How the West was lost
Lalchhuanzuali, an HIV positive woman from India, (with Ulysses Burley on her left) speaks while participating in a July 19, 2014, workshop at the Interfaith Pre-Conference on HIV, held on the eve of the International AIDS Conference in Melbourne, Australia. The event was sponsored by the Ecumenical Advocacy Alliance. Photo/Ecumenical Advocacy Alliance
Editor's note: Ulysses Burley III attended the 2014 International AIDS Conference July 20-25 in Melbourne, Australia, as an ELCA young delegate. An ELCA member, Ulysses, a doctor, is a clinical research associate at Northwestern University’s Feinberg School of Medicine in Chicago and a member of the Always Being Made New: The Campaign for the ELCA steering committee.
By Ulysses Burley
The 20th International AIDS Conference is the largest gathering of clinicians, scientists, activists, advocates, journalists, government officials and people living with HIV in the world to address the global pandemic of AIDS.
Historically, this event has been heavily attended by African nationals, with registration of African nationals sometimes accounting for half of the total participation at the conference, and rightfully so. Africa accounts for 25 million of the 35 million people living with HIV, equaling 71 percent of the epidemic worldwide. With 10 percent of the world’s population, 20 percent of the world’s overall health burden, but only 3 percent of the world’s healthcare providers, Africa is heavily burdened by malaria (the most deadly disease in Africa), tuberculosis, and HIV and AIDS with an inadequate supply of care to address this massive burden. As one result, Sub-Saharan Africa accounts for eight of the top 10 countries in the world with the largest number of people living with HIV.
India ranks third, which probably isn’t hard to believe considering AIDS is largely a disease of poverty, with 30 million of the 35 million people infected globally being of low- to middle-income countries, as are India and Africa. What you may, however, find hard to believe is that the United States ranks ninth in the world in the number of people living with HIV – the only high-income country to make the top 10. When we think about disparity of any kind within the global village, the narrative almost always lies in the gap between the “haves” of the global north and west and “have not's” of the global south. Thusly, it’s natural to never consider the United States in discussions associated to poverty, disease, civil unrest and any other social ills when compared to the rest of the world. Unfortunately, the HIV epidemic in the United States is not one we can afford to lose in the midst of the larger global pandemic, or, for that matter, in the midst of the largest gathering for HIV and AIDS in the world, the International AIDS Conference.
An estimated 1.3 million people are living with HIV and AIDS in the United States with approximately 50,000 new infections and 18,000 AIDS-related deaths annually, totaling 619,500 deaths since the beginning of the HIV and AIDS epidemic in the early 1980s. Injection drug users account for 8 percent of new cases of HIV infection and 16 percent of people living with HIV in the United States, but primary transmission remains to be through sexual intercourse, predominately among men who have sex with men at 63 percent of new infections and nearly half of all people living with HIV. Furthermore, HIV not only affects men who have sex with men at an alarmingly disproportionate rate, but new infections are overwhelmingly among blacks who make up 44 percent of all new infections and people living with HIV and AIDS, while only accounting for 13 percent of the total U.S. population.
Much has changed since the discovery of AIDS in five White, homosexual men in the summer of 1981. The face of HIV in America is now Black America. The Black AIDS Institute reports that if Black America were its own country, it would rank 16th in the world in HIV and AIDS cases, ahead of Ethiopia, Haiti and Botswana – a country that once had the highest prevalence of HIV on earth. This largely explains the United States’ position in the world as a leader in the number of people living with HIV. Four key factors contribute to the epidemic among Black Americans:
- High prevalence of HIV: Blacks are more likely to be exposed to the virus because of the existing heavy burden of HIV in the Black community where intra-racial partnering is the highest among ethnic groups. (Blacks are more likely to partner with other Blacks.)
- High prevalence of sexually transmitted infections: Blacks are more likely to be infected with other sexually transmitted diseases, which increases the susceptibility of HIV transmission.
- Stigma: There is an innate distrust of the healthcare system among Blacks (Tuskegee Experiment) limiting the interactions between Blacks and access to HIV prevention, testing, diagnosis and treatment. Homophobia is pervasive in the Black community where men who have sex with men account for 51 percent of new infections among Blacks and 73 percent of new infections in Black men, stigmatizing a key population from knowing their status and seeking treatment.
- Social determinants: High rates of poverty, lack of access to healthcare, racial discrimination, incarceration and illiteracy persist in Black America and drive a raging epidemic throughout the American African diaspora.
How then was the West lost? The United States has been a leader in funding the fight against HIV globally but has failed to take care of home first, before saving the rest of the world. One of the badges being distributed by activist groups at AIDS 2014 reads, “Save us from the savior,” in this case the United States. We are at a critical tipping point in the fight against HIV and AIDS worldwide, but whether the momentum tips backward or forward hinges upon our ability to leave no one behind as stated by the International AIDS Conference sub-theme. That also goes for the millions of people living with HIV and AIDS in the United States.
Words of wisdom from a flight attendant: “Secure your own oxygen mask first before assisting others.” Words to live, and die, by.