In keeping with all truly historically significant events, its impact recognizes no geographical boundaries, and on top of the huge loses of life and deep economic costs, AIDS has painted a wide spectrum of already marginalized groups with the stigma of being societal outcasts accompanied by the individual having to endure various cultural biases. In the United States, the problem has never presented the catastrophic effects witnessed in more impoverished locales, and Americans enjoy the benefit of a more immediate implementation of the latest technological advancements and medical breakthroughs.
A number of theories have developed around the phenomenon’s origin, ranging from the mildly plausible to the overtly outrageous, giving AIDS a dual identity as another urban legend and an all too real modern day version of pestilence more commonly associated with the Middle Ages. What is certain is that it was in place by the 1980s, and was accelerated in its spread globally by undiagnosed disease, lack of access to prevention information, unprotected sex, poverty, increased drug usage, (especially intravenously), and massive denial.
Things that make you go hum…………………..
“African Americans are more likely to be affected by Sexually Transmitted Infections (STIs) for many of the reasons that they are more likely to have HIV. STIs, particularly those that cause inflammed sores around the genitals, make HIV transmission more likely as they give the virus an easier passage into the bloodsream and can make immune system responses in the area less effective….some people of European descent have a small genetic mutation (known as CCR5 receptor mutation) that makes their immune T-cells partially or fully resistant to HIV infection …..as an entire racial group (ignoring other factors), whites are at a slightly lower risk of HIV infection than others.” – from AVERT international AIDS charity Website (http://www.avert.org/hiv-african-american.htm).
Aside from the sweeping generalizations used to pinpoint and denigrate particular groups (which conveniently have an established tradition of persecution) associated with the disease, there are some legitimate factors that may explain why certain individuals have a high susceptibility towards infection. The reasoning goes that due to a sustained period of exposure to small pox, which shares similar biological characteristics with the HIV-1 virus (attributed to the majority of transmitted infections), these people were able to build up a more resistant immunity.
“…smallpox was only eradicated in 1978, at the same time AIDS appeared. The survival advantage this genetic mutation provided against smallpox has thus been transferred to AIDS, the authors noted.” From “Smallpox in Europe Selected For Genetic Mutation That Confers Resistance to HIV Infection,” in the Nov. 23, 2003 issues of ScienceDaily.
Perhaps its most tragic victims are those who become exposed through no conscious choice of their own. Each year world-wide, hundreds of thousands of infants are born with HIV (Human Immunodeficiency Virus), which may then progress to AIDS rendering the child vulnerable to other infections, consequently continuing the viscous cycle begun with their parent(s) of illness, rapidly declining health, and left untreated, eventual death. Here in the United States, another population at great risk is the adult African American male population behind bars in an environment that promotes homosexual activity among those not normally so inclined, which in turn exacerbates a situation already accelerated by the surge of drug abuse and unprotected sex among heterosexuals.
Allegory and fable in the Inner City
Attempts to address this disease have been further complicated by its close association, (and sometimes confusion), with the illicit drug predilections that are a staple of large municipalities and provide a sympathetic environment in which both can flourish. Any discussion of AIDS as it affects the black community, by necessity must include a mention of the rise in popularity of Methylbenzoylecgonine, or smokable “freebase” cocaine better known as crack. The spread of AIDS and crack cocaine mirrored each other as they proliferated during the 1980s, so it is reasonable to see why the effects and/or symptoms of one might be confused with the other. Indeed, it might be argued that both are the result of a high risk hedonistic lifestyle, be it engaging in promiscuous sexual practices or compulsive recreational drug usage.
Both practices engaged in separately can encourage the likelihood of indulgence one with the other, both having potentially destructive behaviors. Cocaine abuse is not normally associated with intravenous drug usage (the method most liable to induce infection), but is apt to stimulate the sexual appetite and increase the possibility of contagion. In any event, both share a commonality in that the unfortunate often suffer from both afflictions, which in turn spawns a slew of urban mythologies and simultaneously generate social stigma and ostracism from their ls from the community.
Spreading and overlapping in the process, AIDS and crack supported similar urban legends, (including allegations that they both were perpetrated by government agencies to foster genocide via biological warfare), along with the fact that undeniable links existed between them (and that they flourished among those at the bottom of the economic food chain). All of this was intertwined with the always volatile racial component contributing to the hysteria already in place. While the 20th Century ended in the grip of two distinct but closely intersecting epidemics, it is important to realize that either condition can exist independent of the other.
