America's AIDS Apartheid
The domestic HIV/AIDS epidemic is increasingly black and Southern -- and spiraling out of control.
Kai Wright | July 8, 2008
The hope in Tracy's voice was contagious. He had just come out of Alabama's state prison system and was looking forward to starting over. He'd gotten some part-time work and secured a comfortable, if sparsely furnished apartment. He was a classic Southern hunk -- a handsome, stout, mocha-skinned man with a slow drawl and a natural charm -- and so had no trouble finding women to date. That was exciting but also scary, because Tracy had newly committed himself to confronting his 12-year-old HIV infection.
He beamed with pride at the progress he was making. "I talked to one," he bashfully boasted to me about his coming-out process to would-be girlfriends. She'd been pressuring him to have sex, and he knew he had to disclose first. "She appreciated my honesty." Things were going well.
I wanted to be hopeful for Tracy, too. After more than a decade of writing about AIDS, I've come to recognize the liberated look on his face -- the relief that shines in someone's eyes when he gives up on fear and shame and starts figuring out how to live with -- rather than in spite of -- an HIV diagnosis. But I knew Tracy would get little help on what was going to be a hard road to wellness, because his story arc is sadly typical of the epidemic that is now raging around him -- years of denial masquerading as optimism, followed by a mad scramble to patch things up when it's already too late.
Tracy was diagnosed back in 1993, the first time he went into lockup. He got no counseling and no treatment, just the news that he was HIV–positive. He was outwardly healthy so, not surprisingly, he ignored this piece of overwhelming, incomprehensible information and went on with his life, bouncing in and out of jail. It wasn't until 2005, the year I met him, that Tracy finally came to understand the gravity of his situation. He'd gotten some education during his last stint in prison, after activists sued the state and forced it to provide meaningful care to the HIV–positive inmates. Who knows how many others he passed on the virus to in the interim. But to focus on missed HIV–prevention opportunities is crazy-making; they are too many to count. What mattered as I listened to Tracy describe his future was that, finally, he preferred reality to the false comfort of denial. That's more than I can say for both the federal and state-level response to the fast-growing ranks of people like him.
America declared a terribly premature victory over AIDS more than a decade ago, when new treatment regimens hit the market and dramatically halted the parade of young funerals. And there's no denying the progress: Today's death rate is a small fraction of what it was then. But controlling an epidemic isn't the same as ending it. We confused the two achievements and turned our attention to epidemics overseas. We've spent years watching with sympathetic awe as infection rates have spiraled upward in places like sub-Saharan Africa, where people have struggled to afford the lifesaving drugs we assume are readily available here at home. All the while, the U.S. epidemic has been barreling toward the precipice.
More Americans are living with HIV today than ever before -- an estimated 1.2 million -- and the number is increasing by tens of thousands annually. Worse, there's every reason to believe the problem is exponentially graver than we know. AIDS researchers and service providers have been anxiously awaiting a U.S. Centers for Disease Control and Prevention (CDC) study that is expected to find the epidemic to be far larger than believed. Yet, over the last eight years policy-makers have so neglected the care system that we cobbled together in the 1990s to control the epidemic that people have died, right here in America, while lingering on treatment waiting lists like those in the developing world.
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http://www.prospect.org/cs/articles?article=americas_aids_apartheid
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