AIDS and the African American Male – Sounding the Alarm
The Statistics
African Americans are at greater risk of a variety of diseases than are white Americans. Nowhere is the disparity greater than in the statistics on HIV/AIDS. According to data collected by the Centers for Disease Control and Prevention (CDC) in 2002, African Americans accounted for about 21,000 or almost 54% of the diagnosed AIDS cases among adults. The AIDS diagnosis rate among African Americans is almost 11 times the rate among whites. The rate for African American women was 23 times the rate for white women. By the end of 2002, more than 185,000 African Americans ( Almost 40% greater than the entire Black population of Sacramento County) had died of AIDS. African American AIDS victims had the poorest survival rates of all ethnic groups. In 2000, HIV/AIDS was among the top three causes of death for African American men age 24-54 and African American women age 35-44. African Americans are represented among AIDS cases at 4 times their proportion in the U.S. population.
The California data, though distressing, is not as bleak as the national data. According to data reported by the Kaiser Family Foundation in 2002, African Americans constitute 18% of the diagnosed AIDS cases in California. However, that rate is increasing. African Americans constitute 22% of the new AIDS cases reported in 2002 Statistics on AIDS must are subject to variation and differences in interpretation. In truth, we have a very incomplete picture of the scope of the AIDS epidemic. This is due in part to the nature of the disease. The median time from HIV infection to AIDS is about 10 years in adults, even without effective treatments. As reported on HIVInSite, a web site sponsored by the University of California, San Francisco, this fact has major consequences. “In viewing trends in AIDS cases, we are observing trends in infection patterns mostly from a decade earlier. The most useful data to determine how well the HIV/AIDS epidemic is being controlled are good estimates of the incidence rates of HIV infection in different populations across the country. These data are scarce and are derived for the most part from small local studies.”
So, we really don’t know for sure how many people are infected with the AIDS virus. We do know that African Americans are disproportionately affected. This web page presents information, gleaned from a variety of sources, to provide African American men with some insight into the nature of AIDS, their risk for infection, methods to reduce the risk, and available treatments.
AIDS 101 – The Basics – Terminology and Commonly Asked Questions.
AIDS – A disease caused by infection with HIV. The term AIDS applies to the most advanced stages of HIV infection.
HIV – human immunodeficiency virus (HIV) The organism that causes AIDS.
How does a person get infected with HIV?
The virus can enter the body through the lining of the vagina, vulva, penis, rectum, or mouth during sex. It also is spread through contact with infected blood. Early in the AIDS epidemic, before blood was screened for evidence of HIV infection and before heat-treating techniques to destroy HIV in blood products were introduced, HIV was transmitted through transfusions of contaminated blood or blood components. Today, because of blood screening and heat treatment, the risk of getting HIV from such transfusions is extremely small. Women can transmit HIV to their babies during pregnancy or birth. Approximately one-quarter to one-third of all untreated pregnant women infected with HIV will pass the infection to their babies. HIV also can be spread to babies through the breast milk of mothers infected with the virus.
What are the symptoms? Many people have no symptoms when first infected. Others have a flu-like illness within a month or two after exposure to the virus which may include fever, headache, tiredness, and enlarged lymph nodes (organs of the immune system easily felt in the neck and groin). These symptoms usually disappear within a week to a month and are often mistaken for those of another viral infection.
The progression of the disease is variable from person to person. Some people may begin to have symptoms as soon as a few months after HIV enters the body. For other adults, symptoms may not surface for a decade or more. For children born with HIV infection, symptoms generally develop within 2 years. Though no symptoms are manifest, the virus is actively multiplying, infecting, and killing cells of the immune system.
As the immune system deteriorates, a variety of complications start to take over. For many people, their first sign of infection is large lymph nodes or “swollen glands” that may be enlarged for more than three months. Other symptoms, often experienced months to years before the onset of AIDS, include: lack of energy, weight loss, frequent fevers and sweats, persistent or frequent yeast infections (oral or vaginal), persistent skin rashes or flaky skin, pelvic inflammatory disease in women that does not respond to treatment, or short-term memory loss. Some people develop frequent and severe herpes infections that cause mouth, genital, or anal sores, or a painful nerve disease called shingles
What is the significance of T cell counts?
HIV’s effect is seen most obviously in a decline in the blood levels of CD4+ T cells (also called T4 cells)– the immune system’s key infection fighters. At the beginning of its life in the human body, the virus disables or destroys these cells without causing symptoms.
What is “full blown AIDS?”
CDC’s definition of AIDS includes all HIV-infected people who have fewer than 200 CD4+ T cells per cubic millimeter of blood. (Healthy adults usually have CD4+ T-cell counts of 1,000 or more.) In addition, the definition includes 26 clinical conditions that affect people with advanced HIV disease. Most of these conditions are opportunistic infections, which rarely cause harm in healthy people. In people with AIDS these infections are often severe and sometimes fatal because the immune system is so ravaged by HIV that the body cannot fight off certain bacteria, viruses, fungi, parasites, and other microbes.
Opportunistic infections common in people with AIDS cause symptoms such as: coughing and shortness of breath, seizures and lack of coordination, difficult or painful swallowing, mental symptoms such as confusion and forgetfulness, severe and persistent diarrhea, vision loss, nausea, abdominal cramps, and vomiting, weight loss and extreme fatigue, severe headaches, and coma. AIDS victim are prone to various cancers, especially those caused by viruses such as Kaposi’s sarcoma and cervical cancer, or cancers of the immune system known as lymphomas. These cancers are usually more aggressive and difficult to treat in people with AIDS. Signs of Kaposi’s sarcoma in light-skinned people are round brown, reddish, or purple spots that develop in the skin or in the mouth. In dark-skinned people, the spots are more pigmented.
