Hard-hit black communities badly need resources and attention
By Nelson L. Adams, M.D.
and Mohammad N. Akhter, M.D., MPH
President Bush’s recent trip to Africa should help to underscore the U.S.’s commitment to spend billions of dollars to fight the HIV/AIDS epidemic which has already killed some 17 million men, women and children. The president’s five-year, $15 billion aid package for Africa is widely considered to be the most important and popular international program of his presidency.
During the recent State of the Union address, Bush called on Congress to double America’s commitment to combat AIDS in Africa and approve an additional $30 billion over the next five years. If the funds are approved, the president’s humanitarian initiative in Africa could stand out as the most significant accomplishment of his international legacy.
But we fear Bush is overlooking a growing public health crisis among African Americans here at home. The statistics are truly shocking and show the grossly disproportionate impact that HIV/AIDS has on the African-American community.
While African Americans represent about 13 percent of the U.S. population, they account for half of the more than one million people living with HIV in the nation. In 2005, the rate of HIV among black men was nearly seven times higher than that of white men. African-American women’s rate of infection was more than 20 times that of white women.
Needless to say, HIV/AIDS has by far the greatest impact on African Americans than any other group, and is among the leading causes of death.
To get a firsthand look at this deplorable situation, the president need only to travel outside the White House gates. Nowhere is the HIV crisis more widespread than in Washington, D.C. African Americans account for more than 80 percent of recent HIV/AIDS cases in a city where they make up only 57 percent of the population. One in 20 is infected with the virus, and one in 50 has AIDS.
Just as the president’s additional spending request will extend treatment to 2.5 million people and prevent 12 million new infections in Africa, similar progress is needed in this country. The president has a long way to go before his final term ends in January, but he can gain a significant head start by taking three basic steps:
? Develop a national plan. Despite the fact that this scourge is decimating minority communities in this country, the U.S. has no national plan to deal with the AIDS epidemic.
? Appoint a leader. Not only does the U.S. not have a plan, but no one is in charge. Once a leader is named, a broad coalition of community groups, churches, medical groups and others should work together.
? Focus on resources. Rudy Guiliani may not have had much success in his bid to become president, but his accomplishments in New York City were achieved partly by his belief in “focusing resources where the problems are.” While funds are diplomatically scattered around the country to fight HIV/AIDS in many little pockets across the U.S., the bulk of the money should instead be devoted to African-American communities with the highest rates of HIV/AIDS.
The president and Congress should take action now to get a handle on the problem before treatment costs increase to astronomical levels. A recent study estimated that direct and indirect costs of HIV/AIDS in this country are $36.4 billion, of which more than 80 percent is related to productivity losses. Given the rising costs of drugs and as more people in the prime of their lives will be unable to work, this price tag will only increase the longer we wait.
Nearly 26 years into the AIDS epidemic, federal government agencies have tried unsuccessfully to solve the problem. If the president acts immediately and decisively, he can forge a lasting legacy with African Americans.
Nelson L. Adams, M.D., is a practicing Ob-gyn in Miami, Florida and president of the National Medical Association. Mohammad Akhter, M.D., is executive director of the National Medical Association and former D.C. Public Health Commissioner.