8 SF Public Press
June 22, 2010 // sfpublicpress.org
SCIENCE & HEALTH AIDS
HIV, AIDS Gap Widens Between Blacks and Other Ethnic Groups in East Bay Experts divided about the cause of health disparity
Living with HIV Loren Jones, an African American Oakland activist who has been living with HIV for 25 years, talks about what needs to happen in the fight against AIDS in an interview with Gianmaria Franchini.
New HIV cases, Alameda County 1994-2008
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s overall AIDS rates fall in Alameda County, the rate in the black community has hardly budged in the past 10 years, making African Americans in this part of the East Bay increasingly overrepresented among sufferers of the disease. Public health experts disagree about why this is happening — behavior, education, stigma and lack of advocacy are all suspected. Which of these factors is most important will determine the best way to tackle the problem, and how to parcel out increasingly scarce resources in an era of growing state and local budget deficit. To put the dilemma in perspective: African Americans make up 13.5 percent of Alameda County’s 1.5 million residents, yet they Story: account for half of all AIDS Danielle Brown cases reported there in 2008. // Public Press Photo: While the AIDS rate for AfMonica Jensen rican Americans in Alameda // Public Press County has been more or less unchanged since 1994, the ratio of the black AIDS rate to that of all county residents has risen 42 percent. Local officials and health experts have varying opinions as to why the gap between African Americans and other ethnic groups exists, and what to do about it. “There is no mystery now about HIV infection, because we know how to prevent every single mechanism of transmission,” said Dr. Arthur Ammann, president of Global Strategies for HIV Prevention, a nonprofit dedicated to fighting HIV and AIDS overseas. “So why do we have more infections in minority populations in the United States? The problem is that it’s a disease related to sexual behavior, and it’s hard to change behavior.” Ammann, who is also a clinical professor of pediatric immunology at the University of California San Francisco, is a pioneer in the field of HIV prevention. He has researched HIV prevention methods since the early 1980s, and was the first to discover two of the three ways HIV is transmitted. He believes that the solution to Alameda County's AIDS crisis resides beyond education. “Does education change behavior? Not under these circumstances,” he said. “I think we are at the point where we have to say, ‘No, we must find out how to protect the people who are getting infected.’” Conversely, some activists and public officials say AIDS education should be Alameda County’s highest priority for combating the high rate of AIDS among African Americans. Kabir Hypolite, director of the Alameda County Office of AIDS Administration, said education is needed
New AIDS cases, Alameda County 1994-2008
now more than ever, and he blames the high rate of AIDS among the county’s black residents on diminishing fear about the virus, blind trust in the success of anti-retroviral medications, and false impressions about who is at risk. “It is still common for people to think that it’s gay white men that are catching HIV and AIDS, but it’s actually everyone’s problem,” Hypolite said. “At this point, there is no such thing as a high-risk group in my mind.” Hypolite suggests that effective AIDS education in Alameda County begins with reaching out to groups that have not been mobilized, and working with community leaders who can relay the importance of AIDS education. In addressing the widening AIDS gap between African Americans and other racial and ethnic groups in Alameda County, activists and county officials are placing AIDS education on the back burner, claiming that stigma is the primary issue to tackle. Growing numbers of black residents are reluctant to get tested because HIV and AIDS are often associated with being homosexual or a substance abuser. As a result, late testing has become prevalent among Alameda County African Americans; many who seek HIV testing receive AIDS diagnoses. Stigmas linked to cultural values keep people underground and make it more difficult to identify individuals in need of care and services. “I know how it affects the people that we work with, but I worry about how it’s affecting the people who won’t come to us,” said Kevin Bynes, program director of AIDS Project East Bay, a nonprofit organization in Oakland that provides HIV and AIDS prevention and health services. “We have not moved beyond judging,” said Hypolite, “so people will hide their status, will not know it, or will avoid getting care because they are afraid of being ostracized or shunned in some way.” Activists and local officials seem to agree that lack of advocacy for black residents has compounded the ongoing AIDS crisis. Some argue that methods that raised awareness about HIV and AIDS prevention in the past, especially in San Francisco and its gay community, have not carried over across the Bay Bridge. They claim that demographics play a huge role in gaining public support. Ammann said blacks have been part of the AIDS epidemic since the 1980s; however, the virus affected white males with political connections to AIDS advocates as well. Loren Jones, an Oakland activist and African American woman who has been living with HIV for 25 years added, “In 1985, we were not getting information on
Darrel Thigpen (right), 32, was diagnosed with HIV in 2005. He's the assistant manager at a pet food store in Oakland.
