Paper Three:
What Can We Do?
HOW WE CAN FIX THE PROBLEM
The AIDS epidemic in Alameda County has had many faces since the discovery of the disease over two decades ago. The disease that began affecting predominately gay men in the 1980’s has shifted its target. Currently, the disease has developed in the African American community throughout Alameda County but especially in the impoverished areas of Oakland. The California Department of Health Services STD Control Branch in 1997 reported that 63% of the AIDS cases in Alameda County were African Americans. [11] Because of these findings in November of 1998 the Public Health Officer for Alameda County announced that the rate of AIDS and HIV in the African American community had reached a state of emergency.[11] This announcement was the first time a local health official had declared a state of emergency in a specific area because of AIDS in the African American community.[11] Although the state of California only provides cumulative AIDS data and does not supply HIV statistics, there dozens of journal and newspaper articles that demonstrate and discuss the issue of AIDS within the African American community in Alameda County.
The disease has greatly affected the African American population for multiple reasons. Poor education and health care have left impoverished African Americans vulnerable to a multitude of diseases but especially vulnerable to AIDS. Unfortunately, people are still misinformed about the causes and manners of transmission of AIDS. Youth are not receiving proper education on how to protect themselves from HIV in schools or other trustable sources and people are unwilling to discuss the issue because of the touchy subject matter and stigma attached to the disease. This stigma has made it difficult for AIDS prevention groups to openly discuss the disease through out the community. People vulnerable to the disease are not receiving the information they need to protect themselves.
The stigma and lack of knowledge attached to AIDS within the African American community is not the only factor that has contributed to the issue in Alameda County, high risk behavior has also helped HIV continue to spread. Injection drug use is highly prevalent within Alameda County. The sharing and use of dirty needles has continued the spread of the disease. Another contributor to the spread of AIDS is MSM (men who have sex with men), in particular there is been a growing phenomenon among African American men to be on the “down low.” This term has come to mean that men who identify themselves as straight but have sex with other men. This phenomenon has become a great problem because usually men on the “down low” are not honest with their female partners about their homosexual behavior and do not use correct protection because they deny their involvement in risky behavior. A third factor that greatly affects the spread of AIDS within the African American community in Alameda County is MSM experiences and drug use in jail. HIV and other STDs run rampant in United States jail systems and the diseases are spreading to the outside. People are turning a blind eye to the spread of disease in jail because they do not want to admit that prisoners are having sex with each other or using drugs. Because of bad health care and lack of testing in the jail system, prisoners are leaving jail not knowing their HIV status and spreading the disease to the outside community.
To truly get a handle on the AIDS epidemic in Alameda County one needs to attack all aspects and influences of the disease. Firstly, Alameda County needs to improve sexual education in schools and work on providing good health care for all of its citizens. Secondly, AIDS and HIV education needs to be more prevalent throughout the area. Whether, people become informed through billboards or new health clinics the African Americans need to know that they are at risk of contracting the disease. Thirdly, needle exchange programs need to be expanded and given more funding. These programs can not only provide clean needles but also supply condoms and information on how to reduce the risk of contracting the disease. Fourthly, people in jail need to be informed of their vulnerability to HIV transmission and should be allowed to be tested. Lastly, AIDS organizations need to work with churches and local African American organizations to fight the stigma of AIDS and provide people with reliable information. To truly stop the growing AIDS rates in the African American community in Alameda County local government, non-governmental organization’s and churches need to work together to fight the spread of the disease. I am optimistic that if Alameda County can come together to fight AIDS the disease can be handled.
EDUCATION IN SCHOOLS
Recently, the youth of the United States has become increasingly at risk to contract HIV. In general, young people have a higher risk of contracting a STD than other age groups, in fact a quarter of all sexual transmitted diseases in the U.S. occur in teenagers.[12] Adolescents also have less access to proper contraception and safe sex practices because they must rely on parents or schooling to provide them with the correct knowledge about STD’s and HIV prevention. Many young people are not receiving the right information and are not practicing safe sex, this leaves the youth of America particularly vulnerable to contract HIV and other sexually transmitted diseases. For these reasons it is especially important to gear HIV prevention programs to the youth of America. Providing proper education on how to protect yourself from HIV and how to deal with the many issues that surround the sexual experience for teenagers is one way to help stop the increasing HIV and AIDS rates among youth in the United States.
