Twenty-seven regional and national organizations dedicated to preventing HIV in communities of color will receive a total of $21 million from the Centers for Disease Control and Prevention (CDC), the CDC announced on April 7.
The grants, which range in amount from $300,000 to $1,775,000, depending on their intended use, go to 27 non-profit and community-based organizations serving African American, Asian American, Latino, and Native American communities at high risk for HIV infection.
“Minority communities are disproportionately affected by the HIV/AIDS epidemic,” said Secretary of Health and Human Services Tommy G. Thompson. “Partnerships with these communities are critical if we are to get testing and treatment to the people at risk and ultimately reduce the number of infections.”
Organizations based in New York that were named as recipients are Balm in Gilead, which administers to religious, or faith-based, African American communities; the Harm Reduction Coalition; the Latino Commission on AIDS; and the National Black Leadership Commission on AIDS.
While they welcome the funds, administrators at some of these organizations expressed concern over the recent implementation at the CDC of a new HIV prevention strategy, which they say shifts attention from HIV-negative individuals to those already infected with the virus.
“If the dollars were following the trends of the epidemic, our rates of infection would not be so high,” said Philip Hilton, senior vice president for fund development and community affairs at the National Black Leadership Commission on AIDS, which received roughly $400,000. “Am I happy that we’re one of the grantees? Oh, absolutely. But, to me, it’s analogous to a drop of rain in the midst of a drought.”
Less than a year ago, the CDC, the federal government’s central funding, research, and policy arm supporting the prevention and control of disease, introduced “Advancing HIV Prevention” (AHP), a strategy to help reduce new infections nationwide. According to the reasoning behind AHP, early detection of the virus in people who have already contracted HIV prevents them from unknowingly spreading the disease to others, reducing the severity of the need to directly address people who are HIV-negative.
“Prevention programs may be slowing the epidemic, [but] more needs to be done to reduce new infections,” reads one passage from AHP. “Refocusing some activities will result in more HIV-infected people learning their serostatus and should reduce new infections.”
Not so, say the grantees. In the communities of color that they serve, rates of transmission are the highest in the country. These organizations’ primary goal is to make sure people stay negative. It seems ironic and disastrous to them that under the new AHP initiative, their programs could receive funding, but not to do the work most relevant to their constituencies.
“Very generally, the CDC has funded in this round a series of models for HIV prevention,” said Chris Lanier, development director of the Latino Commission on AIDS, which received approximately $700,000. “If an agency is funded, their job is to adapt those models and our job is to help them to do it. Certainly, I think every agency would rather design its own intervention. This way is more restricted, but it makes it easier for the CDC to evaluate their effectiveness.”
The CDC says that it designed the AHP initiative based on research that suggests that once people learn they are HIV-infected, most take steps to reduce the chance of transmitting it to others. This information, in addition to the development of a new HIV test that delivers on-the-spot results, and statistics suggesting that AIDS has stabilized over the past decade made CDC researchers decide to shift their focus in the way that they have.
“Studies suggest that by working with HIV-infected persons, we can achieve greater reductions in risk behaviors and HIV transmission than by working with uninfected persons,” says the CDC. “For example, one study showed that among persons testing positive for HIV, there was a 70 percent reduction in reported risk behavior at one year.”
“I’m hoping and praying that people at the federal level and elsewhere who are in positions of responsibility and authority to make things happen recognize that funding must follow the trends of this epidemic if we’re going to be able to do this job right,” said Hilton.
African Americans currently represent an estimated 64 percent of new HIV transmissions in the nation. For Hilton, that means aggressive prevention efforts should remain high up on the agenda.
“It has to be talked about in our churches, our schools, our homes,” he said. “It’s going to take that kind of attention and focus to get the word out. I think that once you get that kind of information out and people start talking about this the way they are talking about ‘down low,’ then we can get to the root cause of what is feeding the epidemic in our communities.”
The “down low” to which Hilton refers is a controversial interpretation in African American communities of men who have wives and girlfriends, yet also engage in sex with other men, but who refuse definitions of themselves as “gay” or “bisexual.”
With a cover story about the phenomenon in The New York Times Magazine, a recent Times front page article by lesbian African American journalist Linda Villarosa, and an episode about it on the “Oprah Winfrey Show,” this coming Friday, April 16, the hype about the down low life continues to accelerate. The clandestine behavior it describes, however, largely remains hidden to those close to the men participating.
Increasingly, down low behavior is being characterized in the popular press as a key conduit for the spread of HIV from gay men to heterosexual women.
Hilton is distressed about how this behavior is being characterized, even within the African American community, where it is sometimes claimed as a specifically African American practice.
“I’m very concerned about how this is going to impact the whole dialogue about HIV prevention down the road,” Hilton said.
“ The down low is merely a new handle on an old behavior that crosses racial, cultural, and class lines,” said Phill Wilson, executive director of the Los Angeles-based Black AIDS Institute, a non-profit organization that also received funding in the recent CDC grants. Wilson is among those appearing on “Oprah” to discuss the phenomenon.
“The current portrayal of this phenomenon demonizes these men and by extension all black men,” Wilson said. “I think the current discourse on this issue will be a huge distraction in black communities away from larger and more effective issues and strategies to stop the AIDS epidemic in our communities. If the current trends continue, so-called ‘DL,’ and quite frankly, other men who have sex with men, will go further and further undercover.”
Lanier at the Latino Commission on AIDS agreed. He said that although the phenomenon has not been as exposed in Latino communities, it does exist, and must be carefully addressed.
“There are different terms for it, but that is certainly a factor,” he said. “There are different factors within the Latino community, but the fact that there are many men having sex with men who don’t identify as gay and have a committed partner who is a woman is definitely a factor in many Latino communities.”
Hilton quickly dismissed all talk of down low and returned to the issue of outreach and education to prevent HIV.
“We have to craft the right messages,” he said, “but we have to ensure that they’re being uttered by the right messengers.”
Wilson’s Black AIDS Institute will use its CDC grant, some $400,000, to develop what it calls the “African American HIV University.”
“One of the fundamental principles of the Black AIDS Institute is that the messenger is as important and often more important than the message,” said Wilson. “The African American HIV University is a two-year fellowship program designed to increase the quantity of black qualified HIV/AIDS experts working in black communities.”
