There are some predictions that HIV will not be controlled until the middle of the next century and that it may continue to devastate developing countries for the next 100 years.
HIV is a unique human RNA virus, capable of infecting cells of the immune system.
V.-positive, the other negative; they lived in the neighborhood locals call the Bottom, where every fifth or sixth home is abandoned, with broken windows, doors hanging off hinges, downed limbs and dry leaves blanketing front yards. As they headed to and from a doctor’s appointment and a meeting with a counselor, Sturdevant, slow-talking and patient, with eyes that disappear into his cheekbones when he smiles and a snowy beard, gently grilled him, reminding him to stay on his meds. Everybody knows everybody else in Jackson’s small, tight-knit black gay community, and most men will find their sexual partners in this network. boils down to a numbers game rather than a blame game: If the virus is not present in your sexual network, you can have unprotected sex and not get infected. — and many don’t know it and go untreated — any unprotected sexual encounter becomes a potential time bomb.
Pulling off his favorite Dallas Cowboys baseball cap and running a hand over his bald head, Sturdevant added softly, “Breaks my heart.”These patients of Sturdevant’s are the faces of one of America’s most troubling public-health crises. Finally, my thought was, I just want to get out of here.” He moved to Dallas, and then to Memphis. “I was weak, had a fever of 103, couldn’t even keep down water,” he recalled. Healthy people do not contract a disease like PCP, which had been largely confined until then to patients on medication to suppress their immune systems for an organ transplant or cancer patients on chemotherapy. treatment and care for those who have no other way to finance their medication. The largest international health initiative in history to fight a single disease, Pepfar is considered a success story by any measure and a crowning achievement of George W. Yet while buckets of money went overseas, domestic funding for H. V./AIDS remained flat, and efforts to fight the disease here were reduced to a poorly coordinated patchwork affair. is only a problem in sub-Saharan Africa, and that message filtered down to the public. globally, the havoc that it wreaked on the domestic epidemic has been long-lasting.”Beginning in the late ’90s, the United States government funneled billions of federal dollars into abstinence-until-marriage programs here and abroad. “Plus, these are the same individuals that are dealing with structural barriers around lack of employment, lack of education and opportunities, transportation and, of course, very, very overt institutional racism.”An elevated viral load in a smaller sexual network (because most people still tend to have sex with people of the same race), amplified by the structural issues that Moore pointed to, also explains why H. But in the first decades of the epidemic, these ideas and explanations had not been widely accepted to explain the growing body of data pointing to fast-rising numbers of H. In fact, the African-American community was largely in denial about the fact that H. The community’s awakening came in 1991, when Magic Johnson tearfully announced, “Because of the H. I was an editor at Essence in 1994 when the magazine’s editor in chief, Susan L. among African-American women by putting Rae Lewis Thornton, a Chicago woman who described herself as “young, educated, drug-free and dying of AIDS,” on the cover. cases and deaths among black women, there was a lack of empirical evidence to clearly explain why the rates were so high. infection among African-American women was a result of a complicated combination of all these factors, as well as the reality that after decades of denial and neglect, the viral load piled up in black communities, making any unprotected sexual encounter with anyone a potential “bridge to infection.” But two decades ago, in the midst of a very scary, fast-growing epidemic, the down-low brother became the AIDS boogeyman. I assure you that none of the brothers on the down low like me are paying the least bit of attention to anything you have to say.”King’s subsequent 2004 book, “On the Down Low: A Journey Into the Lives of Straight Black Men Who Sleep With Men,” appeared on the New York Times best-seller list for a number of weeks and spawned two “Oprah” shows, an episode of “Law & Order S. U.,” a BET documentary, a sequel by King and another book by his ex-wife. On Wednesday evenings once a month, Sturdevant runs an H. V./AIDS support group in a stark conference room near the State Capitol in Jackson.
AIDS denotes the later stages of the disease and is not diagnosed until the patient has developed a significant OI or the CD4 cell count in the bloodstream falls below 200 (normal is 500 to 1,000 cells per milliliter).
