View this article by my mentor, Mr. Guy Weston. Very interesting.
Courtesy of: http://www.washingtoninformer.com/wi-web/index.php?option=com_content&view=article&id=1014:hiv-is-serious-but-not-critical-it-depends-on-who-you-ask&catid=57:oped&Itemid=154
HIV is serious, but not critical? It depends on who you ask.
Opinion / Editorial
By Guy Weston
Thursday, 16 April 2009 22:53
The District’s recent announcement that DC’s HIV/AIDS rate hit three percent evokes an array of reactions that speak to the complexity of this compelling public health issue. How serious is three percent? To the extent that three percent translates into life-altering impact on 15,120 District residents and their spouses or partners and some family members, I would say “quite serious” as an extended family member and surviving partner of loved ones who died from HIV/AIDS. As a public health professional that analyzes data on local public and private health care expenditures that exceed $100 million each year, I say HIV/AIDS is a “very serious” public policy issue. Considering the fact that the city’s report also tells us that the highest rates of HIV are among residents aged 40-49 and among African American male residents, both at seven percent, I might say “critically serious,” as I am a member of both groups.
While the HIV/AIDS Administration 2007 study on sexual behavior among “men who have sex with men” is pending publication, studies in other cities suggest the rate in this population may be as high as 46 percent for African American men. I have managed to remain HIV negative, having learned my lessons early joining the HIV/AIDS workforce and simultaneously becoming openly gay 23 years ago. Certainly, critical is in the eye of the beholder.
As my personal and professional vantage points may be shared by a significant number of DC residents, (public health professionals, African American men, gay men, and 40-49 year olds), HIV/AIDS is a critical issue for a significant proportion of our population. We should also remember that 3 percent is not unique. HIV/AIDS prevalence among adult residents of Baltimore is also three percent; Newark, New Jersey follows close behind at 2.7 percent, according to published HIV/AIDS statistics and census data.It is also critical to confront findings of the city’s report that frequently escape public discourse.
Heterosexual contact is emerging as the leading mode of HIV transmission in recent years, according to the report’s analysis. The total number of living HIV/AIDS cases among African American women (3902) is already larger than the number of cases identified as African American men who have sex with men (3606).
Moreover, the number of men who have sex with men cases is less than one-third of the total 11,539 living cases recorded among African Americans. Even if the number of cases in men who have sex with men is an undercount, as 976 male cases were reported without risks identified, it is clear that heterosexually transmitted HIV infection is a burgeoning phenomenon.This becomes a sticky subject in the world of HIV funding and politics, where discussions of the dynamics of HIV transmission frequently lead to stigma and blame. The fact that such findings affect resource allocation complicates the discussion further. This is not a new phenomenon. In 1987, the Journal of the National Medical Association published a special analysis of national AIDS data, indicating “nearly half of AIDS cases among Blacks” were heterosexual. At that point in time, cases attributed to heterosexual contact were concentrated in regions of endemic injecting drug use, such as parts of Baltimore and Newark, and injecting drug use was termed HIV’s primary “portal of entry into the heterosexual population.”
It comes as no surprise 20 years later, that heterosexual HIV transmission continues to be highly correlated with injecting and non-injecting substance abuse. That’s not to say that women don’t also become infected from sex with those so called “down low” brothers that sometimes dominate the conversation about women and HIV. On the other hand, we do not have data suggesting that one transmission mode (injecting drug use, sex with a man with a history of injecting drug use, or sex with a bisexual man) is the primary transmission mode to the exclusion of all others. HIV prevention messages that exclude potential transmission modes will not effectively protect our communities from HIV infection.
We do, in fact have a “modern, generalized, and critical” epidemic that affects a number of populations, albeit in different proportions. In addition to the health department’s promotion of early testing and condom availability, we, as affected communities, must deal with the message of statistics frankly, so that persons at risk can feel vulnerable enough to know that the testing and condom messages apply to them.
Guy Weston was Director of Data and Research at the HIV/AIDS Administration from 2001-2003. At present, he is a consultant to local health organizations focusing on Strategic Planning and Program Evaluation.
No comments:
Post a Comment