Brentin Mock is a staff writer at CityLab. He was previously the justice editor at Grist.
Cities in the South are experiencing record-high rates of HIV infection among African Americans.
Pope Francis sent a message of hope to the International AIDS Society’s 8th Conference on HIV Pathogenesis, Treatment and Prevention this past summer. He told participants, “that all advances in pharmacology, treatment, and research will be matched by a firm commitment to promote the integral development of each person as a beloved child of God.”
That blessed match probably seems like little consolation to HIV patients whose pharmaceutical treatment options are becoming prohibitively expensive. Fortunately, there have been great advances made over the decades in treating and managing HIV and AIDS. But they seem out of reach for young, black men living with HIV in the urban South, where diagnoses for the virus and the disease AIDS have reached crisis levels.
It used to be that the cities like New York, D.C., and Philadelphia—the cities the Pope is visiting on his U.S. trip—were the epicenters of HIV and AIDS problems. Today, it’s cities like Atlanta, where black, gay men under the age of 18 are showing HIV incidence rates of nearly 12 percent annually. This is the highest HIV incidence rate ever recorded among a population in a developed country, according to research from the Emory School of Public Health in Atlanta. Emory researchers report that a young black man who has sex with other black men in Atlanta has a 60 percent chance of becoming HIV positive before he reaches age 30.
This is a Southern regional crisis. Of the top 10 metropolitan areas with the highest rates of new HIV diagnoses, all of them are in the South, according to the Centers for Disease Control and Prevention. Black women have been equally victimized, if not more, by HIV and AIDS in the urban South. And then there are the black children born into a life of HIV, adding to the list of stigmas they’ll face growing up.
Pope Francis’ message to the International AIDS Society conference was addressed to Dr. Julio Montaner, the director of the British Columbia Center of Excellence in HIV/AIDS at St. Paul’s Hospital in Vancouver. In response, Montaner said that Pope Francis understood the HIV problem better than some scientists. The conference’s major focus was on ensuring early HIV treatment for the world’s poorest and most vulnerable. Those people are living in U.S. cities like Atlanta, where high HIV rates are largely the consequence of a lack of quality health insurance, as the Emory study found.
Other significant contributing factors identified by Emory researchers were unemployment and incarceration. Given that those are both priority concerns for the pope, and he grasps the extent of the HIV problem, maybe he should make an unscheduled stop in Atlanta, where all of those problems converge.
Lest anyone think that young, black men’s own sexual behavior is a reason for the HIV crisis in their community—something perhaps even a pope this merciful might frown upon—Emory researchers ruled that out as major contributor. In their study, they found that black men have lower rates of unprotected sex with other men then do white men. As the National AIDS Manual (NAM) AIDSmap news site explains about the Emory study:
The investigators did a multivariate analysis to find out what factors might explain higher HIV incidence in black men. In this analysis, black men had 2.9 times the HIV risk of white men. The researchers selected a risk factor and calculated by how much black men’s incidence would still exceed white men’s if this risk factor was adjusted to the mean for the whole cohort. For instance: they found that if the rate of unprotected sex in black men was the same as the average rate for the whole cohort, their risk of HIV would actually rise to 3.3 times the risk in white men: this was because black men were actually having less unprotected sex, and this acted to some degree as a moderating factor.
The network effect was by far the strongest factor: if black men selected their sexual partners from black or white men randomly, it was found, their risk would fall to 1.6 times the risk in white men, which would no longer be a statistically significant excess. If health insurance was added to this, it would reduce the excess risk to 1.5 times the risk in white men. Although analysis of these factors was not presented, presenter Eli Rosenberg said that if incarceration and unemployment were added into the mix, then taken together these four factors entirely accounted for black men’s excess risk of HIV.
The pope is arriving in the U.S. at a critical moment of “black lives matter” discourse around police violence, and how the nation’s world-leading incarceration rates are largely driven by imprisoning African Americans. But HIV prevention and access to health care was part of the “Movement for Black Lives” national convening in Cleveland this past July.
It would be dope if the pope weighed in on police violence against African Americans. But it would be more in his bailiwick to address the injustice of governments failing to provide the necessary funding and resources to address this clear HIV public health emergency in the South. The situation is so bad in Atlanta that half of the patients that were newly diagnosed with HIV when admitted to the city’s Grady Hospital emergency room this year already had full-blown AIDS. This is not just because HIV wasn’t identified and treated early enough in these patients, but because many of them are too poor for the medical care that would have identified the virus to begin with.
New York and D.C. have found ways to mitigate and contain HIV, mainly through applying proper funding to the problem. But Southern states have refused to accept Medicaid and Affordable Care Act federal funding, along with rejecting federally targeted HIV treatment funding in general. The Centers for Disease Control and Prevention actually changed its funding strategy in 2011 so that cities could get HIV funding directly, bypassing states. But in Fulton County, which encompasses a huge part of Atlanta, the health department has been sending millions of dollars in HIV funding back to the CDC, claiming a lack of capacity to administer them.
As if that’s not bad enough, HIV itself is being criminalized in some places, adding to the incarceration problem. In St. Charles County, outside of St. Louis, college wrestling star Michael Johnson, an African American, was sentenced to over 30 years in prison after men accused him of infecting them with HIV. A panel of CDC and U.S. Justice Department issued a guidance to states on reforming HIV-criminalization laws that states:
While HIV-specific state criminal laws may be viewed as initially well-intentioned and necessary law enforcement tools, the vast majority do not reflect the current state of the science of HIV and, as a result, place unique and additional burdens on individuals living with HIV.
Pope Francis would do well to help hammer these points home, especially when he addresses Congress. And when he’s done blessing the northeastern corridor, he needs to head to Atlanta.