Therefore, infection with HIV does not necessarily mean AIDS, but all patients with AIDS have HIV infection.It is also important to note that HIV research may lead to advances in the treatment of other viral infections, as well as cancers, metabolic diseases (diabetes, high cholesterol) and other immune system disorders.The major needs for the future include an effective preventive vaccine, new drugs, better understanding of the long-term side effects of the current drugs and improved health care delivery to people in the developing world.And destruction of CD4 cells renders a patient vulnerable to unusual opportunistic infections (OIs) that are rarely seen in healthy humans.Most patients who die from AIDS succumb to one or more OIs. Sturdevant is a project coordinator at My Brother’s Keeper, a local social-services nonprofit. After a while a young man emerged, shirtless, shrugging off sleep. Sturdevant handed him the package, shook his hand and told him to “stay out of trouble.”Sturdevant drove on another 15 minutes to pick up Marq (a shortened version of his name to protect his privacy), a teenager who was still reeling from the H. He looked up briefly when Sturdevant told him, “You’ve come a long way. In Jackson, a small city of just over 170,000, half a dozen black gay or bisexual men receive the shock of a diagnosis every month, and more than 3,600 people, the majority of them black men, live with the virus. who don’t know they have been infected, which means they are not engaged in lifesaving treatment and care — and are at risk of infecting others. as an underlying cause, with the highest death rates in Mississippi and Louisiana. Sturdevant, born and raised in Metcalfe, a tiny Mississippi Delta town of about 1,000, understands all too well the fear, stigma and isolation that can come with being a black gay man in the South. “I just don’t know how everything got so bad.”Given the advances in research, information and treatment, it seems inconceivable that someone living with the virus today, like Jordon, could look as if he had stepped out of the early years of the epidemic. Barbara Lee, the longtime United States representative from Northern California, has signed her name as a sponsor to every piece of major federal H. V./AIDS legislation since she was first elected in 1998. He pointed to stacks of studies over the years, including a groundbreaking, exhaustive 2006 data dive led by Greg Millett that was published in The American Journal of Public Health. Sturdevant banged on the door of a small house, its yard overgrown with weeds; he knew not to leave the package on the doorstep, where it could be stolen. The teenager slumped in the back seat, half listening, half checking his texts. V.-related death rate was seven times as high as that of the United States population at large. Community organizations became targets of anti-gay crusades, subjected to intense scrutiny, including exhaustive audits, by federal agencies. Most scientists now believe that risk of contracting H. But if you are in a community, like Jackson, where a high percentage of gay and bisexual men are infected with H. This explanation of “viral load” helps dispel the stubbornly held notion that gay and bisexual black men have more sex than other men, a false perception embedded in the American sexual imagination and fueled by stereotypes of black men as hypersexual Mandingos dating back to slavery.“Black men are not just out here having unprotected sex willy-nilly; the science disproves that,” said Terrance Moore, deputy executive director of the National Alliance of State and Territorial AIDS Directors in Washington.Thanks to the success of lifesaving antiretroviral medication pioneered 20 years ago and years of research and education, most H. V.-positive people today can lead long, healthy lives. for several key populations, predicted that if current rates continue, one in two African-American gay and bisexual men will be infected with the virus. The South is also home to 21 of the 25 metropolitan areas with the highest H. Sturdevant has shared his story too many times to count, to let young men know that he has been there, too, and to help them understand that they can survive this plague. “I honestly didn’t believe it.” He paused and then added quietly, “It was the worst day of my life.”With effort, Jordon sat up slightly, untangling himself from a jumble of sheets. diagnosis and the illness are so overwhelming that maintaining a new and unfamiliar regimen of medication can be difficult. “Not as often as I should.” When he saw Sturdevant’s glare, he continued, sounding like a little boy. I have to take six pills, now seven, eight, plus a shot —”Sturdevant cut him off. Though not stated explicitly, the language of the report, by omitting race, implied that its “five young men, all active homosexuals,” were white, which they were. V./AIDS, treated Rock Hudson before he died of AIDS complications in 1985 and still practices in Los Angeles. through a blood transfusion in the ’80s, this federal program provides funding for H. “When we saw that the epidemic was out of proportion in the black community, we started calling for a domestic Pepfar that would bring new resources to the effort, create clear and ambitious objectives and rebuild health care infrastructure around the country,” Lee said. for 14 years and a senior policy adviser for