A review of the National HIV/AIDS Strategy (NHAS)

Cleo Manago | 7/28/2010, 5 p.m.

On Tuesday, July 13, President Barack Obama presented the National HIV/AIDS Strategy (NHAS) for the United States.

According to his administration, the NHAS is a concise plan for moving the country forward in the fight against HIV and AIDS with three primary goals: Reducing the incidence of HIV; increasing access to care as well as optimizing health outcomes; and reducing HIV-related health disparities.

The NHAS is a good first start for America. What I appreciate about the strategy is its unprecedented existence. No other administration has created a White House Office of National HIV/AIDS Policy, or has had so many progressive people in its midst. (The NHAS is now available to the public: http://www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf).

Theoretically, this is a history-making initiative. However, upon close review, NHAS content features elements that are not necessarily signs of innovation or a framework shift, in terms of how HIV services may roll out or be resourced. It appears that the strong [White] gay identity bias (to be explained in more detail later) will continue to skew attempts at culturally diversifying how HIV services are framed, funded and prioritized.

Although diverse groups in America are impacted by HIV/AIDS, Blacks, by a large percentage, are more impacted than all other groups in the country. Yet, deciphering this could be a challenge as presented in this NHAS excerpt: "While anyone can become infected with HIV, some Americans are at greater risk than others. This includes gay and bisexual men of all races and ethnicities, Black men and women, Latinos and Latinas, people struggling with addiction, including injection drug users, and people in geographic hot spots, including the United States South and Northeast, as well as Puerto Rico and the U.S. Virgin Islands. By focusing our efforts in communities where HIV is concentrated, we can have the biggest impact in lowering all communities' collective risk of acquiring HIV."

This NHAS passage also abstracts the disproportionate depth of HIV in Black communities by bundling everyone as "Communities where HIV is concentrated." This passage muddles the fact that, by leaps and bounds, Black men, specifically, are the most HIV-impacted group in the United States.

Yet, what is not abstract is how much the NHSA affirms gay identity, despite the fact many homosexual and bisexual men of color don't identify with being gay. Over the last 30 years, this gay identity bias and barrier has been a contributing factor to reason why the diverse population of Black men at HIV sexual risk do not seek HIV services nor do they internalize the prevention messages.

While Obama's White House is committing resources and efforts to initiatives like HIV/AIDS and healthcare, the explicit context of race and culture continues to be overlooked.

The first HIV/AIDS services paradigm in America was designed by White gay men, and ultimately was very effective for that community. Despite the relative success of this community at saving itself from HIV/AIDS, a once frequently deadly disease, the disease has subsequently gotten Blacker and Blacker. To date, there are no published examples of similar HIV success among African Americans. Even after three decades.