But basic informational sex education is not enough. Many schools only provide limited, if any sexual education classes to their students. Most sex education classes do not go into details or demonstrate HIV/STD prevention methods. In a study that tested the effectiveness of different types of HIV/STD classes amongst African American and Latino teenage girls in Philadelphia, Pennsylvania, it was found that skill based tutorial programs better inform participant how to protect themselves from HIV and other STD’s than basic informational sexual behavior classes or health based classes.[12] In turn, skill based classes can reduce risky sexual behavior and STD rates among youth.[12] The study came to these conclusions by tracking over 600 teenage girls while they took either a health based prevention class, purely informational STD prevention class or a skill based STD prevention class. They found that after one year of tracking and self reporting girls in the skill based classes less frequently practiced unprotected sex, had fewer sexual partners, fewer sexual experiences while intoxicated, were less likely to have an STD and scored higher on HIV/STD informational tests, than participants in the other two groups.[12] This study shows that skill based HIV and STD prevention classes can make a dramatic difference in participants’ behavior and knowledge. Therefore, I believe that instituting skill based sex education classes in Alameda County high schools would greatly help reduce the growing HIV rates. These classes would be an extension or reworking of current sexual education classes already provided in public schools but they would go into further detail and demonstrate how to properly use condoms and other contraceptives.
Another aspect of the improved sexual education classes is to promote awareness and acceptance of HIV and AIDS and of people that have the disease and distill myths and rumors about the disease. In 1989 the San Francisco Department of Health evaluated AIDS curriculum in middle schools and high schools in San Francisco and tested how ADIS intervention classes affected students. Six hundred and thirty nine students, 39.7% in high school and 60.3% in middle school, were split into two groups.[13] Half of the participants received three AIDS intervention classes; the other half did not receive any specific AIDS or HIV education.[13] Not only did more students in intervention classes learn how to protect themselves from HIV and properly use a condom but students in intervention classes were less likely to believe myths about the disease and be afraid or discriminatory of people with HIV or AIDS.[13] Changes in attitudes towards people with AIDS is very important to promote among the youth of Alameda County because positive attitudes towards AIDS could help decrease the stigma surrounding the disease and help people be more comfortable being honest with partners about their HIV status. Helping the youth better understand HIV/AIDS is essential to solving the issue of AIDS in Alameda County because the youth is the next generation and if you can prevent the contraction of AIDS early in an entire generation the number of new AIDS cases will dramatically drop in the coming decades.
COMMUNITY EDUCATION
The African American community of Alameda County needs to understand that they are at risk. Many people still do not understand that African Americans have a higher risk of contracting the disease than any other racial demographic. I think that Alameda County needs to do a massive education campaign, through flyers, billboards and media to continue to educate people throughout the county of the existing AIDS problem. This campaign should target, but not be limited to, low income areas and predominately African American areas. Once people understand how the disease is devastating the county people will be more open to educational and prevention ideas.
NEEDLE EXCHANGE
Injection drug use is another contributing factor to the spread of HIV in Alameda County. In 1999, 45% of all people testing positive for HIV at Alameda County health test sites contracted the disease from injection drug use.[14] Not only do methamphetamine and other injection drug users contract and spread the disease through dirty needles but methamphetamine use has also been linked to increase risky sexual behavior which continues the spread of HIV to the rest of the community.[15] The connection between methamphetamine use and risky sexual behavior is linked in a study performed in five Northern California counties, Alameda, Contra Costa, San Francisco, San Joaquin and San Mateo.[15] In the study, which was overseen by the State of California Health and Welfare Agency and the University of California, San Francisco, 1,011 men, 18-35 years old, residing in low income neighborhood completed interviews in which they were questioned in detail on their sexual and drug habits.[15] The study found that recent methamphetamine users were more likely than non-methamphetamine users to participate in risky sexual and drug use practices.[15] Such practices included, not using a condom, having sex for money or drugs, having sex with an injection drug user, having a STD in the past, having sex with an unknown female partner, having anal sex, and having sex with more than one partner.[15] Methamphetamine users are vulnerable to contracting or transmitting HIV and are playing a significant role in the spread of HIV in Alameda County.
In order to help reduce the transmission of HIV by injection drug use, Alameda County needs to expand the already present needle exchange programs. Currently, Alameda County allows needle exchange programs to exist since they declared a state of emergency in 2000.[14] This declaration came in tandem with a California state law that protected needle exchange workers from arrest and legal prosecution.[16] Prior to 2000 Alameda County law enforcement had pretty much allowed needle exchange programs to exist by putting arrests and closures on “low priority.”[16] Alameda County Department of Public Health now funds three mobile needle exchange programs in Oakland which are run by Casa Segra (Safe House) an organization that is working to reduce the affects of drug use on the community and help drug users protect themselves from the negative sides of drug use.
Needle exchange programs like these have made a huge positive impact on HIV transmission and have been found to not promote drug use. They are also able to reach people that would normally not be tested or receive condoms and clean needles because they are located in at high risk areas and are less intimidating than health clinics. San Francisco Department of Public Health (SFDPH) conducted a study that targeted methamphetamine users that practice MSM.[17] The SFDPH created a Late Night Breakfast Buffet that ran from midnight to 4am and passed out condoms, needles, HIV information and food and water at three different locations in at risk neighborhoods.[17] They found that mobile needle exchange programs that run late at night provide a vital service.[17] By expanding needle exchange programs Alameda County can expand the number of people they help.
