June 4, 2001
AIDS 20 YEARS LATER
New wave of infections hitting minorities hardest
Christopher Heredia, Sabin Russell from the SAN FRANCISCO CHRONICLE
Twenty years after HIV first appeared in America, the face of AIDS has changed, and it looks a lot like Tim'm West.
Through his teen years and early 20s, the smart and angry hip-hop artist living in Oakland kept his sexuality "on the down-low" - a term some African American gay men use to describe being in the closet.
That, the Duke University graduate said, contributed to a low self-esteem, then to unprotected sex.
"There's a rule in the African American community: We don't air our dirty laundry," said West, who is 28 and tested HIV-positive in 1999. "That ethic is killing our community."
Stories like West's are repeating themselves all over the United States, where the AIDS epidemic is moving steadily away from the affluent white gay population and burrowing itself into low-income minority communities.
According to the Centers for Disease Control and Prevention, half the newly infected men in the United States now are African Americans. In large cities, some of the highest infection rates ever recorded are occurring among young gay and bisexual black men. Each year, 15 out of every 100 people ages 23-29 are newly infected, and 32 percent are already HIV-positive. AIDS is the leading cause of death for African Americans ages 25 to 44.
To epidemiologists who have been tracking AIDS for 20 years, the latest trends are disturbing. Study after study is showing that the efforts to maintain safer sex practices are breaking down, particularly among white men. Last year, San Francisco became the first city to report a consequent increase in new cases of HIV infection.
Because new AIDS drugs are saving lives, there are more people in San Francisco living with AIDS who have the potential to transmit disease. Since 1995, the city has seen higher rates of sexually transmitted disease - often a precursor to more HIV infections.
"The same people who were sick five years ago are back at the gym. They are feeling better, and they are going back to the old habits they had when they were younger," said Alfredo Armendariz, coordinator of the Plus Program, which counsels newly infected gay men in San Francisco.
It's particularly challenging to reach the African American community.
Vincent Wright, 39, a gay black man who found he was HIV-positive in 1997, said African Americans must confront a triple dose of stigmatization: being black in America, being gay, and being gay in the African American community.
"The word 'gay' means 'white guy,' " he said. "For some, it would be easier to say I became HIV-positive because I was shooting up, or because I was with a prostitute."
West, whose aunt told him AIDS was his punishment for being gay, said that if African Americans are to deal with AIDS, they must deal with homophobia.
"Put out all the safe-sex messages you want," he challenged. HIV will continue to be a serious problem in the black community "until you can have a real conversation, and do away with shame."
When West finally got the HIV test, his T-cell count was so low (192 - an AIDS diagnosis) that he didn't have the option of postponing the drugs. He has to take medication twice a day, often with harsh side effects.
West has chosen to work as a counselor for the Sexual Minority Alliance of Alameda County and has started a rap group called Deep Dickollective, or the D/DC for short.
D/DC members - who consider themselves part of the "homo-hop" movement - travel around the country. Through poetry and hip hop, they spread a gay- positive message for African Americans: There's nothing wrong with brothers loving each other.
Duane Poe of the Black Coalition on AIDS in San Francisco said prejudicial attitudes in the African American community have hindered the prevention message.
"We've always had gay black people," Poe said. "It's nothing new. But when you put the disease together with being gay, it fueled a negative perception in the black community. . . . We have lost ground in that regard."
Monique (not her real name) is a 26-year-old, an African American mother of two. She tested HIV-positive in 1997 when she was pregnant with her eldest daughter. Both her daughters are HIV-negative.
She manages the disease with medications and counseling and is getting back on her feet, attending classes at Merritt College in Oakland.
"I was hearing about AIDS, and I had the attitude that it couldn't happen to me. I was young and invincible," said Monique, who believes she contracted the virus through unprotected sex with someone she met through a singles telephone line.
In the early years of the epidemic, few women were infected with HIV. But the numbers have grown steadily, and women now account for 1 in every 3 new infections in the United States. African American women have been hit especially hard, accounting for two-thirds of new AIDS cases among U.S. women.
Monique said her mother never talked with her about sex or how to protect herself from AIDS.
Now she tries to encourage other parents to talk with their children about AIDS. "If when this epidemic started, people kept it real, it wouldn't be like this."
At a recent Saturday morning workshop at the Sexual Minority Alliance of Alameda County, Monique joined a group of HIV-positive youth discussing the virus, among other life issues.
One spoke of a bad stomach ache she had from an adverse reaction to AIDS medications; another talked of her fear when she was alone in the hospital with pneumonia; another, about the importance of disclosing one's HIV-status to a sex partner; another, about the need for social activities for HIV- positive young people.
Later, at one of West's poetry readings in downtown Oakland, something hit home with Antoine Davis, a 17-year-old gay youth from Oakland. Davis is HIV- negative and plans to stay that way.
"I see in him a lot of strength," Davis said, standing outside the alliance's Sweeties Cafe after the reading. "He's trying to reach out to the youth, to say there's nothing to be afraid about."
Roosevelth Mosby Jr., executive director of the alliance, emphasized the need for blacks to craft their own response to the epidemic.
"When we begin to talk about our experiences," he said, "that's the way we're going to arrest this epidemic."