Monday, June 12, 2006

Who's at risk for AIDS?

For several years, we had one of those static cling sticker things on the bathroom mirror at the office. It read: 'Who's at risk for AIDS?" You were supposed to look in the mirror and see the answer.

One of the 25th anniversary news articles (USA Today: "Profile: Generation AIDS") included this point [emphasis added]:

The lingering impression that AIDS is a gay disease helped promote its spread among blacks, says Pernessa Seele, founder of Balm in Gilead, a New York-based AIDS advocacy organization that works with 15,000 churches nationwide.

"The fundamental problem with the African-American community is that information about HIV came at us wrong," she says. "It came to us that this was a gay white disease, you don't have to worry about it. Then it was homosexuals and drug addicts. We're still suffering from the wrong information."

I don't disagree with these statements at all, but I highlighted the points about AIDS-as-gay-disease because that was the very first image of AIDS in the media, and we never seem to have gotten past that--even after 25 years. Right now, the demographics of HIV are indicating that it is turning into an epidemic threat to Black women. However, it would, I believe, be a mistake to once again try to characterize the epidemic by those who are infected by the virus.

The sense that "I am not at risk" comes from the tendency to characterize the epidemic in terms of population and not in terms of behavior. Individuals, regardless of sexual orientation, gender, race, age, ethnicity, or preferred pronunciation of "potato," who engage in high risk behavior that is not mitigated by one or more harm reduction strategies, can become infected with HIV if they engage in those unmitigated high risk behaviors in the presence of HIV.

This point matters in the context of determining an appropriate strategy for prevention in the broader community. Do you try to concentrate resources for those who are most affected by the epidemic (whack-a-mole)? Do you look at a broader strategy to address the fact that high risk behaviors are not necessarily concentrated in those groups (shock and awe)?

I don't have the answer. I tend to prefer the latter strategy, although I know that there are all sorts of arguments against it, not the least of which is the fact that we simply don't have enough prevention dollars to waste on the wrong strategy (abstinence-only, for example). However, "Wear a condom" has become so standard around our house, that the hubby once even told the grandson, "If you burn the house down, make sure you wear a condom." And I couldn't help but cringe when I read this blog entry about a young woman's affair. She only ended up pregnant, but I couldn't help thinking: "What educated woman in the 21st century would put herself and her husband at risk by not insisting on a condom?"

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