PEOPLE OF COLOR CONFRONT HIV, HEALTH SYSTEM

In less than ten years the AIDS epidemic has highlighted many failings of health care and social programs in the U. S. These include gaps in education and earnings which guarantee lives of poverty and poor health for disproportionate numbers of Blacks, Latinos, Asians and Native Americans; the inconsistent and often nonexistent health care allotted to working-class peo- ple in general and women in particular; academic research geared to favor the needs of business at the expense of taxpayers and consumers; and an ongoing barrage of discriminatory legislation aimed against gay people, immigrants, and anyone suspected of being either.

These failings and the prospects for correcting them were among the issues addressed at the Third Annual National Black Gay and Lesbian Leadership Conference and Health Institute in Atlanta, February 16-19. AIDS TREATMENT NEWS attended the conference with a particular interest in discussions of HIV treatment access for HIV positive people of color.

The U. S. government and medical complex was neglectfully slow to respond to the AIDS crisis when the epidemic was considered, incorrectly of course, to be a threat mostly for white gay men and intravenous drug users. To compensate for the lack of concern and urgency, activists of all colors in the lesbian and gay community mobilized their political skill, called on the help of affluent friends of the community, and mounted a strong, compassionate response to AIDS both locally and nationally. Explicit information generated from a community perspective produced a sharp decline in the rate of HIV transmission, and campaigns urging early treatment intervention are now extending
health and survival.

The information from the AIDS service community, as well as from the mainstream media, has frequently been designed to target the white, gay male population. The epidemic is expanding rapidly outside of this arbitrary limit, and outside of its network of information and practical resources. People who acquired HIV through heterosexual contact, or contaminated needles or blood products, generally haven't benefitted from the organized community support which helped gays and their families endure the past decade.

A new awareness of these factors is evident in the growing network of organizations and information forums for minority HIV concerns. This network shares much overlap with the older AIDS establishment, particularly for gay and bisexual people of color. Important and unique issues for these communities have frequently been overlooked by the larger gay and minority organizations, but their multiple perspectives are critical to planning for the future.

The largest program offering HIV prevention information to gay and bisexual men of color is the National Task Force on AIDS Prevention, a project of the National Association of Black and White Men Together (NABWMT). This task force is based in San Francisco but operates HIV/safer sex workshops around the nation. Other examples of San Francisco's well-organized multicultural gay and lesbian communities include the Community HIV Project of the Gay Asian Pacific Alliance (GAPA), and workshops for men who have sex with men conducted by the American Indian AIDS Institute. (Supporting early HIV treatment and intervention, the San Francisco Department of Public Health recently awarded $115,000 to the Gay Men of Color Consortium, and $35,000 to the Mission Neighborhood Health Center.)

A particularly urgent situation is now facing African American and Hispanic communities, where longstanding deficits in community health are now compounded by the new crisis. Current assumptions regarding the epidemic's future could be deceptive unless planners factor into their projections the specific variables in given populations. Some examples:

* Public health information on HIV transmission and treatment often does not take account of differences in language and culture, or for lack of a community's access to printed media. If a community relies on television and radio for news, it will probably receive information that is missing large portions of reality, like the importance of condoms, realistic discussions of sex and drugs, and the optimism around early treatment for HIV.

* Access to quality healthcare in the U. S. is hit and miss to begin with, and low-income or underemployed people are essentially thrown scraps by Federal programs, and patchy supplements from particular states and cities. Scraps do not encourage regular check-ups and aggressive, preventive health care. If medical help is sought only when symptoms appear, treatment for many illnesses, including HIV infection, is more difficult.

* The health of someone using intravenous drugs is often compromised by poor nutrition and infrequent health exams. If HIV is factored into the situation, the prospects of monitoring one's health and obtaining early diagnosis or treatment are hindered from the outset.

* Some occupations which are filled predominantly by minorities, such as migrant farm work, may pose increased exposure to sources of opportunistic infections. Toxoplasmosis, valley fever and MAI are all caused by microbes commonly found in soil. Even aside from occupational exposure, Filipino, Native American and Black people are already at higher risk for Valley Fever, or Coccidioidomycosis (Bronnimann and Galgiani, 1989).

These situations help explain why Blacks represent 27.7% of all people diagnosed with AIDS, though only 11.5% of the U. S. population, and Latinos account for 15.6% of AIDS diagnoses, but only 6.4% of the general population. In addition, 75% of all children with AIDS and 71% of all women are Black or Latina. Behind these statistics hides a larger impending disaster, given the delay between the initial infection and the appearance of symptoms, and additional delays in antibody testing or early treatment intervention.

Information on HIV prevention may decrease new infections among people who know their antibody status, yet miss people who are already infected and have not been tested. While they remain asymptomatic, these people may not feel the need to observe safer sex or needle precautions, and can unwittingly transmit HIV to their partners and possibly to future children. Unfortunately, sexually transmitted diseases run highest in the age group least receptive to health cautions -- teenagers from 12 to 15 years of age. An HIV infection occurring in adolescence may not cause obvious symptoms until the mid-twenties, well into child-bearing years.

The future success of efforts to stop HIV transmission may depend heavily on parallel efforts to offer testing and treatment. And successful treatment for over a million Americans with HIV will absolutely require a more rational, equitable system of delivering health care.

An on-going source of news addressing the HIV concerns of minorities are the Multi-Cultural NOTES on AIDS Education and Service of the National AIDS Network (NAN). Specific back issues are available to anyone, although a regular subscription requires membership in NAN. For information, interested persons can call 202/293-2437.

NABWMT's National Task Force on AIDS Prevention can be reached at 415/255-8378.

References

Bronnimann, D A and Galgiani, J N. Coccicioidomycosis. European Journal of Clinical Microbiology and Infectious Diseases, volume 8, number 5, pages 466-473, May 1989.