Procreation complicates things. There are several transmission modes of HIV from mother to child; the passage of fluid through the placenta and umbilical cord, or contamination in the amniotic fluid of the womb itself during the pregnancy, exposure to contaminated blood during the actual birth, and viral material passed from the mother’s breast milk during nursing. (In some instances, a baby born to a woman with HIV may test positive for the anti-bodies, yet still not have the virus itself.)
Only a few short years ago, mother-to-child transmission meant that the child was born with a lifetime burden, a burden often carried over a very shorten lifespan. Currently however, partially because of relentless testing and research and the constant media exposure, there have been incredible improvements in the health management of both pre- and postnatal care for women with HIV.
In California, all pregnant women are required by state law to be offered HIV testing. Though the mother-to-be can refuse, most do not. In the event that a woman tests positive, the chances are one in four that the child will also have the virus. Given the various methods by which HIV is transmitted mother to child, these are still not great odds. (Transmission modes are; Nonetheless, should a child be born with HIV, early treatment with anti-retrovirals can greatly reduce the likelihood of developing AIDS. Current drug therapies administered prenatally or at birth have have been so successful that the chances of a woman with HIV also giving birth to an HIV infected baby have now come down to a one to two chances in a hundred. A tremendous improvement from the one in four of earlier years.
Though medical treatment is often the focus of children with HIV/AIDS, few take into consideration some of the social and psychological implications. First, it is not unusual for these children to be raised by a grandparent, usually the maternal grandmother. This occurs because either the mother and/or father of the child has died, is drug addicted or incapacitated in some other way and unable to take care for themselves, let alone a dependent baby. Secondly, these children grow up never having known a life without medication, monthly doctor visits, or the fear of some uninformed family member or friend rejecting them upon learning of their diagnosis. Then, as these children progress into adolescence, like other teenagers, they too have dreams of what society designates as a normal life, that is graduate from high school, attend college, secure a good paying job, get married and have children. How much of this dream can actually be realized is only now being discovered because many of the children born with HIV 15 to 20 years ago (near the beginning of successful anti-retroviral treatments and drug thearapies), are now coming into their adult years and finding obstacles to their visions of a normal life: Obstacles such as how to have children without infecting their prospective partners, how to make up for time lost during the elementary, middle and high school years because of repeated hospitalizations, how to tell friends and possible boy or girlfriends they could get a life-threatening disease from sexaul intercourse with them, how to live a life when you are not sure low long that life will be, and extremely important, how to have a life free of pills and doctors (a medication vacation), even for a few short months, and not worsen your condition as a consequence? How indeed?
“My name is Quintara. I’m 21 years old. I stay in Miami, Florida, and I was diagnosed with HIV prenatally, meaning that I was born with HIV.” – from the ‘Does HIV look like me?’ website (www.doeshivlooklikeme.com).
One ambassador of good will volunteered for a first person video on the web site doeshivlooklikeme.org to give a face to the plight of those born with the disease. Now a confident 21 year old clad in a beige sweater as she sits perched on a couch, Quintara Lane speaks at length about her prenatal infection and experiences stemming from it. As she entered grammar school, she endured 30 plus medications administered daily, precautions against dehydration, and most poignantly, the obstacles she encountered as she entered the teenage social scene. The Miami Florida native presents an eager smile beneath curly brown hair as she recounts the vicious gossip that motivated her to become a spokesperson and activist in educating the public. Among the organizations she works with are the University of Miami where she works as a youth counselor in the medical school, and Hope’s Voice, who initiated the internet awareness campaign Does HIV look like me? , aimed at targeting and empowering young people.
Dr. Joseph A. Church, head of the Division of Pediatric Allergy and Immunology at Children’s Hospital Los Angeles, emphasizes the sweeping advances in prenatal care, resulting in dramatic reduction rates of infection (less then five cases countywide annually). The key in this, as with all heath related matters, is advanced preparation. One of the most important steps to prevention is the embrace of a combination therapy involving a “cocktail” of two or more antiretroviral drugs which work by slowing down the replication of HIV in the body, which in turn inhibits the advance of full blown AIDS. Application of multiple drugs reduces the chance that immunity (or resistance, as mentioned) will occur.
