A Health Crisis Waiting for Leaders

A generation after the triumphs of the civil rights movement, African Americans confront a health crisis as severe as any in their history. A spiraling number of HIV-AIDS cases in the black community has caused many African Americans to wonder, as did black health activists 70 years ago, whether their “struggle for health might be considered an effort of the race to survive.”

The reticence of many mainstream black leaders on the HIV-AIDS crisis aggravates the problem. There are signs of fresh political activity, most prominently from Rep. Maxine Waters (D-Los Angeles), but nothing on the scale of African American health activism from 1915-50. Few are aware of the 35-year campaign to promote black health, under the banner of National Negro Health Week, that succeeded in making the U.S. public-health system universally accountable. The spread of AIDS to minority communities demands a commensurate response today.

In Waters’ view, the L.A. Board of Supervisors’ recent declaration of an AIDS emergency in the county represents a “slow and late” reaction to what is an epidemic. For years, medical experts have warned about “the changing face” of AIDS. In 1982, before the disease was defined as AIDS, African Americans accounted for 23% of the known cases. Now it is incontrovertible that HIV-AIDS can no longer be pigeonholed as a gay disease.

The proliferation of AIDS cases among African Americans is in staggering contrast to the disease’s overall decline. The rate of HIV-AIDS is progressing faster among African Americans than any other group in the nation. African Americans, who comprise 13% of the population, make up 35% of reported AIDS cases, 43% of new cases and, according to Dr. Eric Goosby of the federal Department of Health and Human Services, nearly one-half of the deaths caused by AIDS. The disease is the No. 1 killer of African American men between ages 23 and 44. Black women represent 60% of new AIDS cases among all women, and they are nine times more likely to die of the disease than their white counterparts. Two-thirds of pediatric cases are black babies. It’s expected that, by the year 2010, 50% of all HIV-AIDS cases reported to the Centers for Disease Control will be African American. In Los Angeles, the figures are comparable.

At the heart of these statistics is a startling trend: “The face of AIDS is more likely to be poor, black and female,” says the UCLA School of Public Health.

If the disease is to be controlled and abated, African American leaders must show a greater willingness to shoulder their part of the burden of community mobilization. There are several avenues open to them. The most immediate is to loosen the chokehold on the ability of California’s public-health system to contain the AIDS virus and report it to the federal government.

When state legislation first added AIDS to the list of 52 communicable diseases tracked by public health, HIV was excluded out of ignorance. It was not known that HIV infections are contagious or that they can progress to AIDS. Gov. Gray Davis currently has on his desk legislation, AB 103, that would set up a notification system using “unique identifiers” or alphanumeric codes to identify and track HIV carriers and those whom they infect. This system, however, has already been abandoned in Texas, and Connecticut is questioning its effectiveness. Davis should veto the bill.

There simply is no effective substitute for a name-based notification service that allows public-health workers to treat HIV as they do all communicable diseases. Opponents worry about privacy and the stigma attached to the virus. But names of AIDS sufferers have been reported by California public-health officials since 1993, and there has not been one breach of confidentiality; 31 other states have name-based systems they say work. Continued resistance to HIV name reporting is due to what Genevieve Clavreul, an original member of ACT-UP L.A., calls “a false issue” based on “a lack of knowledge” about the public-health system.

Community health depends on “shoe-leather epidemiology.” Doctors and clinics notify county public-health departments about positive HIV tests, and public-health workers find the infected and persuade them to voluntarily give the names of their sexual partners who may have been unknowingly infected. These professionals track down the partners named and, without revealing their sources, alert them to the possibility of infection. They then assist them in obtaining treatment to prevent the spread of the disease. There are no shortcuts or substitutes for this time-proven method of public-health vigilance. In California, however, no one knows exactly how many new HIV cases there are, which means that many infected people don’t know they’re infected, and neither do their sexual partners.

It would seem that HIV name reporting would be a political natural for black leaders of communities afflicted with AIDS. But even Waters, not known for political timidity, is still determining her position. Assemblyman Roderick Wright (D-Los Angeles) is considering introducing legislation that would establish name reporting for HIV carriers either as a pilot project in L.A. or statewide.

Black leaders also need to develop strategies to channel more resources to poor blacks with AIDS. There are a range of providers throughout the county, but most with black and Latino clients are disproportionately underfunded. Waters was instrumental in the release of an additional $156 million in federal funds for treatment of infected African Americans. But the money is thinly spread all over the country.

Managing the HIV-AIDS crisis in the black community faces other obstacles besides lack of money. The myth that AIDS is a white, gay male disease, coupled with the black community’s own blindness when confronted with the problem, has diverted resources and blunted health activism. African Americans, because of their strong faith tradition and conservative social values, are generally intolerant of gay sex, safe or not, and drug use involving needles. Their harsh judgment of gays and addicts often extends to carriers who don’t shoot drugs or have gay sex. The absence of the black church until recently on this issue is emblematic of its deep, troubling conflicts over the devastation wrought by AIDS. Finally, nihilism among young blacks, expressed in the death-wish lyrics of gangsta rap, and promiscuous sexual behavior, particularly among young men, have hindered rescue efforts. The sense of futility is illustrated by Chris Rock, who recently hectored the pharmaceutical industry for being “drug pushers” to AIDS sufferers. “Ain’t going to cure AIDS,” Rock ranted. “Ain’t no money in the cure. The money’s in the medicine.”

The nearly forgotten achievements of black health activists offer inspiration here. National Negro Health Week was born when black survival was at risk. Based on a program in Virginia, it was established by Booker T. Washington at Tuskegee Institute, moved to Howard University, then transferred to the federal government under the Office of Negro Health. For 35 years, African American health reformers sponsored thousands of community observances across the country that reached millions of people. Activists successfully persuaded government agencies to focus on segregated populations being excluded from public-health efforts. The movement put black health on the federal agenda and convinced national leadership that, as NAACP head Walter White put it, “the country’s health can be no better proportionately than that of the most neglected health segment of its population.”

A similar political activism targeting the HIV-AIDS crisis is stirring in Los Angeles today. The Alliance of Black Women Organizations, a coalition of about 100 professional, religious, civic, sorority and health organizations headed by Waters, is a bridge between past and future health activism. Since the turn of the century, African American women have provided the infrastructure for community health, as chief fund-raisers for segregated hospitals built by black physicians, as organizers of Negro Health Week activities and as socially involved club women, nurses, social workers and sorority members. These women, often privileged by education and class, followed the mandate set by early civil rights champion Mary Church Terrell: to go among those “to whom they are bound by ties of race and sex and put forth every possible effort to reclaim them.” Members of the alliance, dressed in black from head to toe, often appear on major thoroughfares and at malls to hand out cards with safe-sex admonitions, along with referrals and testing information.

This network can play an important leadership role on behalf of their vulnerable sisters and others afflicted with AIDS. By borrowing from the organizing approach that led to National Negro Health Week, these women could wage a more effective war against the HIV-AIDS catastrophe in their communities. *