Sunday, August 03, 2008

Black U.S. AIDS rates rival some African nations... and Bishops fiddle

...according to this story. (The bit about the Bishops is my own "journalistic" interpretation...)

Do you know why this is? It has to do with high poverty rates (which tend to limit access to medical care) and the inferior education that tends to go along with poverty. It has to do with ignorance and prejudice.

Mostly it has to do with stigma and discrimination.

People die from stigma. People won't even get tested for HIV because they are afraid that merely taking the test indicates something negative about the person taking it.

Seriously.

I once heard a prominent African American local government official in my hometown say he gave blood twice a year to get tested--that way no one would think he'd been doing anything "nasty" (i.e., having sex with men or shooting up).

I nearly throttled him for using the blood donation system as a means of HIV testing. Blood screening is excellent these days, so I don't want to be alarmist--but there are reasons that blood donation guidelines ask people not to donate if they have been engaging in risky sexual or drug-taking behaviors. I have no idea if the person in question was gay or a drug-user---but he willingly put other people at risk, so that no one would think he might be.

Yesterday, the U.S. Centers for Disease Control and Prevention released new HIV surveillance data for the United States. This data is based on better testing procedures and an improved reporting system.

Since the mid-1990s, the CDC has estimated that there are 40,000 Americans who are newly infected with HIV each year. These new numbers indicate a 40 percent increase over that number--the new estimates are over 56,000 new cases each year.

The "spin" is that the numbers aren't necessarily higher---the data is just better. In other words, we've been undercounting because our data hasn't been all that accurate.

That's a fine explanation if you are a statistician---or a politician who doesn't want to spend any more money combating HIV/AIDS in the domestic sphere. (In my experience, Black people in Africa are seen as more "deserving" of prevention and treatment dollars than Black people here in the United States... but I digress.)

Anecdotal evidence may be worth the peer-reviewed journal it was printed in...but I've heard enough stories from people on the ground to be less sanguine about a more benign interpretation of that increase.

Yesterday, as I flew to Mexico City for the International AIDS Conference, I sat next to a physician from Philadelphia. He told me that he's been treating a rising number of young men who have sex with men (MSM) who are HIV-positive. He was frustrated by the fact that most of them know how HIV is spread---yet they engage in risky behaviors and lose their game of Russian roulette.

The numbers are particularly bad among Black MSM. I've been expecting bad news on this front since a 2005 study of five large U.S. cities found that 46% of African American MSM in the sample were HIV-positive.

Read that and weep, people. AIDS is the leading cause of death for African American women aged 25-34 (i.e., women in their prime, child-bearing years) and nearly 1/2 of Black MSM are estimated to be HIV-positive.

If you are not outraged by those numbers, well...I simply don't know what to say to you. You should stop right now and check to see whether you have a pulse yourself...or a heart.

People get HIV/AIDS not because they are stupid---but because they are human. Because the need to be loved--or simply to connect physically with another human being--can be overwhelming. Because they think "It won't happen to me," or they tell themselves that "They have drugs for that now. It's not a death sentence anymore--so if I get it, it won't be great, but it won't kill me either."

If you are one of the millions of Americans who struggles with your weight, you will recognize the inner voice that tempts you to do things you know in your heart are not healthy for you. Taking sexual risks is really no different than taking the risk of eating too much of the wrong kind of food---they are both rooted in human behaviors that are both deeply meaningful in and of themselves and necessary for the survival of the species. Sex and food are the basic foundations for human life--which is why this struggle is, in some ways, a Sisyphean one.

Until and unless researchers develop a vaccine for HIV, we will only combat the spread of the epidemic by recognizing this fact and developing a way to deal with it--a way that does not stigmatize or demonize those who are, ultimately, only being human.

Unfortunately, this has been a week of humans behaving badly in public (i.e., the soap opera called the Anglican Communion and the Lambeth Conference).

Because, you see--along with stigma and discrimination--archaic views of sexuality are what drive the HIV/AIDS epidemic. Powerlessness and shame kill people---and all over the world, issues of sex keep people (particularly women and LBGTs) powerless and shamed.

By and large, religion is the source of that shame. As long as the Church continues to pair sex and shame, people will suffer from, and die of, AIDS.

I say without hesitation---the Church could do a great deal to stop the spread of HIV/AIDS simply by being honest about the role that sex plays in human life and compassionate about the way that individuals act on their sexual desires. People have always had sex outside of marriage and outside the rigid norms set by their local cultures. To admit this, and try to find a holy way of dealing with it, is not to say "Anything goes!" It is to say that the need for both passion and human touch are well nigh universal, and simply saying "Wait until you get married!" gets us nowhere (particularly not for those who cannot get married under law).

(For an excellent start on dealing with this issue theologically, I commend to you Fr. Tobias Haller's series The Sex Articles: A Series of Reflections on Where We Stand.)

There have been churches that have done this, of course---but they have mostly been voices crying in the wilderness for the better part of the last 30 years. Without developing a Christian ethic of sexuality that is rooted in self-respect and mutuality, we won't change the underlying dynamics that allow HIV to spread and to continue its devastating march through our most vulnerable communities.

There is no end in sight---either to the shaming or the suffering and death. Bishops at the Lambeth conference keep issuing "fatwas" about gay and lesbian people. As my friend Jim Naughton noted, "GLBT people are discussed exclusively as a problem and a challenge, never as a gift."

And two weeks ago, the National Institutes of Health (NIH) pulled the plug on the latest HIV vaccine trials. In essence, Anthony Fauci, director of the NIH's National Institute of Allergy and Infectious Diseases (NIAID), said that it was time for everyone to go back to the drawing board--and the lab bench. We haven't learned enough about the virus to make large-scale human trials worth the effort or the risks.

Last night, I walked through the lobby of my hotel in Mexico City, and I could easily pick out some of those who are living with HIV/AIDS. They are mostly men---prematurely aged, frail, and with large bellies...a common side effect of the antiretrovirals that keep them alive. They are here to lobby for better treatments and more humane policies toward those who face the challenge of living with HIV/AIDS. They are here looking for good news and hope.

I wish I could give it to them. To them, and to the 56,300 Americans who will follow them in the next year. (And to the untold millions, worldwide....)

But no. Our leaders--both spiritual and temporal--are too busy doing other things. Pronouncing doctrine. Protecting budgets.

Turning their heads so that they don't have to see what they do in the name of God and country.