Mounting a Social Work Response to the Worsening HIV Epidemic in Black Communities

In 2005, the Centers for Disease Control and Prevention (CDC) reported that African Americans accounted for 51 percent (80,187) of people diagnosed with HIV/AIDS and African American men with HIV/AIDS represented 44 percent of all cases among men (CDC, 2005a). These statistics have been consistently bleak since the late 1990s, with African Americans bearing the greatest burden of new HIV cases in most regions of the United States (CDC, 2007). The plight for black communities overall is underscored by the recent Washington Post story (Vargas & Fears, 2009). These numbers tell a dire story of systems failed and lives lost here in the United States, not far off in a foreign or third world country. In a multisite study of 1,767 men having sex with men (MSM) from five cities (Baltimore, Los Angeles, New York, San Francisco, and Miami), 450 men tested positive for HIV. Although African American MSM (AAMSM) represented only 25 percent of the five-city sample, their seroprevalence rate was 46 percent of the sample. Sixty-seven percent of the AAMSM also reported that they were unaware of their HIV status prior to testing. In addition, several AAMSM in the larger study sample indicated that they had not been tested previously because they were afraid of learning their status or that others might discover their status (CDC, 2005b). Findings like these point to the gross overrepresentation of AAMSM in national HIV statistics. In fact, HIV directly or indirectly related to MSM is the single largest contributor to HIV infection among African Americans (CDC, 2002), accounting for an estimated 50 percent of all U.S. AIDS cases diagnosed among African American men and a substantial but unknown percentage of cases diagnosed among African American women in 2001 (CDC, 2002). HIV among AAMSM is on the rise. Using AIDS surveillance data for MSM, a 1994 back-calculation analysis found that HIV incidence among all birth cohorts of African American MSM rose through the early 1990s, whereas it decreased or remained steady among white MSM (Greenland & Lieb, 1996). Awareness among AAMSM of this risk, however, is low. Less than 10 percent of the HIV-infected young AAMSM surveyed nationally for the Young Men's HIV Surveillance Study reported knowledge of their HIV-positive status, and most (71 percent) of them reported they were at little or no risk of being infected (CDC, 2002). The situation among African American women is nearly as bleak, and some reports have suggested that the increase in HIV infections among these women is linked to undisclosed homosexual or bisexual activity of the African American men (Moreno, El-Bassel, & Morrill, 2007). NATIONAL PREVENTION RESPONSE The CDC has created a compilation of effective HIV interventions--Compendium of HIV Prevention Interventions with Evidence of Effectiveness. The compendium is a collection of summaries of the rigorously studied behavioral and social interventions that were conducted in the United States and that have positive results for relevant outcomes. These studies also have no negative findings, are state-of-the-science, and have positive results representing a statistically significant difference between the intervention and control groups (http://www.cdc.gov/hiv/topics/prev_ prog/rep/resources/initiatives/compendium.htm). Although the compendium contains valuable resources for interventions to prevent new HIV infections and for work with those at risk of transmitting HIV and those already infected, the presence of these "effective" interventions has not translated into outcomes that narrow the gap between black and other racial and ethnic groups. In fact, the compendium is remarkably limited in interventions for the most affected group of individuals--AAMSM. The efficacy of the few interventions that have been used with, tailored for, or designed to address HIV prevention with AAMSM is unclear (Beatty, Wheeler, & Gaiter, 2004; Myrick, 1999). …