Living with HIV (2005)*: 1.2 million (0.6% pop.)
Receiving Drugs (2005): 298,000 (78% of those who need them)
Est. AIDS Deaths (2005): 16,000
In 1995, Mel Prince was a paralegal looking for a career change when she began working as a part-time social worker with Selma AIDS Information and Referral service (AIR). It didn't take long for her to realize what she'd gotten herself into. "The third day on the job, I went to a funeral," she says. Although the AIDS epidemic was centered in New York and San Francisco at that time, in rural Alabama, people in the care of Selma AIR were dying at least once a month. "That's how tragic this disease was," Prince recalls.
Since the mid-1990s, HIV/AIDS has grown only more tragic for the African American community. While new HIV infections in the U.S. have stayed relatively steady at about 40,000 a year, African Americans -- especially young African Americans -- are increasingly likely to become infected. A few statistics show the depth of the virus's inroads into the black community:
- 50 percent of newly infected men, and 60 percent of newly infected women, are African American
- AIDS is the leading cause of death among 25-44-year-old African Americans
- In 2000, 30 percent of young black gay men were HIV-positive
- In 2003, young African American women were 7 times as likely to be HIV-positive as white women and 8 times as likely as Hispanic women
Despite these stark numbers, Prince says finding money and resources to help HIV-positive African Americans is hard. Selma AIR used to be able to help with bills, food and transportation, as well as health services and antiretroviral drugs. Now, she tells FRONTLINE, things are different:"[Our budget has] been cut almost in half. We cannot provide services that we have provided over the years. We are limited ... to help[ing to] get medicine."
That's a big job in itself. For people who don't qualify for Medicaid but are too poor to afford the drugs, options are limited. Some of Prince's clients are on the waiting list for the AIDS Drug Assistance Program (ADAP) for years; others are forced to interrupt their treatment when funding from one source runs out before they find an alternative. Disrupting treatment is very dangerous because it increases the likelihood of the virus developing drug resistance. "We have some programs that are very cooperative in providing our patients with the medicines," Prince said. "Some programs are not as compassionate and they don't care."
Prince is incredibly frustrated watching her fellow African American women fall victim to HIV again and again. She thinks the reasons have to do with pervasive stigma and hopelessness in rural black communities. "Certain parts of Alabama can still be lost in the dark ages where they think this is just a gay white male disease, it doesn't happen in our neighborhoods. ... They'd rather pretend it's not there." She says her clients feel "defeated. ... I would say they feel like the system always lets them down, so what should be different about this? They are just used to it, and therefore, they just accept it."
There's evidence that the African American community has also been let down when it comes to education about HIV/AIDS. A 2006 Kaiser Family Foundation study found that though 63 percent of African Americans say they know someone who is HIV positive (compared to 41 percent of whites and 37 percent of Latinos), and 49 percent of them think that AIDS is a more urgent problem in their local community than a few years ago (compared to 15 percent of whites and 46 percent of Latinos), many African Americans still have bad information about the disease. According to the Kaiser study, African Americans were the race most likely to believe that HIV can be spread through kissing or by sharing a drinking glass -- 38 percent of African Americans believe the former, 25 percent the latter.
Many American AIDS activists see a terrible irony in President Bush pledging billions of dollars to fight HIV overseas while the problem is still so bad at home. Pernessa Seele, the founder of the Balm in Gilead, an HIV/AIDS activist group, works both in Africa and in the United States. She tells FRONTLINE, "I keep telling folks here in the United States ... you don't have to fly [to Africa] to find HIV-positive homeless people who don't have no housing, no access to services, have never seen HIV education. You can find that right here in the African American community."
While African American communities might be suffering from denial and a lack of education about HIV/AIDS, recent evidence shows the disease is making a comeback among the group that was most educated about AIDS over the past 25 years -- the gay community. The number of new infections nationwide among gay men rose every year between 2000 and 2003.
After years of living in fear of AIDS, it seems that many gay men have resumed dangerous sexual practices -- in New York City, the rate of syphilis, which has been shown to be linked to new HIV infections, went up 400 percent from 2000 to 2005. Nearly the entire increase was among gay men.
Why are so many gay men having risky sex? The answer, experts say, is crystal methamphetamine. Referred to as HIV's "parallel epidemic," meth use has skyrocketed among gays since the late 1990s. It doubles the risk of HIV infection in any given sexual encounter, both because users are more likely to be unsafe, and because the body of a person high on meth suffers physiological changes that make transmission easier. The more the drug is used, the more likely infection becomes: Steven Shoptaw, psychologist with the UCLA Integrated Substance Abuse Programs, found that 25 percent of gay men who used meth occasionally were HIV positive; out of those who used meth regularly, 40 percent were positive.
Although there's dramatic evidence that the problem of HIV/AIDS is far from adequately managed in the United States, there are laws on the books that block the federal government from doing everything it could. And it's all connected to the continuing culture wars that have raged in Washington for decades.
In the 1980s and '90s Sen. Jesse Helms (R - N.C.) and other conservative leaders consistently opposed AIDS funding on moral grounds. In 1987, Helms pushed for a bill that prohibited federal money from being spent on literature or programs that "promote homosexual sexual activity." That is still the law of the land.
"That's like saying we want to try and stop alcoholic-related deaths on the highway but we can't talk about booze and we can't talk about cars," says Dr. Merv Silverman, who was the director of San Francisco's Public Health Department in the early years of the AIDS epidemic.
Similarly, federal funding of needle-exchange programs -- which have been shown in numerous studies to actually decrease, not increase, drug use -- is prohibited by law. Today, around 20 percent of new HIV infections in the United States come from injection drug use, as opposed to about 5 percent in the United Kingdom, where needle exchange is fully supported by the British government, and 27 million clean needles are handed out annually. Even Iran's theocratic government allows needle exchange. "Without question politics has been one of the driving forces in the spread of this disease," says Dr. Silverman.
The inadequacies in U.S. public health efforts in tackling AIDS are evident in the statistics. Officials realize they need better information about HIV infection to effectively target prevention.
The Centers for Disease Control (CDC) has encouraged states to adopt name-based confidential reporting of new HIV infections, in order to help eliminate duplicate recordings of infections, and so it can track more information about who is getting infected, where and how.
As of spring 2006, the CDC is finalizing a new recommendation that HIV testing become a routine part of an individual's regular medical check-up. This new thinking on testing is meant to address a disturbing fact: The CDC estimates roughly 1 million Americans are living with HIV, but 25 percent of them don't know they have it.
* Note: Figures reflect most recent statistics from UNAIDS and the World Health Organization.