African Americans Stand to Lose from the War on Contraception

According to Webster’s Dictionary, “Contraception” is defined as the deliberate prevention of conception or impregnation by any of various drugs, techniques, or devices or; birth control. However, with the prevalence of sexually transmitted infections, many people tend to incorporate their contraceptive and sexual health prevention methods under a concept of risk reduction.

There are at least 25 know sexually transmitted infections (STIs) and infect about 15million people annually. As the debate rages about the need for and availability of contraception, we in the African American community should understand the huge stake that we have in this discussion.

African Americans have been disproportionately impacted by sexually transmitted infections, especially HIV. We represent ½ of the new HIV infections, those living with HIV and those who succumb to it each year in the United States. We also have higher rates for other STIs. We represent 50% of the 2.8 million new Chlamydia infections and our infection rates for Gonorrhea and Syphilis are 16 and 23 times those of whites respectively. Nowhere is this impact greatest than in young people, especially young women. A recent CDC study estimated that 48% of black adolescent girls in the United States had at least one STI. Moreover, many are unaware of it. Teenage pregnancy rates have risen to 42 births per 1000 females. Programs such a Planned Parenthood which offer free or low cost contraception services also provide comprehensive risk reduction services as well, services that are desperately needed in our community.

According to the National Center for Health Statistics, teen pregnancy and out of wedlock births are one of the major causes of infant mortality and are often cited as helping to keep the US infant mortality rates higher than in many industrialized countries.

Many studies point to the impact of poverty in exacerbating these rates. The latest recession has had a devastating impact of black people. Unemployment rates have risen as high as 15.9% (26.4 in youth). We have seen a significant decline in home ownership, and median household income. Poverty rates for blacks are double those for whites. And Africans Americans have consistently lower levels of health care than do whites.

In closing, African Americans definitely have a ‘dog in this fight.’ We cannot afford the impact of more unplanned pregnancies to more young women let alone the physical and economic hardship caused by sexually transmitted infections, especially HIV. We can and we must demand more, not less, ownership in our own sexual health.

And the beat goes on...

As the controversy about HIV criminalization continues to rage, the state of Maryland has decided to 'up the ante,' so to speak, by proposing to add more teeth to their current HIV-specific criminal law, according to a recent article in the American Independent newspaper. Presently, a person convicted of knowingly transmitting or attempting to transmit HIV to another person may result in an $2500 fine and up to a three year prison sentence. However, Maryland state legislators are considering changing the law from a misdemeanor to a felony with an up to 25 year sentence. Despite the absence of evidence that these types of punitive methods are a deterrent and that people who know their HIV status, especially if they have achieved viral suppression with anti-retroviral therapy, are less likely to infect others, fear and and the desire for retribution continues to reign.

Another interesting article in the Philadelphia Daily News ("Its Payback Time," 3/6/12) chronicles William Brawner, an HIV+ man who knowingly had unprotected sex with several women while a student at Howard University. He eventually contacted all of the women and disclosed his HIV status. Fortunately, it does not appear that any of the women became infected. Mr. Brawner has gone on to start a non profit organization to help other HIV+ young people. I can't help but wonder if we would have ever heard his story and would he have had the opportunity to help other confused young people, as he was at one time, if he had been thrown in jail for 25 years. While there in no condoning his behavior, won't many more people benefit if he is a contributing member of society?

HIV Criminalization

In May 2008, a homeless, HIV+ man was sentenced to 35 years in prison for assaulting a police officer with a "deadly weapon, his saliva! Willie Campbell, who was clearly intoxicated at the time, has been HIV+ since 1994 and has a history of aggressive behavior with public servants, will have to serve at least 17.5 years to be eligible for parole. The police officers were not infected. According to the Centers for Disease Control (CDC), although there have been a few rare cases of transmission through severe bites, “contact with saliva, tears or sweat has never been shown to result in transmission of H.I.V.”

Thirty four states, 2 U.S. territories and numerous other countries (including Russia, Finland, Australia, England and 20 countries in Sub Saharan Africa) have HIV specific criminal statutes. Other U.S. States and some other countries have used non-HIV specific charges such as assault with a deadly weapon and attempted murder. Many of these laws and prosecutions do not differentiate between whether an HIV+ person used a condom or even whether the virus was transmitted. All of this begs the question: Should we even be on this slippery slope?

