Men make up 70% of new HIV infections. Male-to-male sex remains the primary method on transmission, with 42% of annual cases believed to fall into this category. AIDS has found a disturbing home in minority communities: over half of new cases involve blacks and nearly 20% are Hispanics. The percentage of blacks with AIDS surpassed the percentage of whites for the first time in 1996.
Minorities are disproportionately affected by HIV. In 2000, blacks accounted for 43% of AIDS cases, although they make up 12% of the population. Hispanics accounted for nearly 20% of the cases, while they make up only 13% of the population. American Indians and Alaska natives make up less than 1% of the total population. After several years of decline, the number of adult cases have been increasing steadily since 1998 (150 in 1998 to 184 in 2000), while the other ethnic groups have been on the decline. These groups have traditionally had low access to health care and information. How does one tailor health information to a group of people that cover many tribes, each with its own language and culture?
Rate of AIDS Cases Per 100,000 Population
| 1994 | 2000 | |
| Blacks | 101.0 | 74.2 |
| Hispanics | 51.0 | 30.4 |
| American Indian/Alaska Natives | 12.0 | 12.7 |
| Whites | 17.0 | 7.9 |
| Asians/Pacific Islanders | 6.0 | 4.3 |
The spread of AIDS was controlled in part through prevention efforts: learn how to use condoms, get tested, know your partners. But a generation of young gay men have come of age who were babies during the epidemic. They didn't see stories on HIV ever day in the newspapers, did not attend funerals of friends, or saw sex as a potentially lethal activity. This lack of vigilance comes at a price: Half of the new cases occur among people 25 years old and younger. Reaching young black and Latino men may be particularly difficult, although it is vital that the health industry (and community leaders) do so. Among gays and bisexuals, men of color make up a growing share of the new cases: they made up 52% of cases, up from 31% in 1989, while whites represented 48% of cases, down from 70% in 1989.
There are several issues that complicate prevention strategies. Minorities may not have access to quality and consistent health care. Also, homosexuality is such a stigma that men of color may be unwilling to identify themselves as gay. Some don't, either: according to a CDC study, 24% of blacks and 15% of Latinos who have sex with other men identity themselves as heterosexual (indeed, this is why the health industry uses the men who have sex with other men category in the first place — terms like gay or homosexual contact just don't fit the context).
Another factor is testing. According to the CDC, one in four do not know they are infected with the virus. Again, there are striking racial differences: One recent study of over 5,700 gay men in selected large cities found that of those that tested positive, 91% of black men 16-29 were unaware of their status, compared to 77% for Hispanics and 60% for whites. Look at the potentially deadly combination here: a man does not believe AIDS will "happen to me"; he does not know his HIV+ status because he is never tested, and spreads the virus to partners of both sexes.
It isn't just tailoring the AIDS message to a new generation. Any prevention strategy faces political, financial, and social challenges, of course. The dollars for minority community initatives were fairly small until 1998, when the Congressional Black Caucus urged President Clinton to declare AIDS a "state of emergency" in 1998 for their community. Some have criticized the black community for mobilizing so late in the crisis, arguing that they looked the other way when the primary sufferers were intravenous drug users and gay/bisexual men. Action came only when the disease then began to affect straight women and more middle/upper class blacks. Congress now spends $245 million to target minority communities. Some argue this still is not enough.
This leads to another point: women. The men who have sex with men also have sex with women — who make up the remaining 30% of the 40,000 annual cases. Three quarters of women receive the virus through heterosexual contact. About 65% of the women are black, while 18% are Hispanic. The number of cases for women overall grew 159% from 1993 to 2000, nearly double the rate for men.
In 1999, for men 35 to 44, HIV was the leading cause of death for black men, the third for Hispanic men, and the fifth for white men. It routinely ranks in the top 6 causes of death for various age brackets of both sexes.
Are we ready to have some frank discussions about our lives and behavior, as we did a decade ago?
Sources: Schreiber, Chris. "Demographic Shift." Nurse Week, March 2000. Kai Wright. "AIDS and Black New Yorkers." Village Voice, June 14, 2000, "First 500,000 Cases." MMWR, November 24, 1995. "A Glance at the New Epidemic." "New CDC Studies Shed Light on Factors Underlying High HIV Infection Rates Among Gay and Bisexual Men." Retrieved July 19, 2002 from http://www.cdc.gov.
1 The communities were Hollywood, FL; Bronx, NY, Portland, OR; Rochester, NY; Seattle, WA, Baltimore MD and Houston, TX. Many came from high risk or disadvantaged areas. Over 40% were African American or Caribbean Black and another 29% were Latino or Hispanic. Almost half lived with two parents. Almost a third had had sexual intercourse at least once.
2 Sexually active is defined as having had intercourse in the three months preceding the survey.
3 Nature reports that "the sample taken from the Bantu man has a viral sequence that lies near the ancestral node of subtypes B and D in the major group, suggesting that these HIV-1 subtypes may stem from a single introduction into Africa soon after 1959. The team notes that given the large genetic differences between HIV-1 and HIV-2, the divergence of these viruses could not have occurred in the late 1940s; that branching point must have come considerably earlier."
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