Urban Issues and Actions

                This past Monday was World AIDS Day. I was surprised and happy to see a display in D-Hall full of statistics and AIDS data worldwide. In addition, I saw a few people wearing red ribbons. The reason I was surprised was that there were no posters or flyers around campus. In addition, this day is not common knowledge to the majority of persons in the United States. This particular day is important for several reasons. First, HIV/AIDS is a preventable disease, but it continues to kill millions of people worldwide. Here in the United States, HIV/AIDS is rarely discussed and there is an epidemic among Black Americans and other marginalized groups. Thus, this epidemic challenges that notion that HIV/AIDS is a chronic disease, because people continue to die from it considering that the United States has the resources to contend with the disease. Why are there 40,000 new HIV infection cases a year in the United States? How does the neglect of the U.S. government and society influence the world’s perceptions of the United States ability to fight the epidemic globally? 

                Although my interests and focus on HIV/AIDS is among Blacks Americans and poor communities within the United States, it is important to remember that we live in an interdependent global society, meaning that what occurs in the world, impacts the United States and vice versa. Here are some statically data that I want people to know and think about the epidemic worldwide. According to Avert.org, “Already, more than twenty-five million people around the world have died of AIDS-related diseases. In 2007, around 2.1 million men, women and children lost their lives. 33 million people around the world are now living with HIV, and most of these are likely to die over the next decade or so. The most recent UNAIDS/WHO estimates show that, in 2007 alone, 2.5 million people were newly infected with HIV”¹. About 1.1 million of persons infected with HIV out of the 33 million come from the United States. These are some troublesome numbers, because the cases of HIV/AIDS infections and death continue to rise. The charts below show the global HIV infection trend.

                Earlier I asked two questions regarding why there is an epidemic in the United States in particular and how the United States deals with the epidemic in its country will influence how the world’s views that United States ability to fight the epidemic worldwide. Some of the reasons why there is an epidemic in the United States is that there is still a large amount of stigma and denial, inadequate funding on prevention methods, intertwining issues of poverty, racism, sexism, etc. and a sense of apathy (it’s a chronic disease managed by medications). In addition, there have been more and more news reports regarding the epidemic among Blacks Americans and the ignorance of how devastating the disease has been in this community. Being aware of the United States’ history and continual issues with race and class, the ignorance and lack of governmental and communal response in this country against HIV in the Black community and poor communities may provide the world with a negative impression of the United States. Because HIV/AIDS disproportionally affects people of color globally, how will the United States become the leader in the global fight in the HIV/AIDS epidemic, while the same communities are ignored within its nation? As the sole superpower in the world, it is imperative that we make the link between what we do and the commitments we make globally. 

* 1. Avert.org. AIDS around the world. 04 November 2008. AVERTing HIV and AIDS. 05 December 2008. http://www.avert.org/aroundworld.htm

With a newly elected president who promised that change will come, it is important that AIDS activists (such as myself) and others remind Barack Obama of his promises regarding the domestic and international fight against HIV/AIDS. It is true that the economy is in poor shape, people are losing their jobs and homes and a controversial war continues; however, 40,000 people a year being infected with HIV in the United States with 25% of the HIV infected persons unaware of their status. HIV/AIDS is not a separate issue, but an issue that intersects many boundaries: health care, the economy, and the welfare state. Thus, the issue can be address in conjunction with the other issues that haunt our country. We are in a state of emergency with the HIV/AIDS crisis, because for a preventable disease, many people are infected and dying. Therefore, there must be a correlation between one’s health and the state of the nation as a whole.

On November 21, 2008, roughly 1,000 AIDS activists from all over the East Coast attended a mock “inauguration” of President-elect Barack Obama in which four activists posing as Obama was inaugurated by placing their hands not on the Bible, but on a National AIDS Strategy. The crowd screamed, “Yes, we can!” and “Yes, we will!” in which the activist called on Obama to begin to implement real changes to AIDS policy in the first 100 days of his administration. So, one may ask, “Why are AIDS activist excited about Obama’s plan for the domestic and international AIDS fight?”

According to Barack Obama’s commitment to the AIDS fight, he has developed a National AIDS Strategy and a Global AIDS Strategy. In addition, he supported legislation such as the Early Treatment for HIV Act (ETHA), Microbicide Development Act (one of the primary sponsors), Syringe exchange, Ryan White CARE Act, Employment Non-Discrimination Act (ENDA), Housing Opportunities for People with AIDS (HOPWA) and the repel of the HIV travel and immigration ban. He promotes and supports comprehensive sex education (co-sponsored the Prevention First Act), ending funding for abstinence-only-until-marriage prevention methods and for prison HIV prevention (expressed support for the Unprotected against Sexually Transmitted Infections among Confined and Expose (JUSTICE) Act currently in the House of Representatives). All of this support and action taken by Obama, along with his strategic plans, has many AIDS activists excited and hopeful regarding the future.

