Courtland Milloy, Contributor
DISCUSSING SEX and race requires a subtlety that I don't always possess. But when it comes to AIDS and African Americans, there is no point in mincing words: We must change, or we will die.
Attention now appears to be focused on Africa: The Senate just passed a $15 billion bill aimed at curbing the AIDS pandemic on that continent.
And yet, the same trends including a dramatic increase in AIDS among black women and children can be found right here in the United States.
In the District, girls and young women ages 13 to 24 accounted for 6.5 per cent of AIDS cases last year, according to the D.C. Health Department. When one realizes that it takes about 10 years for AIDS symptoms to show, the horror of what has happened to them is inescapable.
The Senate bill on Africa would provide financial assistance "for the purpose of encouraging men to be responsible in their sexual behaviour, child rearing, and to respect women."
That's fine. But how about funding something like that here, too?
Senate Majority Leader Bill Frist recently told The Washington Post, "Much of the transmission of the HIV virus [in Africa] is facilitated by culture, and issues surrounding injustice against women should be addressed."
Experiment
You would hope that before launching some behaviour-modification experiment in Africa, the Senate would find a way to deal with the AIDS disaster at home. So far, efforts nationally to change black male behaviour through the usual lecturing, preaching, public service sound bites and bus stop posters haven't done the job.
Part of the problem, some specialists say, is that too many public service messages have a well-meaning but misplaced emphasis on looking out for No. 1.
"When it comes to African Americans, an individually focused attempt at motivation is not as effective as focusing on the collective," said John Jemmott, a professor of health communications at the University of Pennsylvania. "What resonates with African Americans is hearing that you have to change your personal behaviour, not just for your own sake but for the sake of your family and the larger community."
To the credit of District officials, there has been progress in reducing AIDS among black men, largely through the increased use of condoms. However, the AIDS rate could skyrocket again. It doesn't help that many men who are released from prison carry the disease with them back to the city.
Among District women, the incidence of AIDS has tripled in the last decade, with African American and Latino women accounting for 96 per cent of the cases, according to the Health Department.
All totalled, about 8,000 District residents are reported to have AIDS, and about 15,000 others are reported to be HIV-positive.
Females 19 and younger now account for half of all chlamydia cases in the District -- and what they did to get that sexually transmitted disease can also give them AIDS.
Are we doing enough to empower our girls, to protect them from child abuse, prostitution and other forms of physical and spiritual violence?
Of course not. And when it comes to helping gay black men, forget that, too. Virtually no studies have been done on what works for them, Jemmott said.
Concentrations
According to a study by Guy Weston, director of research for the city's HIV/AIDS Administration, the incidence of AIDS is highest where there are concentrations of low-income, black female-headed households that attract a variety of at-risk men -- including those who had sex with other men before being released from prison, intravenous drug users and heterosexual males who have multiple female sex partners.
Add in a lack of access to health care, which means that HIV goes undiagnosed, and what you have are the makings of a time bomb.
So, just how do you get men to change their ways?
"Essentially, a new point of view has to evolve out of guided discussions of the pros and cons of such behaviour among men who behave this way," Jemmott said. "Usually, out of that comes a belief that they should change."
You just can't say it enough: We must change, or we will die.
- Washington Post
