As World AIDS Day approaches, black advocates say the deadly disease continues to inflict a staggering human and financial toll on the African American community.

The AIDS epidemic has claimed the lives of more than 230,000 African Americans over the past three decades. And although black Americans constitute just 12 percent of the U.S. population, they account for 46 percent of the 1.1 million Americans currently living with HIV.

To some observers, the fact that America hasn't yet won the battle against AIDS boils down to pure economics.

"If we had large numbers of millionaires, billionaires and those impacting the economy dying of AIDS, I guarantee you a cure would be found virtually overnight," says LaMont Evans, CEO of Healthy Black Communities Inc. in Atlanta.

"It's sad to say," Evans told BlackVoices, "but there's a lack of urgency in addressing this problem because those impacted are seen as disposable and not economically important."

Whether one agrees with Evans, he may be on to something: Wealth and status indeed play a huge role in the likelihood of becoming infected with HIV in America.

In a first of its kind study on the link between economic status and HIV, the Centers for Disease Control and Prevention found in 2010 that those living in poor neighborhoods were more than four times more likely to be stricken with HIV, compared with the national average. Researchers theorized that residents in poor areas had limited access to health care and other basic services, along with higher rates of substance abuse and incarceration – factors that heighten one's risk for HIV.

"This study reveals a powerful link between poverty and HIV risk and a widespread HIV epidemic in America's inner cities," said Kevin Fenton, director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. "In this country, HIV clearly strikes the economically disadvantaged in a devastating way."

So if it's clear that individuals in poor communities in general, and African Americans in particular, are being disproportionately ravaged by AIDS, what is being done to prevent the disease from spreading?

Critics say not nearly enough.


Until this year, America had no comprehensive program to fight the AIDS epidemic. Then, in July 2010, President Obama launched the first National HIV/AIDS Strategy, designed to reduce the number of new HIV infections, increase access to care for people living with HIV, and reduce HIV-related disparities and health inequities.

For 2011, Obama's federal budget includes a $27.2 billion request for HIV and AIDS. That's a 4.6 percent increase over 2010 funding, which totaled $26 billion.

But just 3 percent of the 2011 AIDS budget, or $900 million, is earmarked for prevention. Many AIDS advocates say this is completely insufficient, especially considering that one study conducted by the CDC and John Hopkins University showed that for every HIV infection prevented, $355,000 is saved in the costs of providing lifelong HIV care and treatment. The study concluded that an investment of $4.5 billion in HIV prevention over 10 years would save $104 billion in medical costs.
With relatively few dollars devoted toward prevention it's little wonder, perhaps, that every year, about 56,000 Americans are infected with HIV; 25,000 of them are African-Americans.

The CDC says one in 22 African-Americans are expected to get HIV during their lifetime. The CDC estimates that the chances of a black person being diagnosed with the AIDS virus is more than twice the risk for Hispanics and eight times that of whites. For Hispanics, the odds of contracting HIV in a one's lifetime is one in 52; it's one in 170 for whites. Meanwhile, Asian Americans had the lowest lifetime risk, at roughly one in 222.

In some parts of the country, namely the nation's capitol, the rate of HIV infection is particularly alarming. In 2009, a Washington Post story, citing CDC data, reported an HIV prevalence of at least 3 percent among individuals age 13 and above in the Washington D.C. area. That's an infection rate similar to some parts of sub-Saharan Africa.

The Global AIDS Problem and Worries About the GOP:

And speaking of AIDS in Africa, the problem there isn't getting any better either.

The worst-infected region of the world is sub-Saharan Africa, where approximately 22 million people are living with HIV, which is two-thirds of the 33 million people globally who are living with HIV.

Of the $27.2 billion federal AIDS budget requested by President Obama for 2011, $6.7 billion is allocated for global efforts to combat HIV/AIDS.

But federal AIDS funding is broken into two parts. A chunk of it -- 47 percent or $12.9 billion -- is mandatory, and must be spent on various entitlement programs. However, the majority of the AIDS budget -- 53 percent or $14.3 billion -- is discretionary, meaning Congress has to approve it through the appropriations process.

That worries some people.

Federal funding for HIV/AIDS is already a tiny fraction – less than 1 percent - of the overall federal budget of the United States. And with Republicans recently taking control of the House of Representatives, some observers fear what the GOP may do concerning AIDS spending – domestically and internationally.

The recent election results "present at least three major challenges to the fight against AIDS," Phill Wilson, President and CEO of the Black AIDS Institute, said in a statement.

"First, many of the strongest Congressional AIDS champions will no longer occupy key leadership positions to advance an AIDS-friendly agenda," Wilson said.

"Second, the new Republican majority campaigned on a platform of reducing federal spending on discretionary programs, such as the Ryan White CARE Act, the HIV prevention program at CDC, and substance abuse and mental health services for people living with HIV," Wilson added.

"Third, although it is unlikely that Republicans will be able to muster the votes needed to repeal health care reform, critics of health care reform may well seek to withhold the funding needed to implement key provisions of the legislation," Wilson noted.

The Ryan White Program is the largest HIV-specific discretionary grant program in America. With $2.3 billion in funding requested for the program in 2011, the Ryan White program is also the third largest source of funding for HIV care in the U.S.

Recent Promising Developments:

The news about AIDS isn't all doom and gloom.

In fact, three recent promising developments in the fight against AIDS all emerged on the same day, November 23.

First, a new research study showed that a daily pill now being sold in pharmacies nationwide could help prevent the spread of AIDS among gay and bisexual men. The pill is called Truvada and is marketed by Gilead Science. It was shown to reduce the risk of infection by anywhere from 44 percent to 73 percent.

Likewise, AIDS advocates cheered the news that the number of HIV cases has dropped significantly over the past decade. According to the United Nations, the total number of HIV cases worldwide fell by 20 percent in the last 10 years, and there are now 33 million people living with HIV.

That news came the same day in which the Pope issued a statement saying condom use is acceptable in order to prevent the spread of HIV, the virus that causes AIDS.

While the general population greeted these developments with great enthusiasm, the reaction in the black community was more tempered.

Evans, who is leading the efforts to organize National Black HIV/AIDS Awareness Day on February 7, 2011, questioned who would pay for the pricey drug Truvada. "Will it be insurers or the government?" he asked, suggesting there's ambiguity on whether or not members of poor and minority communities will have access to those pills.

The Truvada pills cost between $5,000 and $12,000 annually in the U.S. They sell for a tiny fraction of that – around $140 a year – in some poor countries that are selling generic versions of the pill.

In America, AIDS patients with good health care coverage can get antiretroviral treatment. But those who are uninsured or under insured typically have to go without, or resort to public programs like Medicare, Medicaid and the Ryan White program.

With funding for those programs subject to Congressional approval, many AIDS prevention advocates worry that the battle against this deadly disease is far from over.

The high rate of HIV infection among African-Americans is, "compelling proof that you get what you pay for, or that you don't get what you fail to pay for," says Wilson, of the Black AIDS Institute, adding, "We simply won't be able to turn the epidemic around in Black communities without stronger federal support for HIV prevention."