Bay Area Reporter - June 15, 2001
David Fraser

Recently there has been some media attention on rising rates of HIV infection among men of color, particularly African Americans.

What is often obscured is the growing infection rate among African American women. Infection rates for black women over 50 are now similar to those for young women ages 14-23.

The Centers for Disease Control and Prevention has acknowledged that AIDS is now the number one killer among African American women, nationwide.

A recent CDC study also found surging HIV infection rates among men: 4.4 percent of gay and bisexual men ages 23-29 are newly infected. Among African Americans in that age group, the figure is 14.7 percent, or one in seven.

Half of newly infected men in the U.S. are African Americans, the CDC found.

Condom use?

Ironically, in a separate study locally, the Stop AIDS Project found that 100 percent condom use among MSM increased and leveled among blacks while decreasing among Latinos and whites between 1997 and 1999.

BCA's David Wallace said that some of the Stop AIDS Project's study "doesn't quite mesh" with anecdotal reports on condom use.

"If we did a heavy-duty study over the whole black [San Francisco] population, usage is probably not that high," said Wallace.

But this type of discussion among AIDS service organizations would be taboo in much of the black community. What are the key problems that thwart HIV prevention efforts?

The black community, according to BCA staff members, faces enormous hurdles to getting the prevention message out.

The photograph accompanying this article shows an innovative approach that crystallizes one of the major problems: how to talk about HIV/AIDS.

"There's a lot more homophobia in the black community," said Wallace. "If a guy is a MSM who also has sex with females, he's not going to tell a woman about that. It would be admitting he's in a high risk group. "They're on the 'down-low,' hiding in the shadows."

"Down-low" is the phrase used by some African American men when they talk of having sex with men. Often, they don't identify as gay.

Racism is another factor. If the infection rates among white women were comparable, Wallace said, "you can bet your ass it would get lots of exposure."

A number of BCA staffers, including Wallace, are white.

To the churches

Black churches, historically in the forefront of the civil rights struggle, often shut their eyes to the HIV epidemic, Wallace said.

In many areas of San Francisco, like Bayview-Hunters Point, it's very hard to be black and out. As Charles Odom, BCA's program coordinator, told the B.A.R. in a recent interview, another major problem is that "there's no black gay area like the Castro" where African American gays and lesbians can feel entirely at ease.

"There simply isn't a place to come to," Odom said.

Churches, which have long been support centers for the community in times of crisis, often reject homosexuality so vehemently that black gay people feel trapped.

So BCA is taking an indirect approach, looking beyond sexual orientation.

Its church-based campaign is called "In the Spirit of Health." The main poster shows a group of black women of varying ages, dressed in bright red choir robes, affectionate and happy.

Under the heading "Get Tested," the poster urges, "Get tested for HIV, as well as anything else your doctor suggests..."

The posters show photos of Congresswoman Barbara Lee of Oakland, newscaster Pam Moore of KRON-TV, and deejay Renel of KISS-FM, in order to provide support from local celebrities.

For some groups, said Wallace, especially the transgender community - perhaps the most at risk for infection - there are even more barriers to getting help. "They don't have the resources ... it takes time and effort for leaders to step up and own the issue, to put in front of people their group's needs. So historically, black churches are leaders in the community but they may refuse to deal with all these issues.

"Fortunately," Wallace added, "there are some that have stepped up. But most don't want to wave condoms from the pulpit."

In 1999, churches like Jones Methodist, New Liberation, and Third Baptist began to face the problems in the context of HIV ministry.

"They've been really cool," Wallace commented. "They've realized HIV is affecting the community to such an extent, that if they remained silent, it's more damaging than trying to promote their views on ways to stop the epidemic.

"They provide spiritual guidance to our clients who want it."

Prison infection

A common infection route for African American women - including older ones - is from their men who have been in prison and may have been infected there. Once they're out, the men are unlikely to talk about their risks, Wallace said.

"These women are still heavily involved in black churches," Wallace added.

"So to tackle the problem, we did some social marketing research. We found that positive imagery, like the five black women in the poster, choir members who just stepped out of church, got a good reaction.

"The overall message is general health needs, like checking for osteoporosis, glaucoma, or breast cancer. But the message in addition is the high risk for black women over 50. They may need to ask their doctor for an HIV test."

For more information about HIV testing or other services, contact the Black Coalition on AIDS at (800) 425-4647. The Web site is www.bcoa.org.
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