Dr. Alice M. Stek, assistant professor of Clinical Obstetrics and Gynecology at USC, boasts a resume giving her a unique perspective on the medical community’s approach to AIDS treatment, and the public’s growing perception of this emotionally charged subject. She marvels at the progress made since she started at USC 16 years ago, when some 25% of all infants born to positive mothers were themselves HIV positive.
Having completed her medical degree at the University of Amsterdam in the Netherlands, she spoke at length to Our Weekly about the approach in Europe as opposed to the United States. Even back in 1985, the Dutch had a more sensible methodology in that they were less concerned with criminalizing deviant behavior. This meant better sex education and less homophobia, which translated to wider use of condoms. There the legal system focused on drug dealers as chief culprits instead of the users, which resulted in a more successful needle exchange system.
Before arriving in California, she spent her residency at the University of Cincinnati and credits the (comparatively) reduced stigma, progressive governmental health system, and the politicized gay community as primary reasons for the success realized locally. When an HIV positive woman enters the maternity ward, her management plan seeks to address the all important non-medical issues that tend to accompany AIDS related clientele, including financial assistance and support services. Social workers are involved early on to reinforce the merits of regular appointments and check-ups, consistent consumption of prescriptive medication, and the value of parental responsibility.
As a tribute to L.A. County’s overall achievement in the treatment and prevention of HIV infection, she points to 1996 as the last year in which the last case of mother to child HIV transmission was recorded.
The real world
While not diminishing the seriousness of AIDS as an issue here in America, health professionals have come a long way in increasing the possibilities of a healthy, successful childhood. Education has blunted the effects of myths and half truths, and raised the awareness of blood and body fluid precautions against HIV/AIDS in general, while emphasizing the benefits of treatment, nutrition and care.
While the specter of narcotics abuse plays a significant part on the organic component of HIV related child birth, it pales in comparison to the impact generated by the less well-defined factors of poverty, family dysfunction, domestic abuse, and class division. Racial concerns are not necessarily a given, since methamphetamine use (also said to be a sexual stimulant) in the gay community has been cited as a prime accelerant in its escalation within that group.
Sources used in the completion of this article include the following:
– www.avert.org, www.doeshivlooklikeme.org, www.genome.gov/.
– Clinical Infectious Diseases, a journal published by the University of Chicago Press.
– ScienceDaily, the online magazine and web portal devoted to science, technology, and medicine.
AIDS still impacting communities of color
As funding shrinks, HIV and AIDS cases continue to increase
By Shirley Hawkins
OW Staff Writer
The OASIS clinic located in Watts/Willowbrook is bustling with ringing phones, incoming and outgoing patients, and medical personnel flipping through patient charts as they stroll through the halls.
For many patients, battling HIV and AIDS, the services provided at OASIS are a lifeline that is keeping them alive. From 8:30 a.m. to 4:30 p.m., 50 to 80 patients flow through OASIS’ doors to receive their weekly or monthly checkups, refill antiretroviral medication, or talk to counselors who lend a sympathetic ear. The clinic treats approximately 1,550 patients a year.
In the midst of the activity is Dr. Wilbert Jordan, a pioneering AIDS crusader who originally founded the clinic in 1979 when it was a volunteer organization and struggled to keep its doors open. With the clinic now fully established, Dr. Jordan continues his efforts to educate and combat the disease in communities of color. Like many other physicians, Dr. Jordan has watched as HIV and AIDS has progressed from a gay, white male disease to a predominantly black and brown disease which has left many AIDS researchers and physicians searching for answers.
“Patients are living longer, but some may be infecting others because they don’t reveal their status,” said Dr. Jordan. “New cases of HIV and AIDS continue to rise among adolescents, women, the transgender population, and men who have sex with men.”
Like many service providers across the country, Dr. Jordan is aware that the number of clients contracting HIV and AIDS has been increasing but funding for the disease has remained level. “There’s a need for increased funding, but where do we turn?” said Dr. Jordan, who said that OASIS is funded by Ryan White Title I and III monies, earmarked for AIDS funding. “For the past two years, the county has gotten less Ryan White funding.”
