HIV Justice -- access to care is key

By SFAF Executive Director Mark Cloutier

Monday, November 28, 2005, San Francisco Chronicle

As we approach 2006, we mark a significant milestone in the AIDS epidemic: 25 years since the first case of AIDS was identified. That quarter century witnessed considerable achievements that we should build upon. Effective treatments exist that can extend life and improve its quality; these urgently need to be made accessible to all who might benefit in the United States and throughout the world. An established set of nondiscrimination and civil-rights protections have helped to preserve and protect the dignity of people with HIV nationally. Proven prevention efforts, including needle exchange, condom distribution and innovative risk reduction strategies continue to reduce new HIV infections here in the Bay Area.

Despite these advances, our success is uneven, and HIV continues to rage in various pockets of our country, causing premature death, isolation and hopelessness. In particular, the epidemic's impact on African Americans continues to be devastating. A recent study conducted in San Francisco, New York, Baltimore, Los Angeles and Miami by the Centers for Disease Control and Prevention found that 46 percent of African-American gay and bisexual men were infected with HIV. This rate was more than double that of any other racial group.

What does such an infection rate among this population say about our progress against HIV nearly 25 years into this fight? Public health officials and mainstream AIDS organizations have woefully neglected this growing tragedy. Even in San Francisco -- which takes pride in its compassionate system of HIV prevention and care -- African Americans fare worse: They are the least likely to know their HIV status, have the lowest rates of being on anti-HIV medications and have lower survival rates than any other racial group, according to the city's Department of Public Health.

Solutions must address the factors that lead to HIV infection. Racism, homophobia, lack of access to health care, poverty and HIV stigma all create an environment in which HIV exacts its deepest toll. In addition, there has been a failure to design and implement programs that are specifically tailored to address the needs of African-American men who have sex with men.

Government and civil society must demonstrate leadership in confronting this crisis. To that end, the San Francisco AIDS Foundation, in partnership with the San Francisco Department of Public Health, has recently expanded its Black Brothers Esteem program. This program fosters HIV prevention, health promotion and leadership-development skills that bolster self-esteem among African-American gay and bisexual men.

The AIDS Foundation is also actively supporting the development of a national organization for and by black gay and bisexual men that will demand a well-resourced, timely and culturally appropriate response from the federal government. African-American community-based health organizations, faith communities and educational institutions should continue to play a leading role, and we need to support their efforts. Programs will only be successful if they are based on the range of health, social and economic needs that African-American men identify for themselves. Our goal is to facilitate this awareness and thereby support increased HIV testing and active participation in primary medical care.

What have we learned after nearly 25 years of living with this disease? That science and medicine are only as effective as our commitment to ensuring access to health and human services for those who need them most. Fortunately, scientific progress will continue to assist us in extending and improving the lives of people living with HIV and preventing new infections. The harder work is guaranteeing access to that science for all who could benefit.

Mark Cloutier is executive director of the San Francisco AIDS Foundation and president of Pangaea Global AIDS Foundation. He is a bioethicist by training.