HIV AND AIDS IN JAILS
HIV transmission in the prison system is also a contributing factor to the AIDS issue within the African American community in Alameda County. Oakland mayor Ron Dellums has suggested that HIV in prison systems is a cause to the increasing number of cases in the African American community. He said on the issue, "That (increasing AIDS cases) can be traced back to the fact that we are sending men back into the community as bullets because they don't know their status, men are coming back HIV-positive."[9] Despite the recent attention in Alameda County, HIV transmission in prisons does not currently receiving the proper attention nationally because the United States government and prison officials are unwilling to recognize the problem. Despite the lack of recognition of a problem by authorities, HIV is spreading in American jail systems through MSM sexual encounters (both consensual and not consensual), and sharing of needles for drug use and tattooing.[18] Currently, HIV is the second largest killer of inmates in the U.S.[18] Despite the severe problem there are very few HIV test being administered in the penal system and thousands of people are contracting the disease while in prison and not getting tested.[18] Upon their return to normal society ex-inmates are unknowingly infecting their partners and spreading the virus. AIDS and HIV in the U.S. jail system is a huge problem that can not be completely solved by people or organizations on the outside. To make a dramatic impact on the issue the U.S. government needs to dramatically overhaul the health care in prisons and provide inmate with access to condom and clean needles. But since the government will not acknowledge the issue this overhaul will not happen anytime soon, risk areas like Alameda County needs to take steps the help solve the problem. The Alameda County Department of Health needs to inform people of the risks of transmission and encourage people coming out of prisons to get tested.
WORKING TO CHANGE THE STIGMA
Possibly the largest problem in managing HIV and AIDS in the African American community is dealing with the extreme stigma that is attached to the disease. Because of past dishonesty of the U.S. health departments and racism, many African Americans have extreme distrust of the health system and of HIV and AIDS information. There are an astounding number of people within the African American community that continue to believe myths and conspiracies about the AIDS virus. In one study 500 African Americans were questioned about different conspiracies that are associated with HIV and AIDS; the study also looked at how these beliefs affected peoples correct condom use.[19] The study found that among other conspiracies 58.8% of people thought that information regarding was being withheld from the black community, 48.2% believed that HIV is a man made virus, 53.4% believe that there is cure for AIDS but it is being given to the poor, and 16.2% believe that AIDS was created by the government in order to control black people.[19] Statistics like these are shocking and demonstrate the uphill battle AIDS workers will have to fight to solve the problem of AIDS in the African American community.
If many African Americans have such distrust of the Public Health system and believe such preposterous myths about the virus how can Alameda County induce change opinions and help reduce the AIDS rates? One way is to combine forces with local African American health organization and churches. But many churches are unwilling to even discuss the issue of AIDS because of the stigma attached to the disease and the uncomfortable discussions the disease raises about sexual orientation and experiences. Those churches that are open to the discussion are unable to fund proper educational programs. A study that examined the barriers that stopped Black churches from creating HIV/AIDS health programs, found that the majority of churches examined did not have any sort of health programs or HIV and AIDS specific programs despite the feeling amongst most ministers that such programs were needed in their communities.[20] Alameda County should fund and work with African American churches to create health and HIV/AIDS programs within the church, so that African Americans can access reliable information about AIDS and discuss the issue in a safe and comfortable environment.
The stigma of HIV/AIDS is not only preventing people from accepting the disease and allowing to people to have misconceptions about the virus, it is also a contributing factor to the spread of the disease. A phenomenon has been created in the African American community called being on the “down low.” This is when African American I men who identify themselves as straight have sex with other men.[21] Men on the “down low” lead heterosexual lives and hide their homosexual activity. Living a double life allows men on the “down low” to have increased risk of contracting HIV but also allows them to pass HIV to their female partners.[21] This group of people is at high risk of contracting and spreading HIV and is very difficult to provide with HIV information and get them tested.[21] Men on the “down low” are an example of the extent the stigma of being gay has taken on the African American community. The issue of men on the “down low” can not be simply solved because it is affected by many different aspects of society. But we can try to change the impact this group of people is having on HIV by alleviating the stigma of HIV/AIDS.
ISSUES THAT COULD ARISE
Although preventing the spread of AIDS is a very important issue, it will be costly to get a handle on the problem. Education programs need qualified teachers and supplies to correctly administer the classes, needle exchange programs need workers and items to distribute and increased testing will raise the cost of health centers. Alameda County is already a poor county with limited funds and other issues to attend to but HIV/AIDS needs to be addressed. If the spread of the virus is not stopped now the situation will only get worse and more costly to contain.
I am optimistic that the new Mayor of Oakland, Ron Dellums, is choosing to address and fight the problem. Hopefully more cities in the county will take his lead and put in place measures to stop the spread of HIV/AIDS.