Local officials say AIDS taking special toll on county’s African-Americans

As health organizers around the globe recognized World AIDS Day on December 1, health officials in Alameda County took the week to look closely at how the epidemic is affecting people here, 11 years after the county declared a state of emergency among its African-American community.

The virus first gained national attention in 1981, but the mandatory reporting of AIDS diagnoses began in 1983. Since then there have been almost 8,000 AIDS diagnoses in Alameda County, and since the county started tracking HIV in 2006, about 1,100 HIV diagnoses. The crisis has disproportionately affected African-Americans, and for more than a decade, African-Americans have accounted for about 20 percent of the county population, but about 40 percent of its HIV/AIDS diagnoses. Almost 70 percent of the county’s HIV/AIDS positive African-American women lived in Oakland when diagnosed.

HIV/AIDS is the leading cause of death among African-American women ages 25-34 nationally, and half of the people newly diagnosed are African-Americans, according to the Centers for Disease Control. “The African-American house is on fire,” said Kabir Hypolite, the executive director of the Alameda County Health Department Office of AIDS Administration. “Other houses are smoking, not engulfed in flames — but they are burning.”

Diagnoses are also up among the Asian and transgender communities, he said.

The Office of AIDS Administration receives and disperses federal, state and local funds for local HIV/AIDS services, and tracks the number of people in the county living with the disease, which determines in part how much the county receives in governmental aid. Most of the 10,000 people the county supports are low-income, Hypolite said.

In July, Governor Schwarzenegger and state legislators slashed $85 million dollars allocated for HIV/AIDS prevention and treatment services from the state budget, according to The California Department of Health Office of AIDS. Originally, those cuts were planned to extend to the state’s AIDS Drug Assistance Program, which provides underinsured and uninsured HIV/AIDS positive individuals with access to medication for HIV/AIDS, as well as other diseases. Hypolite said the threat to that critical program galvanized activists in defense of the program, which ultimately retained most of its funding.

“This is California,” Hypolite said. “We have been leading the fight for 28 years. We are the model around the world for compassion and health care. There was the sense, ‘This will never happen here.’”

Many African-Americans are diagnosed “late” (once HIV has already elevated to AIDS), but medications are keeping people alive longer, sometimes reducing the viral load to an undetectable level, Hypolite said. Worldwide, deaths have decreased by 17 percent over the past 10 years, according to UNAIDS. But one of the unintended consequences of the chronic care model is that young people, particularly those between ages 17 and 25, are not worried about the disease, Hypolite said.

“They see people living with it, taking pills, but what they don’t realize is that some people can’t tolerate the medications and there are drug-resistant strains,” Hypolite said. “This is what keeps researchers and providers awake at night.”

What some young people also don’t realize, Hypolite said, is that access to medication isn’t guaranteed and that if some of the aid programs lose funding, medication might become unaffordable for many patients.

The most affected teens are African-Americans, who make up two-thirds of new infections in their age group, according to the NAACP. The organization released an HIV/AIDS report in September focused on African-American women, with prisoners one concern: According to the report, the HIV infection rate among women offenders is about 15 times higher than the rate among women nationwide. African-American women are more than three times more likely than white women to be incarcerated.

The HIV rate for incarcerated men and women is almost three times greater that the general population rate, according to a report released by the U.S. Department of Justice Monday. Condoms in prisons and other correctional facilities are illegal in all but seven county jail and prison jurisdictions nationwide, according to the National Minority AIDS Council, increasing the chance of transmission both within the prison system and once an inmate is released.

“We have never come to grips with this part of the epidemic,” Hypolite said. “What are the first things on an formerly incarcerated man’s mind when he is released? Sex and housing.”

In October, the NAACP opened its 97^th annual conference with a symposium about HIV/AIDS. The audience, Hypolite said, was asking questions reminiscent of questions posed when the epidemic first broke in the 1980s, such as  “How can I tell from looking at a person whether he or she has HIV?” and “Can you get this from a toilet?”

“I was thinking, ‘Where have you all been?’” Hypolite said.

Increasing the public’s education about HIV/AIDS is one of the main intentions of World AIDS Day, founded on December 1, 1988 by the World Health Organization. WHO hopes to use the day to raise HIV/AIDS awareness and advocacy and refocus attention on the pandemic. The 2009 theme was “Universal Access and Human Rights.”

“Everyday is World AIDS Day for me,” said Roxanne Hanna-Ware, who is HIV-positive, as part of the 6^th annual National Coalition of 100 Black Women event “Sistahs Getting Real about HIV/AIDS.”

Hanna-Ware said one of the major difficulties is keeping focus on the disease in the face of public stigma and ignorance. Part of the problem strategically, Hypolite said, is that marketing campaigns have not been tailored to hit everyone. Due to limited resources, funds are often allocated to reach the group most in crisis, resulting in a lack of education in other demographics.

“The way our society has tried to grapple with this illness hasn’t worked,” Hypolite said. “In the early days, African-Americans thought it was a white gay man’s disease and there was judgment. Socially I would be here [in Oakland] and I’d tell them I worked with the AIDS community and African-Americans would ask me, ‘Aren’t you worried about getting it?’ We’ve come full circle.”

One local campaign that has seen some success is Get Screened Oakland, a program that offers HIV testing for free. The program is funded by the city but run by a national nonprofit; it launched locally in 2007, after it proved successful in Washington D.C. When people know their status, Hypolite said, they are significantly more likely to practice safe sex.

Another progressive local program happens in the emergency room at Highland Hospital, which is one of three Bay Area hospitals to offer testing for HIV/AIDS for patients sitting in the waiting room. The free tests reach people that otherwise would probably not get tested, said Abby Ginsberg, who made a short film documentary called “Get Screened Oakland.” The emergency room program is funded by the CDC.

“Highland Hospital has best practices,” Ginsberg said. She suggested the program be extended nationwide. “We are destroying our future if we are not aware of best practices programs.”

Ginsberg spoke at a November event sponsored by the White House and attended by representatives from the White House Office of National AIDS Policy Office. ONAP will reveal a national AIDS strategy in 2012, timed to coincide with the International AIDS Conference being held in Washington, and based in part on input from open forums in 14 cities and U.S. territories.

On October 30, the president extended the Ryan White Care Act, which provides medication and services to about 530,000 HIV-positive people in financial need nationwide, for 45 years. The funds are administered locally by the Alameda County Office of AIDS and provide care and treatment.

This summer, President Obama said that one American is infected with HIV every nine and a half minutes, making the epidemic a national problem. Hypolite echoed the President’s remarks. “If one house is on fire, all will burn across the community,” he said. “To think you’re in a house that isn’t burning is one of the most risky things out there today.”

Lead image: The women from Lily of the Valley Christian Center wear red ribbons in honor of HIV/AIDS.