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Blacks Now Account for Half Of All New HIV Infections; Homosexuality Still
Taboo (cont. page 2)
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But others disagree. "Within the black community, it's always been taboo,
something to keep to yourself to be ashamed of," says Rahen MeNair, an outreach
worker with People of Color in Crisis Inc.,based in Brooklyn, N.Y.
That has been the case for a 24-year-old Brooklyn man, who is married but has
sex with men periodically. He says he realized he was attracted to men when he
was about 16 but kept his feelings to himself. " My grandfather was a minister,
so the church was definitely an influence, and was part of my decision eventually
to get married," he says. " It's preached in church that homosexuals
go to hell. So it's why I got married and had kids-it was something I didn't want
to deal with."
His wife, he says, has no inkling of his liaisons with men, even though he
is now employed as an outreach worker with an AIDS-prevention agency, trying to
help men like himself. He says he uses condoms when he has sex with men, to protect
himself and his wife from infection with HIV or other sexually transmitted diseases.
But he doesn't use condoms with his wife because that might make her suspicious.
"I feel like I have something to lose if my wife were to find out,"
he says. He asked that his name not be used.
Reaching such men with HIV prevention messages requires innovative strategies,
Mr. MeNair says. Since they generally don't go to gay clubs or other gay hangouts
for fear of being seen publicly, simply handing out fliers and condoms at such
venues won't work. "You have to approach them the right way, go where they
are," he says. His organization sends outreach workers to both public sex
areas, such as parks, and to private sex parties identified through informal networks.
Meanwhile, black churches are increasingly confronting the impact of AIDS on
their congregations. They are being aided by groups like the Balm in Gilead, a
New York-based nonprofit organization endorsed by multiple religious denominations
that trains and mobilizes black clergy to fight AIDS.
Whites continue to account for more than a quarter of new HIV infections each
year, suggesting that many continue to ignore prevention messages about the risks
of unprotected sex and exchanging dirty needles. But their proportional representation
in the epidemic has dwindled, from about half of new AIDS cases reported annually
a decade ago to roughly a third in 1999.
Carlos Velez, director of development for the National Minority AIDS Council
in Washington, D.C., argues that viewing statistics by race and ethnicity alone
can obscure the specific behavior that puts people at risk. According to data
through 1999, roughly 80% of AIDS cases in black males involved men who had sex
with men or used injection drugs, or both. That means prevention should be targeted
at these groups, he says. But, he argues, policy makers often find it easier to
gain support for "feel good" programs, such as those aimed at encouraging
abstinence in heterosexual teens.
There are other complications. Mistrust of the medical establishment endures
among poor, uneducated blacks, discouraging their enrollment in clinical drug
trials and fostering suspicion of education efforts. The suspicion is in part
a legacy of the infamous government-sponsored Tuskegee Syphilis study, in which
poor black men with the disease were left untreated even after the development
of penicillin. A survey by the Addiction Research and Treatment Corp., a nonprofit
group based in Brooklyn, found that eight of 10 people at high risk for infection
believed at least one HIV conspiracy theory - for example, that condoms sold in
black neighborhoods contain the virus. "Because of those belief systems,
many go on practicing behaviors that put them at risk, such as having unprotected
sex," says Beny Primm, executive director of the Brooklyn addiction center
and a prominent AIDS activist.
The best way to overcome mistrust, says Dr. Primm, is to train HIV-infected
people from similar backgrounds who have been tested and are undergoing treatment
so that they will talk to their peers,countering myths directly and setting an
example for changed behavior. His center sends HIV-positive counselors to high-risk
neighborhoods in a bus converted into a mobile testing clinic. "This way,"
he says,"the misinformation is refuted by people who are trusted by the community.
"So-called focused intervention programs can also help increase testing.
One such program in Los Angeles may serve as a blueprint for a broader effort.
It began when Wilbert Jordan, a physician who operates a clinic in the city's
Watts district, agreed on a whim to give a drug-addict patient a few dollars to
recruit friends for HIV screening. When the man brought in five people and all
of them tested positive for the virus, Dr. Jordan realized he was onto something.
He started asking more patients if they had friends or sexual partners at high
risk for HIV infection and what might get them to come in for testing. It turned
out that something as simple as a free movie pass often did the trick.
In a small 1999 study presented at the international AIDS conference last year
in South Africa, patients from Dr. Jordan's clinic brought in 192 people who agreed
to be tested for HIV. Nearly 90% had never been tested before, and 53% tested
positive and were offered medical treatment. By comparison, less than 2% of self-referred
patients at the clinic test positive. An added benefit is that those who test
positive can then turn to their peers for support. "I can talk to them, because
I'm living it," says Carla Bailey, a 45-year-old Los Angeles woman who is
HIV positive and serves as a peer counselor.
GlaxoSmithKline PLC, which markets several AIDS drugs, is spending $1 million
to test a program, based on Dr. Jordan's, at as many as 11 U.S. sites near large
black populations. The results, expected in about a year, will be used to create
educational materials that other community groups can use to seek public funding
for similar programs. "If we can duplicate his success, we'll know we have
a consistent initiative," says Valerie Scott, head of therapeutic area analysis
for GlaxoSmithKline.
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