Being HIV+ is not a crime. With the new developments in treatment, it is no longer a death sentence. Moreover, recent studies have demonstrated that one of the most effective methods of prevention is aggressively treating individuals with HIV, thereby lowering their viral load so that they may be less infectious. Studies have also shown that people who know there status tend to behave more responsibly. Unfortunately, the CDC estimates that as many as 1 in 5 people who are HIV+ are unaware of their status. Therefore it is crucial that people know their HIV status.

I understand the fear and demagogory that has dogged the HIV epidemic. And, I am certainly not making the case for irresponsibility when it comes to having sex. I get it! But we have made significant gains in this country, not just in treatment, but in making HIV testing a routine part of medical care. The last thing that we need is to arm prosecuters with powerful laws to 'punish the victim,' eg... to lock away hundreds, if not thousands of HIV+ people to protect us from them. And what responsibility does the 'partner' have in all of this. Does a person have to be told that their potential partner is HIV+, before they will use a condom?

Unfortunately, this issue is much more complex that the time and space that I will currently give to it. Perhaps the greatest concern is that these laws, which were no doubt designed to prevent infection, will more likely have the opposite effect of scaring people away from getting tested. After all, what is to stop a scorned ex-lover from pressing charges, stating that they WERE NOT TOLD of their partner's HIV status. Haven't we learned that punitive action is not always the answer. In other words, in our efforts to prevent the spread of HIV, the shield is mightier than the sword.

AIDS Denialism

Recently, someone named Curtis Cost wrote an article assailing the importance and validity of African Americans knowing their HIV status. Since the first widely reported cases in 1981, HIV has been mired in controversies, ranging from its origin to the possible existence of a cure. Sadly, over thirty years later, we continue to have many of the same conversations. What should NOT be in doubt any longer is that HIV disease is having a devastating impact on the African American community. Although African Americans represented only 14% of the US population in 2009, we accounted for 44% of all new HIV infections in that year. Overall, African Americans account for a higher proportion of HIV infections at all stages of disease—from new infections to death, than any other racial of ethnic group. Moreover, as many as 21% of people living with HIV are unaware of their status and, consequently cause up to 70% of the new infections. So why then, would Mr. Cost write such an impassioned plea for African Americans to NOT get tested for HIV? In short, we refer to people like Mr. Cost as AIDS Denialists. AIDS Denialists represent individuals or groups who deny that the human immunodeficiency virus (HIV) is the cause of Acquired Immune Deficiency Syndrome (AIDS). While the link between HIV and AIDS has long been established in the scientific community, AIDS Denialists continue to dismiss HIV as a harmless passenger virus and assign the cause of AIDS to anything from malnutrition to the drugs used to treat it. Now, before you dismiss the Denialists as just foolish or uninformed, let me remind you about Thabo Mbeki, the former President of South Africa and once a poster child for AIDS Denialism. By some estimates, his alleged 'fiddling while Rome was burning' may have led to as many as 330,000 AIDS deaths as well as almost over 200,00 new HIV infections.

The greatest weapon against AIDS Denialists is knowledge, ours. AIDS Denialists prey on our own cynicism, ignorance and, yes, our denial. It always amazes me how willing we are to jump on the bandwagon of someone offering very little in the way of proof and disavow decades of scientific evidence. Healthy skepticism can be a good thing. However, use that cynicism to motivate yourselves to seek more information. In other words, do your own homework!

Can Certain Contraceptives Increase HIV risk?

I can imagine that those who try to remain current with new developments in contraception and HIV risk reduction may cringe at discovering that something else might place them at increased risk of HIV infection. This time, that something else may be a popular form of contraception, injectable hormones. Injectable hormones, such as the well-known Depo-Provera, are one of the easiest, most cost effective contraception alternatives because they are long lasting, easily administered and and gives women more control over the timing of their pregnancies. Unfortunately, they do not protect against HIV or other sexually transmitted infection. Now, a recent study published in Lancet on October 3, 2011, raises concern that their role in HIV infection might be even more problematic. Researchers from the University of Washington followed almost 4,000 couples for two years in Botswana, Kenya, Rwanda, South Africa, Tanzania, Uganda and Zambia. In each couple, either the man or the woman was already infected with HIV.