the Obama administration’s White House Office of National AIDS Policy, put it more candidly. Though the Bush administration did wonderful work in combating H. In place of effective sex education, these programs often discouraged condom use while teaching abstinence as the only way to prevent the spread of AIDS — even as well-regarded research established that this kind of sex education does not lower the risk of contracting H. Taylor, insisted that we shine a light on the disturbing increase of H. I had been writing about AIDS in the black community since the mid-’80s but had never seen anything like the coordinated efforts that started in the late ’90s, when civil rights groups, politicians, clergy, fraternities and sororities and celebrities stepped up to encourage testing and distribute prevention information. and other agencies offered plenty of alarming statistics confirming the high and growing numbers of H. Experts in academia and government researchers tried to unravel a knotted tangle of factors: Women were contracting the virus from bisexual men; higher rates of sexually transmitted infections among black women facilitated the spread of H. V.; socioeconomic issues drove up the rates of all disease. Ta-Nehisi Coates jumped into the fray in a 2007 essay for Slate that questioned why the myth of the “on-the-down-low brother” refused to die, referencing a controversial 2003 cover story in this magazine by a white writer who went into the scene to uncover closeted black men who lead double lives. diagnoses among African-American women plummeted 42 percent, though the number of new infections remains unconscionably high — 16 times as high as that of white women. The meetings end promptly at p.m., so the dozen or so young men can race home to watch “Empire.” Sturdevant began October’s gathering with a prayer.In cities like New York and San Francisco, once ground zero for the AIDS epidemic, the virus is no longer a death sentence, and rates of infection have plummeted. Last year, the Centers for Disease Control and Prevention, using the first comprehensive national estimates of lifetime risk of H. That compares with a lifetime risk of one in 99 for all Americans and one in 11 for white gay and bisexual men. If gay and bisexual African-American men made up a country, its rate would surpass that of this impoverished African nation — and all other nations. He also knows that many black gay and bisexual men have been rejected and discarded, and has wrapped his arms around as many as he can grab hold of, treating them like family. He feeds them, sometimes houses them, but mostly listens to them. Sturdevant asked how he was doing, and he cataloged a laundry list of what he called his “old man” ailments. But there were two more documented cases, not mentioned in the notice, and these sixth and seventh cases were black — one of them a gay African-American, the other a heterosexual Haitian. Gottlieb said he is often asked why he didn’t include in that first report the documented case of the gay African-American man, who had both PCP and cytomegalovirus, a virus that attacks the organs of patients with compromised immune systems. “But we just couldn’t get the administration to focus on a domestic plan.”Greg Millett, a senior scientist for the C. “During the Bush years, the administration dropped all pretense that they cared about AIDS in this country,” said Millett, who is now the vice president and director of public policy at amf AR, the Foundation for AIDS Research. All the major black publications collaborated in a highly visible campaign to spotlight the disease as a major health crisis. testing — and the number of congregations participating in the Black Church Week of Prayer for the Healing of AIDS ballooned to more than 10,000. The lack of research to create a coherent explanation was further confounded by a reluctance on the part of some scientists and activists to perpetuate the dangerous myth of black women as sexually promiscuous — another holdover from slavery. in high numbers, provided a “bridge to infection” to black heterosexual women, a phrase I first heard from researchers at a medical conference. In my reporting for both The Times and Essence, I found no shortage of anecdotal accounts of H. V.-positive women who were infected by male partners who had been having sex with other men in secret. This idea made a certain amount of sense in the frustrating absence of scientific data. Keith Boykin, a former Clinton White House aide, became so incensed by the down-low hysteria that he wrote a 2005 best-selling book, “Beyond the Down Low: Sex, Lies and Denial in Black America.” “Because the whole down-low story was doing a disservice to the black gay community and creating a racially troubling narrative that black men who have sex with men were villains, I felt I had to step in and correct the record,” said Boykin, a CNN commentator who teaches at Columbia University’s Institute for Research in African-American Studies. and black gay and bisexual men, wrote a heartfelt open letter to the talk-show host. “Hold hands and bow your heads — and take off that hat,” he said to Tommy Brown, who had rushed in from his job at Popeyes.Specifically, HIV targets T helper cells (CD4 cells), leading to the eventual death of the cell.CD4 cells are vital players in the regulation of immune responses to invading microorganisms.