The recent passage of bipartisan legislation reauthorizing and expanding the President’s Emergency Plan for AIDS Relief (PEPFAR) is a landmark achievement that will save millions of people from certain death and prevent millions of new HIV infections in the developing world. Sadly, our commitment to fighting AIDS globally has not extended to the fight against AIDS here at home.
A new report by the Black AIDS Institute, aptly titled “Left Behind!,” provides startling evidence that, while we excel at fighting AIDS overseas, we have not sufficiently addressed the growing African American epidemic within our own borders. The report compares African American HIV rates in Detroit, New Orleans and Washington, DC, with countries such as South Africa, Haiti and Tanzania, and concludes that, although AIDS is a health crisis on a global scale, Black America is confronting the epidemic with precious little support from the government.
The Centers for Disease Control and Prevention estimates that more than half a million Black Americans are HIV-positive. It is the number one killer of young Black women and the number two killer of young Black men. African Americans are eight times more likely than Whites to contract HIV, and they fair more poorly when infected, due to late diagnoses and lack of services. While treatment has made AIDS a chronic manageable condition for people with quality health care, one study found that HIV-positive Blacks are 2.5 more likely to die than HIV-positive Whites.
More locally, the report notes that HIV prevalence in Washington DC, where more than 80 percent of HIV cases are among Blacks, is estimated at 5 percent — nearly the rate found in Uganda and higher than that of Port-au-Prince, Haiti, capital of the poorest country in our Hemisphere.
This observation prompted the Black AIDS Institute to ask a thought-provoking question: how would the United States react to this epidemic if Black America were a separate country? The conclusion: if Black America existed outside our borders, it would be a prime candidate for U.S. aid. Black America would rank 88th in infant mortality (with twice the rate of infant deaths as Cuba) and 105th in life expectancy (behind Algeria, the Dominican Republic and Sri Lanka.)
Black America would also rank 16th worldwide in the number of people with HIV. There are more people with HIV in Black America than in Botswana, Côte d’Ivoire, Lesotho or Swaziland. While most sub-Saharan nations have general HIV prevalence rates higher than the 2-3 percent found across Black America, infection rates among some segments of the Black community, including men overall, and gay and bisexual Black men in particular, rival those of many African nations.
So, where is the emergency response to our own AIDS epidemic? Although Black communities and leaders are now mobilized on AIDS, the federal government has not committed the necessary funding and focus to fight AIDS in America, let along AIDS in Black America. Even as our government has dramatically scaled up funding for AIDS relief overseas, it has simultaneously cut real spending for domestic HIV prevention and care initiatives.
Sadly, the United States would probably deny its own application for AIDS relief; because our response does not even meet the minimum standards we set for other nations. PEPFAR beneficiary countries, for example, must have a national AIDS strategy in place. Three decades into our own epidemic, the U.S. has no such strategy. Disturbingly, we are also one of just 40 countries worldwide that fails to report our progress in fighting HIV/AIDS to the United Nations. These failures threaten not only the health of our own citizens, but our credibility abroad as well.
It’s past time our government stopped turning a blind eye to our national AIDS epidemic. Far greater support is needed for community responses to the epidemic in Black America, especially through the Minority AIDS Initiative. We must significantly expand access to essential HIV prevention, treatment and care. In particular, we must develop a national AIDS strategy and fund HIV prevention initiatives designed for African Americans.
Contrary to what many people may wish to believe, HIV/AIDS is not just a foreign policy issue. If we wish to show real global leadership on AIDS, we must keep our commitments abroad and take care of our epidemic here at home.
Congresswoman Barbara Lee (Oakland-D) is a leader in the fight against the global HIV/AIDS pandemic. She is the only member of Congress serving on both the House Committee on Foreign Affairs and the House Appropriations Subcommittee on State, Foreign Operations and the Subcommittee on Labor, Health and Human Services and Education which have jurisdiction over all US global and domestic AIDS programs.