As patients of color contracting HIV and AIDS virus continues to increase, Dr. Jordan is meeting the dilemma head-on by launching a national campaign to urge increased testing by his fellow physicians. “I have a grant to conduct outreach and my main focus is to try to reach out to the people who are not in care. I just mailed 2,700 letters to physicians in Los Angeles County who treat black patients and I am urging all physicians to test their patients twice a year from May 15 through June 19 and from November 1 through November 30 leading up to World AIDS Day.” Dr. Jordan said that so far the response has been phenomenal. “Many of the physicians have been supportive and I am very pleased.”
Dr. Jordan acknowledges that a stigma still lingers surrounding the issue of HIV and AIDS in the black community but concedes that it may still be a while before the black community will accept that the virus is taking a drastic toll on communities of color. “One way of fighting the disease is that we need to acknowledge the fact that HIV and AIDS exists,” said Dr. Jordan. “Education about the disease is a process of evolution. During the civil rights movement, all black people didn’t wake up and start marching down the street–it took a while. In fact, some black people never participated in the civil rights movement at all,” the physician pointed out.
Dr. Jordan said that one of the fastest rising groups contracting the HIV and AIDS are the African American youth. “Most of the time, mama finds out that the son is homosexual, so they get kicked out of the house and go to Hollywood and prostitute. I call it survival sex,” said Dr. Jordan. “As soon as we get more funding, I want to expand our services and open an adolescent clinic to offer testing on Saturdays.”
Derrick Martin, a charge nurse at OASIS who has worked at the facility for more than 10 years, said, “No one is exempt from the AIDS virus. We’re seeing a lot more younger people now as well as older people who are contracting the virus in their fifties and sixties. What’s occurring is that they are waiting until their children are grown before they start dating again. It’s only after these seniors contract the virus that they realize that their partner was infected.”
Martin said that when a resident is diagnosed, reactions to the news elicits myriad reactions. “Sometimes they break down and cry while others are quiet and just hold the news in,” said Martin. “We have two case managers available who sit down and talk to them. Sometimes they go into a crying jag. Most are immediately placed on antiretroviral medication.”
Dr. Jean Davis, who has been an associate professor of the Department of International Medicine at Charles Drew University since 1991, treats patients from the age of 18 to senior citizens. In the past decade, Dr. Davis has seen her mostly male clientele change to an almost even distribution of both men and women. “African American women are the fastest growing group contracting HIV and AIDS,” said Dr. Davis, who said she sees approximately 120 patients a month and blames the increase on misinformation disseminated to the community. “The problem with our community is that we did not receive the proper information about HIV and AIDS from the very beginning,” said Dr. Davis. “We were told that HIV and AIDS were diseases for gay, white men, so our community did not think that we were at risk. Then we were told that the disease was only among homosexual men.”
Dr. Davis said the information has led to a twofold problem. “We find that HIV can be passed through heterosexual transmission with men having sex with women and that women can also transfer it to men. That’s because black men who have sex with men do not see themselves as homosexual,” Dr. Davis pointed out. “And because their female partners do not see their male partners as homosexual, they do not think they are at risk.”
The physician recalls one patient, a 62-year-old woman who had not had sex in 10 years. “She took a blood test for a life insurance policy and found out that she was HIV positive,” said Dr. Davis. “She had had sex with a male 10 years ago who she didn’t know was carrying the AIDS virus.”
Dr. Davis pointed out that it is imperative for women to become proactive in relationships. “If a guy she is seeing says he does not want to use a condom, she should walk away,” she said. “And before a woman has sex with someone, she should have an STD screening.” Dr. Davis said that monogomous, mainstream African American women are becoming more at risk because they do not meet the criteria of the normal HIV or AIDS patient. “Our community thinks that if you are over 50 and you go to church, you can’t have HIV,” she maintained.
Dr. Davis said that more funding is needed to be funneled into prevention. “Most of the funding right now is to take care of patients with HIV,” she observed. “But everybody knows that if you distribute the money into prevention, common sense would say you are going to have less cases of HIV and AIDS.”
“It doesn’t matter if you’re unfaithful to a man or a woman–if you are indulging in risky sexual behavior, you are putting others at risk,” said Dr. Davis.