As an individual passionate about the HIV/AIDS epidemic nationally and worldwide, I am excited about Obama’s commitments to the ongoing fight. However, I question how much will be able to do regarding not only AIDS, but other critical issues in general. The reality is that as a country and under the Bush Administration, we are intertwined in several complex situations that must be addressed. Our creditability and reputation worldwide is poor, our economy affects that of the world, we are involved in two wars, etc. However, I will just have to see what Obama will and can do once he is officially inaugurated.

Human Immunodeficiency Virus or HIV has devastated the Black Community within the United States in which 64% of HIV infection cases among women and 49% infection cases among men are Black. There are numerous factors that created this situation within Black America poverty, inaccessibility to health care, unprotected heterosexual sex, men on the DL (down low), intravenous drug users, lack of resources from the federal government, competition for resources, stigma in the community, etc. According to a CNN report, if Blacks were their own country, HIV infection rates would emulate third world countries in Africa such as the Ivory Coast. How could a problem of this portion exist in one, if not, the wealthiest nations in world?

According to the Henry J. Kaiser Family Foundation’s Race, Ethnicity and Heath Care statistical data of 2005, the percent of African American men ages 18-29 in US prisons was 10.1% compared to 1.5% white and 3.6% Hispanic. In addition, they reported that HIV was the third leading cause among African Americans between the ages of 25-34. So these statistics causes one to question the link between incarnated Black males contribute to the HIV epidemic in Black America when these males come from prison.

The treatment for diagnosed HIV or AIDS infected inmates in prisons is horrendous. According to the Department of Health and Human Services and the National Institute of Human and Health Services, the recommended regimen for HIV infected person is a drug cocktail of three drugs known as HAART (Highly Active Antiretroviral Therapy). The preferred combination of the three drugs includes one PI (protease inhibitor) and two NNRTI (non-nucleotide reverse transcriptase inhibitor) as an initial treatment. In addition, the DHHS and NIHHS recommend that an HIV-specialist be present to monitor and advise the infected inmates in which the HAART require a specific manner and time to take the medications.

However, there are problems that inmates encounter. Many prisons have strict policies that an inmate must meet in order to receive treatment. Then, the prisons would delay the diagnostic process for months. When the inmate’s HIV status is known, many prisons state in their policies that the inmate has to take two of the three drugs for a period, before being allowed to take all three. The drug excluded is the PI, because it is the most expensive of the three. In addition, prisons do not distribute the drugs to the inmates at the correction times, because the PI must be taken at least two hours prior to a meal or else the absorption of the drug is decreased by 77%. Thus, the inmate must take the medicine with the meal, skip the meal or purchase food to eat later.

Since Blacks are disproportionately represented in prisons and have the highest cases of HIV infection than any other group, there is a clear link between HIV infection rates in the Black community and rate of incarcerated men and women. When the three drugs are not taken at the same time, HIV virus mutates and the inmates develops resistance. In addition, the HIV mutated virus creates a new strain of HIV and when the inmate leaves the prison, this resistant strain is then passed to the community. Many of the Black inmates come from the Black communities that live in poverty, so problems become further complicated and increased.

              A year ago, I came across this article by Robert E. Fullilove and Mindy Thompson Fullilove entitled HIV/AIDS in the African American Community: The Legacy of Urban Abandonment. Both of these scholars provided a different prospective on combating the HIV/AIDS epidemic in Black America. They argued that a disproportionate concentration of HIV/AIDS cases in many African American communities correlates to a collapsed social structure; therefore, the focus upon illicit drug use and high rates of unprotected sex all – the foundations of HIV/AIDS infection – are the “symptoms” of the loss of important social controls within the communities¹. Thus, the structural problems that have created the HIV/AIDS epidemic must be addressed first and take precedence over, but in conjugation to,  interventions tailored to individuals at risks (such as massive testing and treatment endeavors)¹.               