The study found that women using hormonal contraception became infected at a rate of almost twice as high compared with those not using that method. Transmission of HIV to men also occurred at a rate almost double from women using hormonal contraception than for those who did not. Two other major ones have also demonstrated increased risk of HIV through the use of injectable contraceptives.

It is not entirely clear why this may be happening. The Progestin in injectable contraceptives may have a physiological effect, such as immunologic changes in the vagina and cervix. Moreover, researchers found more HIV in the vaginal fluid of those using hormonal contraception than those who did not. This might help to explain why men might have increased risk of infection from hormonal contraceptive users.

While the results of this study may be quite sobering, especially to those who use injectible hormonal contraceptives, it is just as important that we remember that for most, HIV risk reduction still remains firmly within our control and underscores the importance of not just knowing one's own HIV status, but that of our partners.

Treatment is Prevention Part 1

Some of you may be aware that the annual HIV Prevention conference has been taking place in Atlanta this week. One of the unique aspects of HIV conferences is that they tend to bring together an eclectic mix of people: consumers, researchers, medical providers, non profits and other assorted advocates. As we, as a society, struggle with finding new and creative ways to reduce the transmission of HIV, it was only natural to consider the impact a medical model might have on this challenge. Perhaps one of the most exciting studies within the last several months demonstrates the benefit of immediate, aggressive HIV treatment in reducing transmission.

Historically, HIV prevention targeted those who were negative. Eventually, more emphasis was placed on "Prevention for Postives," which focused primarily on changing the potentially risky behavior of people who are HIV+. However the promising results of a study, known as HPTN 052,that evaluated whether the immediate use of HAART (Highly Active Anti-retroviral therapy) by HIV-infected individuals would reduce transmission of HIV to their HIV-uninfected partners (which would also potentially benefit the HIV-infected individual), demonstrates the increased role of medical treatmet in prevention. The results of the study were truly groundbreaking: there was a 96 percent reduction in risk of HIV transmission to the HIV-uninfected sexual partners.

The results of this study underscores previous efforts to test as many people as possible by making HIV a routine part of medical care as well as aggressive community mobilization by showing that if we can get HIV+ individuals into care and keep them there, it may reduce overall HIV incidence and save lives. Put another way, this study adds another needed weapon to our arsenal as we continue to make progress if our war against this formidable, entrenched enemy: HIV.

HIV at 30

For the two or three of you (lol) who follow my blog, you may have noticed that I haven't blogged in a while. A lot has happened to me over the last several months that I won't get into now. However, I have returned with a renewed sense of purpose and quite a lot to say.

Much has been written about the 30th anniversary of HIV. I plan to write throughout the year on this topic. It is long and complex area and I cannot begin to do it justice in one or two blogs. So hear I go......

My blog today will be more in the form of a rant. It comes on the heels of a recent radio show on which I appeared. During the show, I experienced a sense of déjà vu; that the conversation I was engaged in has happened before. After 30 years, I was answering many of the same questions, the same way:

* Why are the rates so high in the African Americans so high?
* Whay aren't the churches more involved?
* Why do so many African Americans have conspiracy theories?
* Isn't Magic Johnson cured?
* Why is the stigma so great?
* Isn't AIDS a gay disease occurred to me?

After 30 years, with so many ways to access the information, why hasn't it sunken in? Moreover, this 'HIV illiteracy' does not seemed to be impacted by SES (socio-economic status) I have had the same conversations with people ranging from 6th grade reading levels to doctorates.

Certainly the glass isn't completely empty. We have made strides. There is finally a National HIV strategy. Many cities have instituted robust social marketing and testing intitiatives. And, some faith-based institutions have become involved. But, as I have these daily conversations and watch the rates continue to rise, it still seems apparent that it just hasn't sunken in enough. Without our most important asset, knowledge, we still have a long way to go.