this side of the Bay, because it was perceived that this disease was being spread through the gay, white male population, most specifically in San Francisco. That's the kind of illogical thought process that leads to this backlog of people who are getting this disease — obviously that was a false premise.” Jones, among other black AIDS activists in Alameda County, serves a vital role in raising awareness within the black community, and she rallies with her community in order to target county officials and make their issues visible. “We have this whole idea that HIV and AIDS doesn’t have a face — it does have a face, and it's black," Bynes said. "We have experienced no greater emergency as black people, and as a community, we need to get involved and do something." While Alameda County's public health dilemma persists, and experts remain divided about the cause of the problem, several advocates have presented possible solutions. Ammann and Hypolite encourage practical methods to control AIDS infection rates. One method is partner notification. Another is contact tracing, in which anyone who has been in sexual contact with an infected person is tested and treated. Both have been problematic in the past because of the stigma associated with HIV and AIDS, but studies have shown they are effective means of outreach and prevention. Public officials encourage Alameda County residents to remain persistent in lobbying for funding and policy changes in order to contain a public health dilemma whose end is long overdue.
Contact SFPP writer Danielle Brown at: dbrown@sfpublicpress.org The story continues: http://sfpr.es/aidsalamedacounty
On activism It’s part of my survival, because I am a low-income African American woman myself – I always have been. I was born to a welfare mother, and have had inand-out struggles with severe poverty. My activism comes naturally to me. I was diagnosed with HIV more than 25 years ago, in ’85 or ’86. I don’t directly link the disease to race as much as I do to lack of knowledge. To see that the situation has continued, and has not improved that much for black women, is a major concern. For me it has been a 25-year struggle, and to see that information has still not reached people in a way that is empowering for them, I think is very disturbing. My reason for being involved is that I really believe as individuals we can stop this. We can stop the madness. I don’t think the public is aware of the numbers. People are not aware of a whole age group of women that are already dead. The fact is that AIDS is the number one cause of death for African American women 24-35 nationwide. This is according to the CDC. Quite frankly, I think if it were white women, it would be on the news every day. Within any culture, these are a woman’s most productive years. These are not disposable people. To have them silently disappearing is not a good thing. America is a very proud country, and that is not something to be proud of. On the role of education and poverty When you are poor, you do what you need to do to survive. Unfortunately, and this is not just for black people, your worth as a sex object is marketable. I will say that I’m a fairly attractive woman. I’ve been homeless, and I’ve been on the street. I’ve had men tell me, ”If I was a woman and I had what you had I wouldn’t be homeless.” And everyone knows what that means. That’s very sad, but it’s the truth of the matter. That’s pretty much where it’s at for black women. If you need something, you have to give something up, and the preference is sex. Of course, there is never any conversation about using condoms and protection. On whether the black community has difficulty talking about AIDS openly I think that has been the case. But I think that this is a generation that ought to be able to break that. People talk about sex in the media and in every other kind of way, so there is no reasonable explanation for why we cannot talk about protecting yourself from this disease. On why African Americans suffer from AIDS disproportionately That is the case. I am not going to be one to deny these numbers, although
I do question them. I don’t know that we’re clear that these numbers reflect everyone that needs to be tested. The testing is pushed to target groups that are perceived as high risk. If you are a white woman who has not had many sexual partners, or who lives in a small town somewhere even in California, your white doctor is not going to suggest the possibility of an HIV test, because he doesn’t believe you are at risk. Whereas if you are a black woman and you look and dress a certain way, you will be perceived as high risk. On what the statistics indicate I think that they are irrelevant, because they give the perception that the virus is spread by race. AIDS is a disease that passes from person to person through unprotected sexual contact. This isn’t a situation where white people are just having sex with white people, and black people are having sex with black people. Even the questions on surveys and CDC reports, they do not ask the race of the people someone has had sex with. They ask if you are HIV positive, if you shared a needle, if you had unprotected heterosexual or homosexual sex and so forth. If I am a heterosexual black woman, the natural assumption is that the person I have had sex with is a black man. I have two daughters, their fathers are white. In ’85 we were not getting information on this side of the Bay, because it was perceived the disease was being spread through the gay, white male population, most specifically in San Francisco. That’s the kind of illogical, pseudo-scientific thought process that leads to this backlog of people who are getting this disease, according to ’statistics,’ they should not have the disease to begin with. Obviously, that was a false premise. Nobody was looking for it over here. On whether women have a strong voice or figures who give them a strong voice when it comes to this issue Yes, we definitely do. The organization that I work with, WORLD (Women Organized to Respond to Life-Threatening Diseases) was founded in 1991 by Rebecca Denison in her apartment. She was shocked to find out she had this disease, and also that there was no information about it that related to her as a woman. For a woman, particularly a young woman who has not yet had children, a sexually transmitted disease is devastating and very serious. Any woman would want answers and expect them to be there immediately, and at that time, there were no answers for her. Doctors were not even comfortable talking about it. Now things are different. On what needs to happen It has to stop. Our preference is a cure. Even if we don’t have a cure, the message is so simple: You have to use protection no matter who you have sex with or how you have it. The message here in Oakland is, “AIDS stops with me.” It’s very clear.
