The New Faces of AIDS

Jeff Henderson remembers the day he finally went to get tested for acquired immune deficiency syndrome. He was living in Washington, D.C., in the mid-1980s and was experiencing classic symptoms of AIDS: swollen lymph nodes, fatigue, and acute body aches. As it happened, Henderson, then a young man working for a federally funded housing program, lived near a well-known provider of AIDS services called the Whitman-Walker Clinic. But Henderson had a hard time getting himself through the door. He walked around and around the block, nervous -- not only about the results.

Henderson is African American. So, largely, was the neighborhood around the clinic, the neighborhood where he lived. Yet the clinic's clientele was mostly white, gay men. Henderson worried: If his neighbors saw him walking in, what would they think?

He eventually did get tested and found out he was infected with the human immunodeficiency virus (HIV) that causes AIDS. But it has taken him a long time to get where he is today, sitting in his Seattle living room -- cluttered comfortably with potted plants, African fabrics, and books by African Americans such as Bell Hooks -- talking openly about his disease.

Henderson's longtime reluctance to talk about his illness is shared by many in the African-American community, where AIDS often is thought of both as a white, gay disease and as God's punishment. Consequently, many have failed to notice a remarkable demographic shift in the AIDS epidemic: If it once made sense in this country to talk about AIDS as a white, gay disease, it does no longer. Today, if anything, AIDS is turning into a black disease.

Since 1996, African Americans have accounted for a greater share of new AIDS cases nationwide than any other racial group. In 2000, the latest year for which data are available from the federal Centers for Disease Control (CDC), African Americans represented 49 percent of reported cases, although they make up only 12 percent of the population. Whites accounted for just 30 percent of cases.

African Americans account for an even greater proportion -- a majority -- of new HIV diagnoses: an estimated 54 percent, according to the CDC.

Neither black nor white communities generally recognize the new demographics, says Phill Wilson, executive director of the African American AIDS Policy and Training Institute in Los Angeles. "Every time I tell people that, they're absolutely shocked," he says.

Locally, the number of African Americans with AIDS is not as high, given that less than 4 percent of the state's population is black. Even so, African Americans account for 17 percent of both AIDS and HIV cases reported in the state between 1998 and the present, a figure representing more than four times their share of the population.

The numbers come as no surprise to public-health professionals. Dr. Helene Gayle is a former head of the CDC's AIDS program who now directs AIDS-related giving at the Bill and Melinda Gates Foundation: "The first time we wrote about it in a report was 1985. Even at that time, there was a disproportionate impact -- 25 percent of AIDS cases were among African Americans."

The epidemic was simply going where epidemics usually go, she explains: into "communities of the disenfranchised" -- those with poor access to health care, high rates of drug use, and other social burdens that fuel disease.

Yet at the highest political levels, there sometimes have been reasons for turning a blind eye to this phenomenon. Al Jonsen, a retired chair of the University of Washington's department of medical history and ethics, headed a National Academy of Sciences committee that in 1993 produced a report predicting the rise of AIDS in communities of color. In an e-mail, Jonsen remembers that the report "was severely criticized by Dr. David Rogers," then vice chair of the National Commission on AIDS, "who feared that our message would jeopardize the current political approach to getting AIDS funding, namely that the epidemic was a threat to all citizens equally."