted that with 39 million people, "black America" would be the 35th most populous country, and the 28th richest, if it were a separate nation. Two percent of adult black Americans are infected, the government estimates, and only four countries outside Africa have a higher HIV prevalence. It would rank 16th in the world in the number of people living with HIV.
The District has the highest prevalence of HIV infection of any American jurisdiction -- 5 percent, or about 1 in every 20 residents. This is nearly as high as the prevalence in Uganda (5.4 percent), which has one of the oldest and most intense epidemics in Africa.
Looked at these ways, the authors wrote, the African American epidemic "would undoubtedly elicit major concern and extensive assistance from the U.S. government."
"The U.S. response to the epidemic in black America stands in sharp contrast to our response to the epidemic overseas," said Phill Wilson, a longtime AIDS activist who is executive director of the Black AIDS Institute.
He added that his purpose in making the comparisons is not to criticize the global program but to urge that more money and attention be directed to the domestic one.
But Kevin A. Fenton, the head of HIV/AIDS prevention at the Centers for Disease Control and Prevention, said the argument that government prevention efforts are not tailored to the black epidemic is mistaken. "CDC prevention efforts have really tried to follow the epidemic," he said.
The proportion of AIDS-prevention funding devoted to the black community has risen as the epidemic has become more concentrated there and now constitutes about $300 million of the $600 million spent each year, Fenton said.
According to the CDC, 1 million to 1.2 million people in the United States are HIV-positive, although that estimate is now five years old. The CDC on Sunday will release more precise estimates of the HIV incidence, or the number of new infections that occur each year. It is believed to be about 50,000. The 2 percent HIV prevalence in adult African Americans exceeds the 1 percent threshold that defines a "generalized" epidemic, rather than one limited to certain subgroups. Two of the striking features of the epidemic in black Americans is the high rate of infection in women and the frequency of heterosexual transmission, both characteristic of Africa.
The CDC estimates that 38 percent of all new infections in African Americans from 2001 to 2005 were in women. Of new infections in black men and women, 46 percent were the result of heterosexual contact. In the District, about 40 percent of new infections are acquired heterosexually, 30 percent from male homosexual contact, and 15 percent from injected drug use.
Among white Americans during the same period, 16 percent of new infections were in women, and 16 percent of new infections in men and women were attributed to heterosexual transmission.
In sub-Saharan Africa, 60 percent of new infections occur in women, and the vast majority of all infections are acquired through heterosexual contact.
"I think there are important parallels between the epidemic in Africa and the epidemic among black people in the United States," said Helene D. Gayle, an epidemiologist who spoke in support of the new report during a teleconference yesterday. "In a lot of places, it is a generalized epidemic."
Once the head of AIDS programs at the CDC, Gayle is now the president of the charity CARE.
The report cited numerous other similarities between the African and African American epidemics. In each, there is HIV prevalence in some rural areas (such as the Mississippi Delta) as high as in cities. Sexual networks in which people have many partners at the same time -- rather than practicing "serial monogamy" with many partners -- is characteristic of both. So are the assertions by many women that they are powerless to negotiate condom use or abstinence.
Also yesterday, the United Nations released its latest synopsis of the global AIDS epidemic, which showed a steady decline in the number of people infected with HIV to 2.7 million last year, from 3 million in 2001. The number of AIDS-related deaths fell from 2.2 million in 2005 to 2 million last year, primarily because of a huge increase in the availability of antiretroviral drug treatment, particularly in Africa.
"We've achieved more in the fight against AIDS in the last two years than in the preceding 20 years," said Peter Piot, executive director of UNAIDS, which published the report. But he cautioned that five people were infected for every two people who gained access to treatment. "The gap between those who are in need of treatment and those who have access to treatment is widening."
Staff writers Paul A. Schwartzman in Washington and Colum Lynch at the United Nations contributed to this report.