ASK AN ENVIRONMENTALIST QUESTION: I know airplanes burn enormous amounts of fuel. What’s the carbon footprint comparison between driving the 400 miles between San Francisco and Los Angeles and flying? — Jessica, the Marina This kind of carbon calculus is notoriously tricky, but very roughly speaking, flying to L.A. will spew about two and a half times more carbon into the atmosphere than driving there — about 435 kg of CO2 versus about 180 kg. Still, getting exact numbers would mean considering an almost endless web of progressively more maddening variables. For one thing, airplanes release their exhaust higher in the atmosphere rather than at road level, and climatologists believe this intensifies the effect of its greenhouse gass emissions two or threefold. Weight must also be taken into account: a Boeing 757 full of pregnant women will burn Advice Column: more fuel than one containing a single elderly woman. Jon Mooallem // Public Press On the other hand, how heavy is the car you’re driving? And Illustration: how fuel-efficient? Is it a belching old sedan? A Prius? OK, but is Justin Allen the Prius’ trunk filled with iron ore? And what about carpooling? // Public Press Do you have any LA-bound friends? Can you round up strangers and vagrants through Craigslist, or even pick up early-adopting hobos along the way through nifty new iPhone ridesharing apps like Avego? Bear in mind that the more people you pack in, the less carbon you emit per head, although added weight, as with airplanes, means you burn more fuel. But how many can you fit in a car? Two? Three? Seven? Go far enough into this thought experiment, and you wind up awed and chastened by the ecological unassailability of the clown car. Q: Can I compost my old clothing? — Lisa, Glen Park Clothing is not accepted by San Francisco’s citywide composting program. But a small number of scraps of 100 percent cotton clothing, provided they’re free of dyes and bleaches, should mix into your own backyard compost just fine. Also, coconut bikinis!
wind power, which is enough electricity to power all its stores in San Francisco, its corporate headquarters and then some. Of course, all the wind power production that Safeway underwrites merely gets fed from those various wind turbines into the electrical grid, where it congeals with electrons from every other conceivable energy source, and they all begin zipping around madly and indiscriminately, like the sperm in that Woody Allen movie, spurting out of walls everywhere whenever something switches on. Thus, the probability that your neighborhood Safeway is powered at all times, exclusively, by wind power is damn close to zero. Maybe some Safeway-funded wind power streams into a Safeway; maybe none of it does. Maybe, in some twisted, grocerial cosmic joke, it all ends up powering the Trader Joe’s on Masonic. Still, my contact at the EPA explains: “Safeway’s claim to be ‘running on wind power’ is a statement we support.”
Q: The Safeway near my house has a sign that reads, “This store is powered entirely by wind power.” What’s up with that? It’s got to be hooked up to the same electrical grid as the rest of the city, right? Do they have a bunch of people farting into it or something? — Ruben, Lower Haight Oh come on, Ruben. I can tell by your tone that you already know the answer: It’s not true. But it’s not exactly a lie either, and it’s not nearly as brazenly deceptive as some of the other green-washing we’re accustomed to seeing on a daily basis – and which you, Ruben, have apparently been using as a leather strop against which to sharpen your gleaming snark razor. Since 2005, the Safeway Corporation has been a part of an EPA program called Green Power Partnership, which requires businesses and organizations to purchase a certain amount of renewable energy. Actually, Safeway buys something called RECs – renewable energy certificates — which function like currency, corresponding to the price of generating a certain amount and type of clean energy and entitling the buyer to the bragging rights of having produced or used it. Right now, Safeway is buying the REC-equivalent of 90 million kilowatt hours of
Q: In the early '90s, the hole in the ozone layer and aerosol cans were all anyone talked about in terms of environmental issues. Now it’s hardly mentioned. Is it fixed? Is it still growing? — James, Glen Park Actually, it was the mid-’80s. But 43 countries came together in 1987 to limit the emissions of chlorofluorocarbons and other ozone-depleting chemicals, averting what might have otherwise been a disastrous situation by now, if not fixing it outright. The Montreal Protocol, as this agreement is known, is an inspiring precedent to keep in mind as we face more severe environmental threats. Clearly no progress would have been possible without such swift, multinational cooperation, and without the support of the general populace, which, as is now apparent, really rallied behind scientists’ anti-aerosol findings because they saw a chance to stop women from cementing their bangs into hideous waves and towers with hairspray. We can’t rest on our laurels though. This year scientists raised new alarms about another potent threat to the ozone layer not addressed by the Montreal Protocol: nitrous oxide gas. If the world can once again put our differences aside and band together, it will be miraculous. It will also be just the kind of clear global referendum on Phishheads and dentists so many of us have longed for.