By Chris Schreiber
March 2, 2000
Photo: Photodisc

Last month, federal health officials announced that African-American and Latino men now represent the majority of new AIDS cases in the gay community, culminating in a trend that experts began tracking about 10 years ago, but is now being called "the changing face of AIDS."

The national Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report found that among gay and bisexual men, white men accounted for 48 percent of new AIDS cases in 1998, down from nearly 70 percent in 1989, while men of color represent 52 percent of new cases, up from 31 percent in 1989.

The demographic shift of new AIDS cases to minority communities is not new, but it is troubling and revealing, said Richard Sowell, PhD, RN, professor and department chair for clinical and administrative nursing at the University of South Carolina and editor of the Journal of the Association of Nurses in AIDS Care.

"It wasn’t surprising that people of color were being infected at a higher rate. We’ve been seeing that in the South since the early 1990s," Sowell said. "But it concerns me that we call this the ‘changing face of AIDS’ when we still have a serious problem in all communities. Do we really need to be talking about the changing face or the expanding face?"

Social stigma

Whatever public health experts choose to call it, the risk of contracting HIV and AIDS is growing sharply in minority communities and could pose grave problems in urban centers, which are the site of 85 percent of HIV and AIDS cases. And according to CDC data, the problem is compounded by cultural and ethnic factors that further exacerbate the risk.

The CDC found that cultural attitudes about homosexuality, which can manifest themselves in self-identification, may complicate HIV education, prevention, and treatment programs. According to the CDC, 24 percent of African-American men who have sex with men and 15 percent of Latino men who have sex with men, identify themselves as heterosexual. Only 6 percent of white men in the same category identify themselves as heterosexual.

What this means, said Kathryn Bina, an HIV specialist for the CDC, is that "Latino and African-American gay men may not feel comfortable accessing HIV prevention services in their area because they don’t feel as safe and as comfortable in their community as they need to. And if you’re not getting access to treatment [for HIV], you are more likely to get AIDS."

The CDC approved $7 million in funding in October to target minority communities, continuing a trend of the last five years. However, "in the early 1990s prevention dollars were placed in the [broader] gay community," said Harold Rasmussen, chief of the education and prevention services branch of the California Department of Health Services. Rasmussen said gay minorities were "a group that admittedly slipped through the cracks for HIV prevention."

Programs customarily have been designed to target groups based on risk behavior—such as intravenous drug use or gay lifestyles—"rather than on ethnic situations," Rasmussen said. Some activists in the minority HIV/AIDS community have said the behavioral approach has been a failure because targeting gays in the African-American community, for example, is almost impossible to do effectively.

"To make inroads in a community that doesn’t self-identify is very hard," Sowell said. "It makes it twice as hard to try to reach people because there is no self-identified community. If you were going to reach women at risk, you would know where to start looking, but where do you go to find the gay black community in rural South Carolina?"

The stigma of being gay and being a minority can be so overwhelming that gay minorities ignore available resources, said Jamal Bey, a manager in the Black Brothers Esteem program for the San Francisco AIDS Foundation. "Homophobia and AIDS phobia need to be addressed; the stigma of who gets [HIV/AIDS] needs to be addressed. Not only does the African-American community need to respond to this, but all communities need to respond. This is a trend that impacts all people," he said.

Complacent behavior

Increasing complacency about the disease is also taking a toll on infection rates, according to a joint study done by the CDC and UCSF. In a survey of people deemed at greater risk for HIV infection—including gay men at bars, intravenous drug users surveyed on the street, and heterosexuals at sex clinics—better treatment for HIV has made almost one-third of the respondents less concerned about contracting HIV.

This complacency poses even more problems for minorities, who generally have less access to insurance and medical treatment than whites, according to a study by the Henry J. Kaiser Family Foundation. "All the other barriers that people of color face are compounded when they try to access medical services," said Jennifer Kates, senior program officer and HIV specialist for the foundation.

But most experts caution against tailoring programs too specifically for minorities because such programs can "pit one group against another," Sowell said.

Appropriate response is a delicate balance between programs that illustrate the cross-cultural and pervasiveness of the disease without losing sight of the target audience, according to Sowell. Bey said the epidemic requires a united front, and Kay McVay, RN, president of the California Nurses Association, said people "need to recognize this isn’t just a gay issue."

If the trend continues to implicate minorities, Sowell said, too many people will forget that "the only risk factor [for HIV/AIDS] is being human."