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AIDS kills in silence in black community

Experts call for action on emerging 'epidemic of color'

Tuesday, July 07, 1998

By Steve Levin and Angela Agoawike, Post-Gazette Staff Writers

Every time Desiree Davis goes out to educate blacks about AIDS, she comes face to face with an epidemic.

In the bars, clubs, stores and residences of Homewood, Davis spreads the word that AIDS is devastating the black community. And then the volunteer with the Minority AIDS Working Group adds: "The message is, 'You do not have to get the disease."'

Despite that assurance, blacks infected with HIV have been especially reluctant to acknowledge they have the AIDS virus or seek early treatment, experts say. As a result, they now account for most of the new AIDS cases in the United States and constitute a far greater share of those with the disease than their proportion in the general population.

The disparity between blacks as a percentage of AIDS cases and as a percentage of the general population is consistently wide. In Allegheny County, blacks make up 35 percent of all AIDS cases recorded since 1981, but just 12 percent of the population. In the 11-county region, the figures are 31 percent and 15 percent. In the state as a whole, they are 47 percent and 12 percent.

More frightening is this statistic: blacks now account for about 57 percent of all new infections with the human immunodeficiency virus, or HIV. Among those age 13 to 24, the rate is 67 percent.

Dr. David Satcher, the new U.S. surgeon general, said recently: "I don't think there is any question that the (AIDS) epidemic in this country is becoming increasingly an epidemic of color."

As the racial disparities grow, many worry AIDS will become marginalized -- just another inner-city problem, like crime, drugs or graffiti.

Despite Satcher's bleak assessment, neither of the nation's two largest black civil rights groups, the Urban League and the National Association for the Advancement of Colored People, have made AIDS a top agenda item at their national conventions this summer.

"It's exasperating," said Rep. Louis Stokes, the Ohio Democrat who is chairman of the Congressional Black Caucus' health committee. The caucus recently asked the Clinton administration to declare AIDS a national public health emergency among black people, a move Stokes hoped would rally civil rights leaders. "But," he said, "this is one that black leadership has shied away from."

Karen Reddick saw the future eight years ago, and she began the Pittsburgh AIDS Task Force's Minority Outreach Program. Even then, blacks accounted for 30 percent of reported AIDS cases in Allegheny County.

"Everywhere I went, people pulled me aside to whisper about a relative who had AIDS or had died of AIDS," said Reddick, who now is director of prevention services for the task force.

Reddick estimates the task force reaches 50,000 to 60,000 people a year with some type of HIV-prevention message.

But any type of outreach program to black people faces a struggle. Initially, black communities were slow in acknowledging the existence of AIDS, believing it was confined to gay white men. Once AIDS was recognized as a problem within the black community, there remained a deep-seated mistrust of social service agencies, public health groups and the government, said Reddick, who is black. Plus, there is the persistent belief among many blacks that AIDS is a man-made virus meant to eradicate people of color.

On top of all that are the general social and economic stresses in many black communities, said Sabira Bushra, coordinator of special programs for the Minority AIDS Working Group, funded by the state Department of Health's Bureau of HIV/AIDS.

"It has a lot to do with the fact that when you have communities that are in generally poor health and because of the economic situation in these communities there is drug use, violence and intimate violence, maintaining health is not a high priority because feeding your family is more important," Bushra said.

"HIV and AIDS is really a poor people's disease. For a lot of years we looked at the HIV/AIDS epidemic as something that happened in Washington, D.C., New York and Los Angeles. Now the numbers are hitting home. It's something that you can't overlook."

Unlike gay white men, who have been open about AIDS and have raised millions of dollars to create powerful organizations to combat the epidemic, health experts say most black people who are infected have tended to keep their diagnosis a secret. That is because of twin taboos linked to the disease, which are especially strong among blacks: homosexuality and drug abuse.

Public health experts, including the surgeon general, complain the epidemic has been greeted with deafening silence not only by civil rights groups but also by black preachers, who have long been an important force in black society.

"I grew up in the black church," Satcher said. "I think the church has problems with the lifestyle of homosexuality. A real problem has been getting ministers who are even willing to talk about it in their pulpits."

The Rev. Johnnie Monroe, of the 300-member Grace Memorial Presbyterian Church in Schenley Heights, said he has spoken from the pulpit on the subject, and his church "will be open and accepting to persons who come with full-blown AIDS. They're children of God."

In the past few years, he said the church has held two seminars on AIDS education.

"We continue to live up to the fact that we have to deal with this because it's in our community," said Monroe, pastor at the church for six years. "One of the things that we are facing is the fact that AIDS does not only hit homosexuals, does not only hit those who abuse drugs."

In fact, among black women, who make up 56 percent of AIDS cases nationally, heterosexual sex has surpassed drug use as the leading cause of infection.

Desiree Davis, Patricia Jones and the other 25 minority working group volunteers here try to deliver that message -- that AIDS can affect anyone -- when they go out into the black community.

Volunteers work days and nights in teams of four or five people on different blocks. In addition to dispensing information, they offer free, confidential AIDS antibody testing by appointment.

Jones, of Homewood, has been a volunteer for two months.

"I wanted to give something back to my community," she said. "The (people) love it. They ask for us. We do bars, clubs, stores. We just walk up to whoever we feel comfortable with. In most cases, it's anybody. We usually introduce ourselves, tell people what we are doing and go from there."

The volunteers have all undergone HIV/AIDS education training, plus a four-day training session on how to communicate the information. The volunteers discuss everything from condom use to how AIDS is spread.

"We do not counsel," Davis said. "We simply spread the message and are there as a support system for them. We tell them what AIDS does to the body. We educate them on sexually transmitted diseases and the need for self-esteem even when they already have the disease."

This month, outreach efforts are planned in Wilkinsburg, Garfield, East Liberty, the Hill District, Larimer Avenue and the Lincoln-Lemington area.

Reddick says the primary focus of the AIDS Task Force's outreach over the years has been men who have sex with men, but future outreach will be aimed more at the homeless and sex-industry workers. The task force also has introduced risk reduction groups, which meet over a four-to-eight-week period and provide participants with a clearer understanding of HIV and themselves. Reddick also tries to identify black-owned businesses where her volunteers can leave safe-sex educational kits for customers.

"Instead of simply targeting just people who already have the disease, the outreach reaches out to those who have not gone through the HIV diagnosis," Reddick said. That included handing out 1,000 specially designed condom kits at 12 high school proms in 1997.

The task force has expanded its HIV testing to one evening per week. On an HIV testing day last month, Reddick said between 17 and 20 people were tested at a half dozen sites. The use of Orasure, a new HIV test that takes a sample from the inside of the cheek instead of using a needle to draw blood, has made testing easier, she said.

"We know that one HIV education session is not enough to get people to change their behavior," she said. "We know people need to have multiple contacts. People have to be in the mindset themselves of wanting to change their behavior. And we need to meet people where they are."

Over the next five years, as part of President Clinton's plan to eliminate racial disparities in disease by the year 2010, the government has proposed spending $400 million on model community programs. Part of the money would be set aside for AIDS, although Satcher acknowledged it may be too optimistic to think the epidemic's racial disparities can be eliminated in just 12 years.

"It is a long-term proposition," the surgeon general said. "There is no immediate fix."

(The New York Times contributed to this report.)

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