                So, one may ask, “What social controls were lost in the Black communities that contributed to the spread of HIV/AIDS?” Fullilove argued that it is imperative that one understands the historical, social, and political factors that had transform the once social cohesiveness of Black neighborhoods into an environment perfect for HIV/AIDS infection. What the article focused upon were the urban renewal projects in the 1950 – 1970s in which the long-term impact resulted in the deterioration of neighborhoods and social networks that ultimately affects one’s health¹. Following WWII with the passing of the Housing Act of 1949, cities were able to use their discretion to remove blighted areas for redevelopment, which most of the blighted areas identified as the inner city ghettos in which waves of Black immigrants from the South migrated to the North. Despite the poor quality of the homes and poverty, the neighborhoods were cohesive, thriving neighborhoods¹. According to Fullilove, from 1949 – 1973, the housing act of 1949 and its subsequent revisions funded about 2,553 urban renewal projects in which about 1,600 of the projects were predominately Black communities¹.               

                Prior to the urban renewal projects, the neighborhood was socially cohesive in which neighbors new one another and supervised each other’s children, which was the means of social control of one’s behavior. The urban renewal projects scattered neighborhoods and disrupted that social cohesiveness. In addition, deindustrialization increased the poverty as many Blacks were poor and jobless. The renewal projects increased segregation and racial isolation of Blacks from mainstream society; therefore, these communities commenced to experience high levels of crime, morbidity, and mortality from preventable illnesses in relations to the disrupted links to neighbors, work and society¹. Thus, these marginalized communities, suffering social disintegration and economic woes, created the perfect environment for HIV/AIDS spread. Many of the buildings that replaced the dislocated tenants have become empty and abandon, which become crack houses or shooting galleries for IV drug users and havens for prostitution or other illicit activities¹.  In addition, the War on Drugs created another place for HIV/AIDS spread: the prison system in which condoms are unavailable (banned) and many IV drug users or dealers incarcerated¹. The cycling of inmates in and out of prisons and their home communities contributes to HIV/AIDS infection spreading in poor communities.                 

                The reason for writing about this article is that it provided a different perspective on the HIV/AIDS crisis. The article is not suggesting that prevention, treatment and testing methods do not work. However, emphasis on this alone will not combat the epidemic, because the social forces that have fueled this epidemic are extremely powerful. Thus, there must be a primarily focus, along with individual behavior, upon the social, economic and political forces that resulted in the marginalization of Blacks into intense poverty and lack of societal cohesiveness, which in turn made them susceptible to HIV infection.

          Human Immunodeficiency virus (HIV), which causes Acquired Immunodeficiency (AIDS), has disproportionally devastated marginalized individuals within the United States. Many sources, such as the Centers for Disease Control and Prevention (CDC) and non-profit organizations, have documented a relationship between poverty and HIV/AIDS rates. Therefore, there has been increase interested in not only how the disease has affected working-class, poor racial and ethnic minorities, the HIV/AIDS virus has been and becoming an increasing problem among the homelessness, especially among youths and women.

          Persons infected with HIV/AIDS are increasing becoming homeless because of stigma attached to the disease such as sexually and behavior immorality (drug users, homosexuality, etc); therefore, they face discrimination in employment and housing. Because many have lost their jobs, they subsequently lose their homes and unable to afford the appropriate health care. In addition to them becoming homeless, governmental subsidies designed for persons with HIV/AIDS have faced increasing budget cuts; thus, the lack of funds not only make treatment difficult, but hampers the ability to find housing for them.

         However, homeless people are at a higher rate of being infected with HIV and dying of AIDS. The National Coalition for the Homeless states that people who are homeless have higher rates of chronic diseases than people who are housed, due in part to the effects of lifestyle factors (such as drug and alcohol use), exposure to extreme weather, nutritional deficiencies, and being victimized by violence ¹. Homeless youth and women are more likely to be sexually and physically abuse and exploited (many have to sell their bodies to make ends meet). In addition, the NCH documented that the HIV rate among the homeless is 3.4% - three times higher than the national average of 1% in 2003¹. However, because of the annual HIV infection rate of 40,000 per year and the decrease in federal funding, the national average has increased since then and so has the homeless population.

         Therefore, the lack of housing, decreased governmental factors, no health care (therefore, no treatment or lack of treatment) and the effects of poverty that increases HIV/AIDS rates demands critical attention and intervention for the homeless. As HIV/AIDS infected persons become homeless and join the present homeless population along with the cycle of poverty, HIV/AIDS spreads rapidly. Because the homeless suffer more with chronic diseases than their housed counterparts suffer and are less likely to receive treatment, homeless persons account for a larger portion of HIV/AIDS related deaths. Overall, the HIV/AIDS problem becomes more pervasive and more difficult to contain, thus, political advocacy for more resources and funding along with the networking of non-profit organizations becomes critical.  

1. National Coalition for the Homeless.“HIV/AIDS and Homeless’’. NCH.  http://www.nationalhomeless.org/publications/facts/HIV.pdf