Misjudged Threat

By Ian Smith, M.D.

For the past few years, we've seemed to be on the way to winning the war against AIDS. But last week we got a chilling reminder that victory is still not in sight. It came in the form of some grim statistics from the nation's first large-scale HIV-prevention conference, held in Atlanta by the Centers for Disease Control and Prevention.

Although the number of AIDS deaths has dropped to slightly fewer than 20,000 a year, off 60% from 1995, a closer look at the figures indicates that it is much too early to even think about uncorking the champagne. While the number of deaths declined 42% from 1996 to 1997, they were off only 20% from 1997 to 1998. In short, the decline is slowing. We're actually losing ground.

One explanation is the diminishing effectiveness of medications used against the stubborn virus, which is showing signs of developing resistance to even the powerful new protease inhibitors. It's also apparent, however, that another factor is at work. The very success of the drugs has made us forget that the best way to fight AIDS is prevention, and that's the second important message out of Atlanta.

Nowhere is this harsh reality more evident than among African Americans, a special focus of the conference. In 1984 the CDC reported that 50% of all children infected with the virus in the U.S. were African Americans. By 1988, African Americans accounted for 70% or more of the AIDS cases among heterosexual men, heterosexual women and children. These alarming statistics haven't got much better since then. Even now, African Americans have an AIDS incidence and a death rate that are 10 times those of whites.

In part, the problem is misinformation. Explains Dr. Helene Gayle, director of AIDS prevention at the CDC: "First and foremost is the fact that this epidemic got cast as a white disease, particularly a white gay disease, and that lulled people into a sense of denial in the African-American community." The result: too many heterosexual African-American males still think it's perfectly safe to practice unsafe sex with female partners.

But how do you change risky habits? Clearly, as emphasized by counselors from Gay Men of African Descent, an organization based in New York City that advises young adults, it's important to know the cultural heritage of your audience. While it may make sense to recommend that teenagers and young adults use condoms, you must be aware that many young African Americans view them as a challenge to their manhood.

You'll also hear something else from young African Americans: they are no longer afraid of the disease. After all, they'll tell you, if a celebrity with AIDS like former pro-basketball star Magic Johnson, who has done so much to bring attention to the epidemic, can continue his glitzy lifestyle without any obvious ill effects, why should they worry about the virus? You'll also hear some sophisticated advice. Many youngsters will tell you that showing pictures of the devastation caused by the disease could provide effective shock therapy.

The CDC is reaching out to African-American church leaders in the hope that they will use the power of the pulpit to get out the word about AIDS. Let's hope the tactic works. At this critical moment in the AIDS epidemic, what happens next will depend largely on how well we educate--and how well people listen.

For more information on AIDS and race, see our website at time.com/personal You can e-mail Ian at [email protected]