Distrust, stigma hinder fight
By BRIAN MOORE
© St. Petersburg Times,
Pinellas County's fight against AIDS dramatically shifted in 1998 when figures revealed that African-Americans were contracting the disease at an alarming rate.
For more than a decade, county health workers targeted gay, white men with their prevention message. But the new figures showed it was time for an about-face.
Health workers started pouring into black neighborhoods. They went to churches and schools, handing out educational brochures and condoms. They spent hours with people, one-on-one, discussing the dangers of HIV, the virus that causes AIDS.
Derailing the infection rate was their mission. Now, three years later, health workers painfully realize that their work has been nearly ineffective.
When they began focusing on the black community in 1998, black men and women made up 35 percent of new adult AIDS cases reported in Pinellas. Last year, the figure rose to 36 percent. All this in a county in which black adults make up 7.4 percent of the population.
Officials say a range of obstacles exclusive to minority communities has stymied their work. And they're at a loss for what to do.
"If I were an optimist, I'd say hopefully the numbers will change next year," said James Sikes, director of community health services for the Tampa AIDS Network. "But I think . . . we're headed to another wave of death like you saw in the late '80s and early '90s, that a lot of people are going to have to die before something good really happens."
Sikes says the same problems that plague Pinellas County's prevention efforts are also playing out in Hillsborough County and across the nation. According to the Centers for Disease Control and Prevention, 40,000 new HIV cases occur every year and 54 percent of them are among African-Americans, who make up 13 percent of the nation's population.
Lorenzo Robertson, 39, knows about the struggle firsthand. He learned he had AIDS in 1997 without even knowing he had HIV. He may have contracted the disease through unprotected sex, but he has vowed not to let it keep him from living an active life.
He's working at Pinellas AIDS Prevention Services, Inc., formerly People of Color AIDS Coalition, in St. Petersburg. Robertson said, and others agree, that a major problem with helping black residents is that many will not get tested voluntarily.
The stigma against homosexuality is much stronger among blacks than whites, he said. Some gay men lead hidden lives to protect their sexual orientation, and they maintain a heterosexual relationship to keep others from knowing they're gay, Robertson said.
For that reason, they view getting tested as a risky proposition. Someone could find out about their sexuality.
Such thinking leads to problems. A man with HIV may never know he's infected until he's tested. Without that knowledge, he might pass along his infection to his female partner, which might further boost the infection rate among black people.
Health workers say that if many minorities won't seek treatment, the treatment must seek them. Lisa Cohen, HIV/AIDS program coordinator for the Pinellas Health Department, leads the county's effort to provide patient care, testing, education programs and surveillance of AIDS and HIV cases.
From April to June, Cohen's workers supplied 1,876 people with AIDS and HIV information about the disease.
Next month, the Pinellas County Health Department will place two full-time employees, including a registered nurse, at the Pinellas County Jail. They'll provide counseling services and HIV testing to inmates. If inmates test positive, the department will stick with them even after their jail release to ensure adequate medical treatment, Cohen said.
Other obstacles have bedeviled Pinellas health workers.
There's little doubt that churches are powerful vehicles for social change among African-Americans. While some predominantly black churches have embraced AIDS education, many have not. Churches that support abstinence until marriage, for example, oppose distributing condoms to single teens and adults, Sikes said.
Because HIV can be spread through sex and drug-use with needles, being infected carries a negative image within the church.
"It deals with a lot of negative things in terms of how the church views how you should live your life," Robertson said. "They're not necessarily looking at the fact that you're HIV positive and that you need their help; they're looking more so at the fact that you were out using drugs or doing God-knows-what to get your drugs.
"They've attached a morality to AIDS and HIV, whereas with cancer, there's no morality attached to that."
Jeff Nadler, professor of medicine and director of clinical research of infectious diseases at the University of South Florida, said low incomes also contribute to a high infection rate among African-Americans.
Many infected African-Americans don't have easy access to health care, as many of the wealthier, gay white men did when the AIDS epidemic exploded in the late 1980s. Many have no insurance, which keeps them from the care they need, Nadler said. For example, 30 percent of HIV and AIDS patients who visit county health clinics in Hillsborough County do not have a phone, he said.
Distrust is also a factor, he said. Robertson agreed, saying many people turn away from what they perceive as the "white medical field." Some might second-guess anything they're told, and they're not going to seek help from people unlike themselves, he said.
"It's hard for the patients to identify with us," Nadler said of white health workers. "It's hard for us to communicate the procedures about medications and treatment when they feel fine, meaning they're infected but they're not feeling the effects.
"We struggle with education."
There is good news: The number of new AIDS cases overall declined nationally, including in Pinellas County. There were 179 new AIDS cases reported last year in the county, compared with a record 372 cases reported in 1992.
Reports of new AIDS cases have dropped nationally six years in a row, down to 41,849 in 1999, the latest totals from the CDC. Cohen said outreach programs have prompted more people to get tested and therefore people are discovering earlier whether they have HIV.
Finding the infection earlier allows people to get treatment that slows the virus from developing into AIDS.
"HIV patients are living much, much longer now," Cohen said. "They're enjoying life. They're going back to work, and a lot of it has to do with surveillance. We look at high-risk people, and we do everything we can to get them the information and the care that they need."
Health workers hope the success experienced in the white community will reach the black community.
"We'll just keep trying," Nadler said.
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