World AIDS Day 2008

Can Obama help black America survive this plague?


Here's a thought experiment: What if black America was its own country? We'd be relatively big, with a population roughly the size of the northeastern United States. We'd have an up-and-coming economy, in league with countries like South Africa and Argentina. And we'd be one of the least healthy places on Earth.  

Black folks have made remarkable strides since the civil rights movement's apex. We're equal under the law, building a middle class and running corporations—not to mention a superpower nation. But we've made little to no progress on the most important measure: staying alive. From infant mortality to diabetes, an independent black America would look more like the world's poorest nations than the rich one it's actually part of.

Nowhere is that ugly fact more evident than in AIDS. As my Black AIDS Institute colleagues pointed out in a report this summer, a free-standing black America would have a larger epidemic than about half the countries that get billions of dollars in special assistance from the U.S. to fight HIV. Physician, heal thyself as well. 

That's exactly what Barack Obama says he's gonna do. It's one not-so-symbolic reason to celebrate the Obama revolution: His clear, emphatic vow to finally bring the domestic HIV epidemic under control. That's an important point to remember as we mark yet another World AIDS Day today. More than a quarter century into this epidemic, the annual outpouring of empathetic rhetoric that clamors up every Dec. 1 stands to actually have some meaning—if we hold our man Barack to his word.

It's significant that Obama has been out front on AIDS in a deeply personal way. He and Michelle took public HIV tests during a trip to Kenya two years ago. 

Their willingness to model a healthy sexual relationship by getting tested together offered leadership on an intransigent problem. Health officials everywhere have struggled to get more people to voluntarily learn their HIV status. As much as a third of people living with HIV in the U.S. don't know they've got it—which both fuels the virus' spread and ensures people don't get into treatment until they're sick, when it's most expensive and least likely to work. 

Obama also understands AIDS is another symptom of the larger malady that allows a host of deadly, preventable illnesses to ravage black neighborhoods. "When we are impoverished," he said in an early primary debate, "when people don't have jobs, they are more likely to be afflicted not just with AIDS, but with substance abuse problems, with guns in the streets. So it's important for us too look at the whole body here."

But complex, big-picture analysis too often becomes an excuse for inaction in the face of tough problems. On AIDS in particular, Washington has spent three decades vacillating between sitting paralyzed and lurching for quick fixes. Obama's AIDS platform, released early in the campaign, is refreshing for its willingness to see both the big picture and the devilish details. 

So what did he vow to do? Here are the three most crucial actions the president-elect has pledged—all of which are nonnegotiable if he truly intends to bring HIV to heel. 

Get a plan. It's a shockingly simple step that the U.S. has never taken. We insist that any nation seeking our help in its AIDS work first develop a strategy for how it will spend the money. But America has never had anything resembling an overarching strategy on how to deal with AIDS. No wonder we continue to log an estimated 56,000 new infections every year—half of them among blacks. (Yes, half.) No surprise, then, that clinics serving black and Latino neighborhoods—particularly in the South—are struggling to keep the doors open.