amfAR, The Foundation for AIDS Research

HIV in Black America—World AIDS Day Congressional Briefing Focuses on Black Women and Families

December 18, 2006—“People still die. Here in America, in my America,” said Danielle Warren-Diaz, a panelist at a World AIDS Day Congressional Briefing sponsored by AIDS Alliance for Children, Youth & Families, amfAR, and the Sexuality Information and Education Council of the United States.

“I buried a 10-year-old three months ago. A week ago, I went to bury one of my friends. In the America that I live in, we’re dying, we’re fighting for our lives.”

Warren-Diaz, an HIV-positive case manager who works with families affected by HIV/AIDS, was joined by actress Gloria Reuben, researcher Dr. Adaora Adimora of the University of North Carolina at Chapel Hill, and Candace Webb of AIDS Alliance for Children, Youth & Families for a frank discussion about what policy makers can do to protect black women and families from HIV/AIDS.

“We need to make it a priority to come up with a national AIDS plan that is responsive to everyone and doesn’t let women and children die in 2006 when they don’t have to,” said moderator Diana Bruce, of AIDS Alliance. “That’s just completely unacceptable in this country.”

Disturbing Disparities

African Americans make up 12 percent of the U.S. population, but represent nearly 50 percent of the estimated 1.2 million Americans living with HIV/AIDS, according to the U.S. Centers for Disease Control and Prevention. In 2001-2004, blacks represented 61 percent of people under 25 diagnosed with HIV/AIDS. Black women comprised 67 percent of new AIDS diagnoses among women in 2004, and the rate of AIDS diagnoses for African American women was approximately 23 times the rate for white women.

Gloria Reuben, who played an HIV-positive physician assistant on the medical drama E.R., implored political leaders to work with media and prominent entertainers to once again bring HIV prevention to the forefront of public discourse in the United States.

“The thing that disturbs me the most is to witness HIV become pandemic in the black community,” Reuben said. “AIDS is the number one killer of black women age 25-34. How could this be?”

Why are black women at such high risk for HIV? According to Dr. Adimora, who has done extensive research on heterosexual transmission of HIV among African Americans in the rural south, a high rate of sexually transmitted infections and a complex mix of socioeconomic factors set the stage for higher HIV rates.

Black men and women in a study group reported extensive economic depression and racial discrimination that restricted educational and employment opportunities. Women noted how incarceration, drug addiction, and violence had greatly reduced the number of available black men, profoundly affecting the partners women chose and the type of behavior they would tolerate from their men.

The rate of concurrent partnerships—sexual relationships that overlap over time and spread HIV and other sexually transmitted infections much more quickly than sequential partnerships—is much higher among African Americans than whites.

Incarceration, the ratio of available men to women, low marriage rates, and economic instability all contribute to high-risk sexual network patterns—such as concurrency—
possibly causing “bridging” from low-risk women to men from higher risk subgroups. Residential segregation also affects sexual networks, concentrating poverty, drug use, and other negative factors within the segregated group. Youth are more likely to be exposed to risk factors or to become sexually involved with someone in a high-risk group. A high rate of other sexually transmitted infections—which facilitate the spread of HIV—is also helping to fuel the HIV epidemic among black Americans, she said.

Why “Flat” Funding Hurts the Most in Need

Today, 69 percent of those infected with HIV are uninsured or on public assistance and rely on Ryan White funding programs for primary health care and support services. Title IV of the Ryan White CARE Act provides vital support services such as transportation, mental health services, and support groups to help remove some of the obstacles that keep people from accessing treatment.

Eighty-eight percent of Title IV clients are people of color. Title IV clinics have been instrumental in reducing mother-to-child HIV transmission in the U.S. from more than 2,000 HIV-positive infants born annually a decade ago to fewer than 200 in 2004.

Warren-Diaz works with families at the University of Connecticut Health Center in a program funded through Title IV. She knows firsthand how difficult it can be to make sure some people receive treatment.

“We have the medications that can bring down mother-to-child transmissions, but in a lot of these cases, it’s a big step to get these women to sit in front of a doctor to get that prescription,” Warren-Diaz explained. To illustrate her point, she read a letter from a woman whom she helped into recovery several years ago. The woman was an HIV-positive alcoholic and Warren-Diaz was concerned that her child would be born with the virus and fetal alcohol syndrome.

“She wasn’t going to her prenatal appointments, wasn’t seeing the infectious disease doctors because she couldn’t. Her life was out of control.”

With Warren-Diaz’s help, funded through Title IV, the child was born negative and the woman has been in recovery for six years.

But Title IV has received "flat" funding for several years now and the legislation to reauthorize Title IV recommends that the program continue to receive flat funding for the next three years. If this trend continues, we will see cuts in lifesaving programs, especially to front-line staff who bring and keep women and youth in care, said Bruce.
The current budget allocated $71.8 million for Title IV, while $113 million is the minimum needed to meet the growing needs of women and youth living with HIV, she said.

“We need that money,” Bruce said. “Level funding on top of all these rescissions mean that people like Danielle (Warren-Diaz) get laid off every day across the country. People who Danielle touches, these young people and these women, whose lives she turns around and whose lives she preserves, they will lose when title IV gets flat funded.”

Funding for Future Generations

Candace Webb lost her mother to AIDS six years ago. Strong, proud, and willing to sacrifice everything for her daughters, her mother told no one about her diagnosis. Webb was left trying to make sense of her death.

“I started educating myself, trying to find out what happened and why my family didn’t know and why my mother didn’t have the right support system in place,” Webb said. Originally planning a career in medicine, she took the advocacy route to try to “change the system” so her mother’s death would not be “in vain.”

“Had my mother had some of these support systems, I think she would be alive,” Webb said. “I want to make sure that programs like Title IV are funded and expanded, to reach women who are in isolation, to bring them into a network where they can have the support that they need to see HIV not as a death sentence, but to understand that there is life after diagnosis.”

Warren-Diaz has been living with HIV for 15 years. She became a mother several years ago when she agreed to raise three children whose mother had died of AIDS.

“I promised her that I would keep all of them healthy, but at the rate that HIV is growing in my community, I don’t know if I can keep my promise,” she said, her voice shaky with emotion. “I don’t like begging, but if that’s what it takes to preserve my family, then I ask that you go back to your bosses and make some noise. Tell them you’re saving American families.”