While AIDS is no longer the death sentence that it was when it first arose, HIV rates are on the rise in certain subsections of the population, especially gay African-Americans.
Later this month, scientists, politicians, activists and journalists will gather in Washington D.C. for the 19th International AIDS Conference, which will be held in the U.S. for the first time since 1990.
And while there's a lot for AIDS researchers and activists to celebrate -- like the recent FDA approval of Gilead Sciences Inc.'s Truvada, the first drug aimed at preventing HIV infection in people that may be having sex with infected partners -- the problem among Black gay men is getting worse. Much worse, Phill Wilson, the president of the Black AIDS Institute, writes in a report released Wednesday.
According to the U.S. Centers for Disease Control, African Americans represented only 14% of the US population but accounted for 44% of all new HIV infections in 2009. Black men who have sex with men, or black MSM (a term researchers use to account for the fact that many in this group do not self-identify as homosexual) accounted for 73% of new infections among all black men.
HIV infections among young black MSM aged 13 to 29 increased by 48% from 2006 to 2009. During that same time, the estimated diagnosis rate remained relatively stable, at 17.4 HIV diagnoses per 100,000 people, according to the CDC.
It's impossible to pin down any one cause for the disproportionate infection rates. The stigma of homophobia and shame may deter Black MSM from getting tested and seeking out treatment.
Black men also often disproportionately lack access to health care, reflected in late diagnosis of HIV, sub-optimal receipt of life-prolonging and prevention-promoting antiretroviral treatment, and poorer prognosis among those who are living with HIV.
It's unclear whether or not the large proportion of African-American men in prison is also to blame for the greater prevalence of HIV. The CDC says there is little evidence that there is a signifiant rate of transmission in prison, but it does occur.
What is apparent, though, is that few prison settings take meaningful steps to protect inmates from HIV. Federal prisons prohibit condom distribution, and as of 2007 only two state systems and five municipal prisons systems made condoms available. Methadone maintenance or needle exchange is even scarcer, the report says.
And while black communities are quite aware of AIDS these days, that awareness exists in tandem with persistent conspiracy theories about the nature of HIV. A 2009 survey of 205 HIV-positive African-Americans published in the journal Psychological Reports found that 29% thought AIDS was created by the U.S. government to control the black population and more than half thought the government was withholding a cure for the disease.
Ironically, a lack of fear may also be contributing to the problem. Kevin Fenton, the director of the CDC's National Center for HIV/AIDS, told the Black AIDS Institute that the agency is seeing increases in risk behavior in many MSM communities, including being less vigilant about safer sex.
In part, these changes are occurring because we are 30 years into the epidemic, perhaps leading to a certain complacency about HIV, a lack of urgency, a lack of fear about the seriousness of the disease, or ignorance about the epidemic and its impact, Fenton said in the report.
AIDS also tends to disproportionately affect people in the Southern U.S., where over 50% of new HIV infections in the country occur.
On Tuesday, veteran news anchor Dan Rather aired a report called It's a Southern Thing examining the disconnect between the higher rates of infection in the South and its lack of funds for education, prevention and treatment services.
We have heavy disease burden down here for our population and they are without the resources, and that gets overlooked. The South gets overlooked, Dr. Michelle Ogle, the director of an HIV clinic in North Carolina, says in a trailer for the program.
In a 2008 interview with National Public Radio, Dr. Ogle said that the stigma against AIDS in her community is so strong that her clinic doesn't have a sign out front.
Ogle told NPR that she's made headway by going to churches and speaking to the congregations about the threat of HIV.
It's taken us a few years to get the churches to really realize they have to be involved, she said. And we have had actual HIV testing in the church, and it's been wonderful experience for us.