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The Promise of Equality: Fighting HIV Among African Americans

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When President Obama stood on the steps of the U.S. Capitol on Martin Luther King Jr. Day to take his second oath of office, he said, "We, the people, declare today that the most evident of truths, that all of us are created equal, is the star that guides us still, just as it guided our forebears through Seneca Falls, and Selma, and Stonewall."

It was a significant and historic moment for the gay rights movement -- and for the fight against HIV/AIDS among African Americans. Only when we achieve full equality and inclusion of everyone, as the president so boldly envisioned in his inaugural address, will we truly end the AIDS epidemic as we've known it in the United States. On this National Black HIV/AIDS Awareness Day, it is important to reflect on the tremendous progress we've made, and to rededicate ourselves to the hard work still ahead to stop the spread of HIV among people of color and expand access to lifesaving care.

The most recent surveillance report from the U.S. Centers for Disease Control and Prevention shows a 21-percent decrease in new infections among black women. This is tremendously good news, despite the fact that African-American women still make up the majority of HIV/AIDS cases among women nationwide. But we must continue the momentum, not only among women but particularly among young black gay men, who are still suffering greatly in this epidemic.

Between 2006 and 2009, new HIV infections increased 48-percent among young black gay men aged 13 to 29. It is imperative that the public health community now put its full attention toward making significant progress with this group. We owe it to these young men, not just as HIV advocates but as the broader LGBT community, not to let them fall through the cracks. Black gay men and their transgender sisters are at the intersection of multiple communities and civil rights struggles -- the exact ones President Obama spoke of: Seneca Falls, Selma and Stonewall. They are key constituents of each and deserve targeted attention to address this persistent crisis. As the president said, our journey as a nation is not complete until we all achieve the promise of full equality. That means lifting up the most marginalized among us. That means lifting up young gay black men.

This work begins with reducing HIV stigma in the black community so that testing becomes routine and access to care is a given for those who test positive. According to a recent survey of HIV testing practices among African-American primary care physicians, although 80 percent support routinizing HIV testing, only 55 percent report routine screening (rather than risk-based testing) as the primary reason for testing their patients. Furthermore, physicians report testing only one third of their patients for HIV in the past year. HIV stigma and fear of offending their patients were top reasons for not recommending HIV testing. This must change; black physicians must begin to view routine HIV testing as a standard of medical care, not a judgmental statement about their patients.

Identifying undiagnosed HIV infections may be aided by the U.S. Preventive Services Task Force's policy shift toward routinizing HIV testing -- and ensuring that insurance companies pay for it. The task force's recent draft recommendation that clinicians screen all patients aged 15 to 65 for HIV infection would guarantee that insurance plans be required to cover not just diagnostic HIV testing but routine screening. This change is especially critical for the African-American community, where so many cases remain undiagnosed and contribute to the high rate of new HIV infections among black gay men.

By increasing HIV status awareness among disproportionately affected African-Americans, we can take full advantage of our new biomedical understanding of the value of treatment as prevention. This approach improves health outcomes for the individual, and for the greater community. The now-famous HPTN 052 study found that early treatment reduced transmission risk by 96 percent in heterosexual couples -- a breakthrough that provides us with a roadmap to ending the epidemic nature of HIV. Although the current data come nearly exclusively from heterosexual couples, there is broad belief in the research community that maintaining an undetectable viral load with effective HIV treatment may render individuals, gay or straight, virtually noninfectious to their sexual partners.

To capitalize on this astounding breakthrough in HIV prevention, we need continued leadership from public health departments across the country. The San Francisco Department of Public Health, for example, has led this charge by backing its own "treatment and linkage to care" model with policy and resources. Biomedical breakthroughs are for naught if health departments at the state and local levels do not embrace and implement the science. The federal government, too, must continue to invest in ongoing research; budgetary crises are moments when priorities must be identified and protected. The historic advances we are seeing today in science, HIV treatment and prevention and health outcomes must be prioritized, celebrated and preserved.

From the federal government to the community health clinic to the kitchen table, there is a space for each of us to muster our strengths and tackle the structural and social barriers that impede access to HIV testing, treatment and care and support services -- barriers like stigma, discrimination and economic hardship that continue to drive HIV infections among African Americans, and among black gay men in particular. Our community has a long history of well-founded distrust of public health practices. With the passage of the Affordable Care Act, we have an opportunity to break that cycle of distrust, to create a generation that embraces preventive health care and to topple the barriers that contribute to stark health disparities in the black community.

In order to realize this opportunity, black people will have to actively seek health care knowledge. We must educate ourselves about the health care insurance "marketplaces" and pick plans that meet our individual health care needs. We must take advantage of the many financing plans available to make these plans affordable. And we must not delay. Delays in enrollment in these insurance plans will raise questions about the value of the Affordable Care Act and put one of this country's greatest achievements at risk for repeal.

We are living in a unique moment of change and discovery. We must take advantage of the promises these advances provide us. Let's move forward together and end the epidemic as we know it.