Many AIDS victims are so debilitated they cannot hold steady employment or do household chores. Others experience phases of intense life-threatening illness followed by phases in which they function normally. A small number of people (fewer than 50) initially infected with HIV ten or more years ago have not developed symptoms of AIDS.
AIDS – A Gay Disease?
In its infancy, the AIDS epidemic was viewed as a problem of the male homosexual community. Later, the disease became identified with intravenous drug users. No longer. The largest proportional increase in the incidence of AIDS has occurred in cases attributed to heterosexual transmission–an almost six fold increase over the last 20 years. This is not to suggest homosexual transmission is inconsequential. Such cases, categorized as “men who have sex with men” (MSM) have declined considerably from 71% in 1983, but it remains high:- 46% nationwide in 1996 and 69% in California. This is contrary to some predictions in the early 1990s that MSM cases would decline to about 25% of new diagnoses.
AIDS – A Man’s Disease?
Although AIDS has moved outside the gay community, it remains a predominately male disease. Over 82% of the cases detected nationally, and 92% of cases in California involve males. However, the trend is otherwise. While only 18% AIDS cases historically have involved women, 26% of the new cases involve women. The trend holds forth in California as well; 13% of new AIDS cases involve women though only 8% have historically involved women. African Americans constitute the vast majority of women infected with AIDS – over 72%. Sixty-two percent of children born to HIV-infected mothers were African American. The leading cause of HIV infection among African-American men is homosexual conduct, followed by drug injections and heterosexual contact. The leading cause of HIV infection among African-American women is heterosexual contact, followed by injection drug use, meaning that African American men are the primary disease carriers to African American women.
How is AIDS diagnosed?
Doctors diagnose HIV infection by using two different types of antibody tests, ELISA and Western Blot. which detect the presence of antibodies (disease-fighting proteins) to HIV. HIV antibodies generally do not reach levels in the blood that the doctor can see until one to three months following infection, and it may take the antibodies as long as six months to be produced in quantities large enough to show up in standard blood tests. Repeated testing is often necessary.
Early testing is important. By getting tested early, the right treatment can be administered at a time when the immune systems is most able to combat HIV and thus prevent the emergence of certain opportunistic infections Early testing also alerts HIV-infected people to avoid high-risk behaviors that could spread the virus to others
Is an AIDS diagnosis a death sentence?
In brief, the answer is no – it is not. Since the peak number of deaths in 1995, there has been a steep decline in AIDS mortality (to 38,780 in 1996 and to 14,499 in 2000) The majority of this decline is probably attributable to the effectiveness of the multidrug treatment regimens that became widespread beginning in 1996, although it is also due in part to the peaking of infection incidence rates in the mid-1980s. (HIVInSite)
Still, for AIDS cases since 1994, African Americans have the poorest survival rate. Only 55% of African Americans survive after 9 years compared with 61% of whites, 64% of Hispanics and 69% of Asians. In 2000, AIDS was the third highest cause of death among African American males age 25-54 and African American women aged 35-44.
Is there a cure?
No, but AIDS can be treated. Most dramatically, if doctors treat mothers with the drug AZT and deliver their babies by cesarean section, the chances of the baby being infected can be reduced to a rate of 1 percent. A Ugandan medical study reported similar results with the antiretroviral drug nevirapine (NVP) given to an HIV-infected woman in labor and another to her baby within three days of birth. Treatment of adult AIDS patients does not yield as dramatic results but is also life extending.
How is AIDS treated?
The Food and Drug Administration has approved a number of drugs for treating HIV infection. The first group of drugs used to treat HIV infection, called nucleoside reverse transcriptase (RT) inhibitors, interrupt an early stage of the virus making copies of itself. Included in this class of drugs (called nucleoside analogs) are AZT (also known as zidovudine or ZDV), ddC (zalcitabine), ddI (dideoxyinosine), d4T (stavudine), and 3TC (lamivudine). These drugs may slow the spread of HIV in the body and delay the onset of opportunistic infections. More recently, a second class of drugs has been approved for treating HIV infection. These drugs, called protease inhibitors, interrupt virus replication at a later step in its life cycle. They include ritonavir (Norvir), saquinivir (Invirase), indinavir (Crixivan), amprenivir (Agenerase), and nelfinavir (Viracept). Because HIV can become resistant to both classes of drugs, combination treatment using both is necessary to effectively suppress the virus.
Researchers have credited highly active antiretroviral therapy, or HAART, as being a major factor in reducing the number of deaths from AIDS in the United States by 47 percent in 1997. HAART is a combination of several drugs to treat patients. These drugs include reverse transcriptase inhibitors and protease inhibitors. Patients who are newly infected with HIV as well as AIDS patients can take the combination.
Can AIDS be prevented?
Most certainly Overall, the rate of HIV infection in the United States has slowed from over 150,000 cases per year in the mid-1980s to the current estimated 40,000 annually. There has been a 50% decrease in HIV infections among white gay males in the United States between 1988-1993, a more than 40% decrease among selected populations of injection drug users and a 75% decrease in perinatal infections according to surveys in selected cities.
Guides to Prevention:
ABSTINENCE is the only sure method of preventing sexual transmission of the disease
SAFE SEX – CONDOM USE. Use of latex condoms offers partial protection, during oral, anal, or vaginal sex. Only condoms made of latex should be used, and water-based lubricants should be used with latex condoms.
Although some laboratory evidence shows that spermicides can kill HIV, researchers have not found that these products can prevent a person from getting HIV.
For unborn babies: early detection of HIV in the mother, treatment with AZT and cesarian delivery can prevent AIDS.
Know your HIV status. The Centers for Disease Control recommend routine HIV testing among persons in high risk (males who have sex with other males and injection drug users)