IAPAC Monthly - Vol. 8, No. 2, January 2002
José M. Zuniga

According to public opinion polls, the United States remains plagued by questions of domestic security, national economy, and personal solvency. Yet, although it would seem that there is little room on our collective agenda for competing public priorities, we must find room to take notice of those in our midst who continue to suffer lingering injustices. Accordingly, ours is a responsibility of recognizing the importance of Black History Month (commemorated each February), and seeking to redress the host of issues which perpetuate what is the United States' longest-standing and most embarrassing injustice: racial and ethnic disparity.

As a citizen of the United States, I find permanent discomfort in the stark reality that in this robust country of ours, public health continues to be largely determined along racial lines. Perhaps nowhere is this reality more evident than with regard to incidence, morbidity, and mortality associated with HIV disease. Therefore, as we pay homage to the struggles past and present of African Americans, we must also highlight the devastation being visited upon African-American men, women, and children by HIV/AIDS.

The US Centers for Disease Control and Prevention (CDC) tells us that the rates of new HIV infections and AIDS-related deaths in the United States appear to be slowing. However, there remain startling differences among incidence rates when examined by racial category. Foremost among these discrepancies is the fact that more than half of all infections last year were within the African-American community. Equally alarming is that when race and gender are examined in combination, we see that of these new cases, 64 percent were in African-American women.

In partial response to the AIDS crisis within the African-American community, February 7 of each calendar year has been designated National Black HIV/AIDS Awareness Day. Yet, while this day provides the type of high visibility that this struggle desperately requires, we must guard against the temptation to view these events (eg, World AIDS Day) as a panacea. HIV/AIDS within the African-American community is not a problem that clever public health messages alone will reverse. The battle against HIV/AIDS in the African-American community is an undertaking requiring long-term commitment and comprehensive strategies, as well as a broad-based vanguard of advocates addressing a host of social, political, and economic factors feeding the epidemic.

On this last note, it is important for us to consider that the United States is currently experiencing an anomaly of sorts within the African-American community; one whose existence points to difficult questions and to a challenge which must be confronted if we are to adequately and appropriately tackle the HIV/AIDS epidemic. I refer to the gradual (and long overdue) integration of corporate structures and the increased access of certain segments of the African-American community to seats of power and affluence, while at the same time, the community at-large trails behind national averages in terms of both wealth and health. My colleagues and I welcomed, for example, a January 2002 Newsweek cover story describing "The New Black Power," in reference to the recent ascension of African-American executives to the highest levels of corporate power. Yet, this news falls against the backdrop of disproportionate poverty, illness, and incarceration that is known to vast segments of the African-American community.

The International Association of Physicians in AIDS Care (IAPAC) counts within our membership ranks many African-American physicians and allied health professionals. There is an urgent need for these individuals to assume leadership roles within professional institutions such as IAPAC. Beyond leadership, we require guidance, assistance, and commitment to stem the tide of unnecessary suffering and hastened death wrought by HIV disease.

Let us be frank. Those who assume true leadership roles in the battle against HIV/AIDS in the African-American community will be confronted by daunting challenges and spiritual struggles. In our search for intestinal fortitude and tenacity, perhaps no example of confidence and commitment shines brighter than that lived by Martin Luther King Jr. Faced with a different moral and political crisis - the choice between nonviolent direct action or religious acquiescence in confronting the Jim Crow South - King provided us a lasting image of the strength and greatness to which those of us in leadership positions should aspire.

From the floor of his jail cell in Birmingham, Alabama, following a department store sit-in, and confronted by the criticism of a conservative southern black clergy which felt that his program of civil disobedience was untimely, King reminded us that, "... like a boil that can never be cured so long as it is covered up but must be opened and its ugliness exposed to the natural medicines of air and light, injustice must be exposed, with all the tension its exposure creates, to the light of human conscience and the air of national opinion before it can be cured."

Jose M. Zuniga is President of the International Association of Physicians in AIDS Care and Editor-in-Chief of IAPAC Monthly.

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