Issues of race, poverty extend AIDS' toll on blacks everywhere

In 1981 the Centers for Disease Control (CDC) identified a new infectious disease, AIDS (acquired immune deficiency syndrome), which had appeared in a few dozen American men, mostly white, mostly gay. Within a scant few years, the number of deaths from the disease exploded from fewer than 100 to more than a quarter million, and the demographics were global -- no one was immune.

On July 6, 2004, the United Nations issued its latest report on the global AIDS epidemic. Dr. Peter Piot, the UNAIDS executive director, revealed grim statistics: more cases than ever, more than half of them in women, with outbreaks spreading through Asia and Eastern Europe. In the United States, the picture is equally bleak. After years of declining numbers of new cases, the disease is in resurgence, largely within the black community, in which more than 75 percent of new cases are found. Piot was unequivocal: "AIDS, without any doubt, is the largest epidemic in human history."


There are more than 38 million people infected worldwide. Last year 4.8 million became infected. Almost 3 million people a year are dying from AIDS. In the 21st century, the majority of the dying are black -- not just in Africa, where the disease is pandemic, but here in the U.S. In Washington, D.C., for example, the CDC estimates that one in 20 African-American men is infected with HIV -- a rate of infection comparable to areas of sub-Saharan Africa where AIDS has killed millions. AIDS is now the leading cause of death among African-American men and women between the ages of 15 and 44.

A series of new books chillingly details the escalating AIDS infection rate and subsequent death toll among blacks worldwide. Complicit in the spread of HIV / AIDS in America are, astoundingly, black church leaders, who have frequently linked AIDS to the "sin" of homosexuality and demonized those infected, and, less surprisingly, conservative politicians, who have taken a similarly moralistic tack toward the infectious disease.


The Invisible People: How the U.S. Has Slept Through the Global AIDS Pandemic, the Greatest Humanitarian Catastrophe of Our Time (Free Press, 400 pages, $25) tells the grim tale of how AIDS exploded better than any book on AIDS to date. Greg Behrman's eloquent history of the epidemic in the U.S. and Africa is compellingly written, thoroughly researched and peopled with dozens of characters important to the discovery of AIDS and the development of strategies to control it.

The book names names and lays blame. It is unstinting in its account of how epidemiologists worldwide brought news to the U.S. government of an epidemic rising in Africa and sneaking into the U.S. in the early 1980s and how the Reagan administration stood fast in its refusal to acknowledge that epidemic and its potential consequences. (Reagan never even spoke the word AIDS until 1985, when his friend Rock Hudson died of it.)

Reagan's refusal to address the impact of the disease in the U.S., where the infection rate rose cataclysmically within three years, or in the developing world, where the death rate has been devastating, was, as Behrman asserts with provocative detail, as much a factor in the spread of AIDS as unsafe sexual practices and drug use have been in the years since.

Many have mythologized Reagan since his recent death, but Behrman illumines Reagan's greatest failing as a president and world leader. Not only did Reagan ignore the epidemic, but his anti-gay rhetoric (and that of his administration) also presupposed that a coterie of gay men had brought the disease on themselves.

That position, which, Behrman explains, refuted scientific data about the concomitant heterosexual epidemic in Africa, actually fueled the epidemic worldwide by ignoring the possibility of heterosexual transmission. The subsequent AIDS policy of George Bush Sr. -- isolating the U.S. from that worldwide pandemic by making HIV status an immigration policy -- did nothing to address AIDS within U.S. borders.

The Clinton administration deemed AIDS the greatest terrorist threat to America, and the current administration has, like Clinton's, focused its attention on global AIDS, especially in Africa. But the Bush administration has reduced AIDS funding in the U.S., has refused to address the issue of price-gouging among pharmaceutical companies for life-saving AIDS drugs and has steadfastly focused on morality-based approaches rather than safer sex and safer drug-use education.

Jacob Levenson broadens the view of the U.S. epidemic, indicting politicians but also explaining how a legacy of racism and an American dream not quite realizable for African-Americans so soon after Jim Crow created an atmosphere in which AIDS would flourish in black communities. The Secret Epidemic: The Story of AIDS and Black America (Pantheon / Random House, 310 pages, $25) provides a fascinating history of how HIV / AIDS has spread -- particularly in the South ("the new frontier of AIDS in America") -- through poverty and a drug culture wildly out of control.

Like Behrman's marvelous book, Levenson's reads like a thriller, intricately weaving tales of individual characters (scientists, doctors, people with AIDS) with their environs. It exposes a range of political, scientific, religious and migratory changes that all led to where we are now: in the center of a epidemiological conflagration in which African-Americans are being consumed.


As Levenson asserts without equivocation, the combination of lack of jobs for certain socio-economic classes of African-Americans, combined with the ready availability of cheap and violently addictive crack cocaine, has created an atmosphere in which casual and unprotected sex predominates. Factor in the incidence of black men in and out of the penal system with its phenomenal HIV infection problem, and disease rates were bound to explode.

J.L. King's provocative and highly personal account of blacks and AIDS in America, On the Down Low: A Journey Into the Lives of "Straight" Black Men Who Sleep With Men (Broadway Books, 206 pages, $21.95), indicts black churches and the non-identified bisexual black men who move adeptly between the beds of their wives / girlfriends and those of other men with no thought of STDs or safer sex practices. King (caught in flagrante with his pastor by his wife) is open and honest about the dangerous prevalence of this sexual trend in black culture. According to King, it is the most likely reason for the incidence of HIV infection among black heterosexual women -- who now have the highest rate of new infections.

Written in a colloquial, accessible style, King's book explores the homophobia rife within the black community and churches and the impact it has had on the HIV / AIDS epidemic in black America. Ironically, it is in those same black churches where homosexuality is regularly decried (King includes biblical quotations preached there that name homosexuality outright -- quotations that cannot be found in the standard King James version of the Bible) where King and others living the "down low" double life he led find the majority of their sexual partners.

AIDS is fraught with legal complications, as well, as Debran Rowland delineates in the stellar The Boundaries of Her Body: A Shocking History of Women's Rights in America (Sourcebooks, 898 pages, $29.95). Rowland, a civil rights lawyer and an award-winning black journalist, elucidates the role race and gender have played in the prosecution of people with AIDS. She addresses King's concerns from a legal standpoint. Using case law and examples, Rowland examines how people with AIDS have become both victims and victimizers as laws have evolved over the epidemic and the fears it has engendered.

Despite the grim forecasts, AIDS is treatable, and diagnosis need not be a death sentence. Dark Remedy: The Impact of Thalidomide and Its Revival as a Vital Medicine (Perseus, 240 pages, $16) provides compelling data on new treatments by its scientist authors Rock Brynner (son of Yul) and Trent Stephens, while Timothy Critzer's valuable dissertation, HIV and Me: Information for Coping With HIV and AIDS (Firsthand Books, 224 pages, $16.95), provides detailed information on how to live a full life with HIV / AIDS.

As upbeat as these latter books are, however, the real story of AIDS lies in the continuing epidemic and the lack of attention by those in power to its racial and poverty components both here and abroad. Until those elements are addressed, by this president or the next, blacks will continue to perish, victims of a disease only education, compassion and funds for treatments can contain.


Victoria A. Brownworth has written extensively on HIV / AIDS for many national and international newspapers and magazines. Her reports on AIDS and the re-introduction of tuberculosis into the inner city in America appeared in The Philadelphia Inquirer, the Village Voice, SPIN, POZ and the Advocate. She has written about global AIDS for publications in the United Kingdom, Canada, Australia and Germany, as well as the United States. She teaches writing and film at the University of the Arts in Philadelphia.