Crime, Sin, or Disease: Drug Abuse and AIDS in the African-American Community

212 Guest editorial CRIME, SIN, OR DISEASE: DRUG ABUSE AND AIDS IN THE AFRICAN-AMERICAN COMMUNITY DAVID SATCHER, M.D., Ph.D. President Meharry Medical College 1005 D.B. Tood Boulevard Nashville, Tennessee 32708 The grim consequences of AIDS and drug abuse weigh so heavily on the African-American community that it is easy to forget that while drug abuse has been with us for generations, AIDS is a relatively recent problem. Prior to 1980, we had not heard of the disease Acquired Immune Deficiency Syndrome (AIDS) or Human Immunodeficiency Virus (HIV) infections. That may be difficult to believe, but it is true. Even in the now famous 1985 HecklerMalone report, The Report of the Secretary's TaskForceon Blackand Minority Health, AIDS was not mentioned.1 That report, which showed that blacks had a life expectancy six to seven years shorter than that of whites; that infant mortality was twice as great in blacks as among whites; and that, in fact, each year 60,000 more deaths occurred among blacks than would occur if blacks had the same age- and sex-adjusted death rates as whites—that report did not mention AIDS as a health problem for blacks. Yet today, just five years later, AIDS has become one of the most severe and devastating health problems ever to confront the African-American community and the world at large. In the United States alone, more than 100,000 people have been diagnosed as having AIDS, and over half of those persons have already died. Over 1.5 million others in this country are estimated to carry the human immunovirus, or HIV.2 In Africa, it is believed that over 3.5 million people are affected and that 600,000 of those persons are children under five years of age.3 In this country, the impact of AIDS falls disproportionately on the minority community. While minorities represent only 24 percent of the population as a whole, 45 percent of the 140,000 reported AIDS cases as of July 1990 involved minorities. Even more striking, blacks constitute more than 51 percent of AIDS Journal of Health Care for the Poor and Underserved, Vol. 1, No. 2, Fall 1990 __________________________Satcher____________________________213 cases among women, and almost 53 percent of the AIDS cases among children. Moreover, a comparison of recent AIDS surveillance reports to older data indicates that the proportionate impact of this disease among minorities is increasing . While minorities comprised 25 percent of AIDS cases in 1988, the proportion increased to 28 percent by 1990.4^ In some inner-city hospitals, hike Interfaith Medical Center in Brooklyn, New York, more than 20 percent of the newborn babies are victims of AIDS, drug abuse, or both. In nearby Rhode Island, authorities recently found that over 8 percent of minority women presenting for delivery were using drugs, and 16 percent of those on public funding were using drugs at the time (including 9 percent using cocaine).6 Such statistics move experts such as Margaret Heagerty , M.D., who chairs the Department of Pediatrics at New York's Harlem Hospital, to express concern about the quiet destruction of an entire generation.7 Our challenge, then, is clear. We must intervene at the level of the community in the form of prevention, early diagnosis, treatment, and rehabilitation , in dealing with this devastating disease. Without question, drug abuse will be a major barrier at each of these stages. Drug abuse and AIDS among African-Americans AIDS or HIV infection is caused by a virus which attacks and debilitates the immune system of the human body, making the victim incapable of resisting infections and having direct and indirect toxic effects upon the cells, including the cells of the brain. AIDS is spread from person to person by the transfer of body fluids such as in sexual intercourse, but also through blood transfusions; through needle exchange in intravenous drug abuse (IVDA); and vertically from mother to child. Overall and especially for men in this country, most of the transfer of AIDS has been by anal intercourse. Homosexual or bisexual men constitute 85 percent of AIDS cases among whites and 44 percent of those cases among blacks, according to a July 1988 Morbidity...