World AIDS Day 2008

Image for article titled World AIDS Day 2008

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.

Obama has said he will "develop and begin to implement a comprehensive national HIV/AIDS strategy" with "measurable goals, timelines and accountability mechanisms." And he says he'll do it in the first year of his administration. He also pledges to tap a senior-level point person to coordinate agency actions from the White House. 


Sew up the safety net. All the planning in the world won't mean a thing without money to implement it. Two directly opposing trends have unfolded over the last eight years: The U.S. epidemic has grown larger than ever before, to more than a million people, while the overall federal AIDS budget has not grown at all. In some vital areas—like prevention—it has shrunk.

Obama's platform places AIDS treatment access in the broader context of his health-insurance reforms. But he has also stated his "strong support" for the program that doles out most of the feds' money for AIDS care. And he wants Medicaid expanded to allow poor people with HIV to get access to treatment before they get sick—currently, the program bizarrely withholds help until the disease has reached an advanced stage.


Tell the truth. Perhaps the most galling aspect of AIDS policy making is the ideologically driven fight over ways to prevent the virus' spread. 

A mound of research has proven that muzzling sex educators ensures only that young people will have sex with no information. Yet, we continue to allow a vocal minority to get in the way of comprehensive sex ed. A similarly large pile of research proves making clean needles accessible to injection drug users both stops HIV's spread and lures them into rehab. Yet, a ban on federal funding for syringe exchange programs remains in place.


Obama backs an end to the syringe exchange ban, an investment in sex ed for schools and reform of prison policies that keeps condoms out of inmates' hands. (Though, some AIDS advocates are already worried about contrary positions his rumored choice for drug czar has taken.)

The new administration will face competing grave priorities. The economy, the war, energy, health care—the past eight years have left all of these in tatters, and President-elect Obama has made many, many promises to the country about patching them up.


But black folks must grasp that our community's survival—literally—depends on an end to this plague. When federal health officials announced this summer that the U.S. epidemic is in far worse shape than anyone had understood, they also confirmed that black neighborhoods were in the worst trouble. Obama has promised to fix that, too, and now we have to speak up and make sure he follows through. 

Kai Wright is a regular contributor to The Root.