July 13, 2010

THE LOW DOWN ON THE DOWN LOW:

"The View" silent on HIV misstep: GLAAD calls out ABC for spreading misinformation about black women and AIDS, and the network stays quiet (Tracy Clark-Flory, 7/12/10, Salon)

On Monday, GLAAD stepped up its campaign to get ABC to correct a careless myth it recently promoted on-air about HIV and black women. The organization chose that favorite escalation strategy of the entertainment industry: a full-page ad in Variety.

On the June 22 episode of "The View," guest co-host D.L. Hughley announced with seeming authority: "When you look at the prevalence [of HIV] in the African American community, it's primarily young women who are getting it from men who are the down low." In case you missed the fear-mongering episode of "Oprah" that introduced middle America to the concept, a black man is said to be "on the down low" when he is in a straight relationship but secretly sleeps with other men.

The buzzterm has been used to explain the alarmingly high rate of HIV among African Americans and the skyrocketing rate of new infections in black women. But, as is often the case with catchy phrases of the moment, it's too easy an answer, and it's been thoroughly debunked as a causal (or even correlative) theory. Black women are far more likely to contract HIV by having unprotected sex with a man who uses intravenous drugs or has multiple partners.


HIV Risk Behaviors Among African American Men in Los Angeles County Who Self-Identify as Heterosexual (U.S. Centers for Disease Control and Prevention,
November 12, 2002)
The current study examines risk behaviors in a case-control study of 90 HIV-infected and 272 uninfected African American men in Los Angeles County who self-identified as heterosexual. Thirty-one percent of the infected men and sixteen percent of the uninfected men reported having anal sex with men. Among that group, 100 percent of the infected men and 67 percent of the uninfected men reported inconsistent condom use during anal sex with men. Few of the infected (12 percent) or uninfected (2 percent) men reported oral sex with other men. Forty-six percent of the HIV-positive men and 37 percent of the HIV-negative heterosexuals reported anal sex with women with infrequent condom use.

Whatever Happened to AIDS and Straight Men? (Kevin Gray, March 2004, Details)
Straight men and women make up 90 percent of the population, but they account for only 15 percent of non-childhood AIDS cases. Only 6 percent of men with AIDS, the Centers for Disease Control and Prevention says, contracted the virus from straight sex. And even that figure doesn't hold up to a closer look. Several studies now suggest that most men who claim they got the virus this way are lying. They got it from sex with other men or sharing needles with addicts. Those studies also show that many women listed in the straight-sex category are either IV-drug users themselves or have likely contracted AIDS from sex with an IV drug user.

Health officials have known these things for years. A growing pile of federally funded reports on HIV transmission, published over the past decade and available to anyone who has the time to read them, shows that men almost never get HIV from women. In fact, according to a 1998 study in the Journal of the American Medical Association, a disease-free man who has an unprotected one-nighter with a drug-free woman stands a one in 5 million chance of getting HIV. If he wears a condom, it’s one in 50 million. He’s more likely to be struck by lightning (one in 7000,000).

Female to male transmission is very inefficient, says Dr. Nancy Padian a professor in the department of obstetrics, gynecology and reproductive science at the University of California, San Francisco and the author of a 1996 10 year study of HIV infected heterosexual couples, the nation's longest and largest. She points out that “its two to three times easier for men to infect women.” But even so, if there are no other risk factors involved, the rate at which an infected man will transmit the virus to a woman is one in 1,100 sex acts.

Today it’s clear that the AIDS epidemic in the United States peaked in 1993 when 106.000 new cases turned up [A & W note: The 106,00 new cases referred to above were added by reclassifying past and present HIV positives under an expanded definition of AIDS instituted in 1993. This broadened definition included more types of pneumonia, women with cervical cancer, and the non-illness criteria of a lab test of 200 or less T cells that has since been the determining factor for an AIDS diagnosis in at least 50% of all new cases. AIDS cases had actually leveled off by 1992 and increased only due to the expanded definition, a fact omitted from this article]. Then it began a slow decline and has now leveled off to 40,000 new cases a year. Thanks to powerful anti-retroviral drugs that allow HIV-infected people to live longer, AIDS deaths have plummeted 14 percent since 1998, falling in 2002 to a new low of 16,371.
[A & W note: The figure cited above of 40,000 new AIDS cases a year is an error. Rather, official estimates claim there are 40,000 new HIV infections annually in the US. The notion there are 40,000 new HIV positives each year however is derived from an unsubstantiated estimate and calculated by dividing the high end total of estimated HIV positive Americans (around 900,000) by the number of “AIDS years” (around 20). Also, the “powerful new AIDS drugs” thought to be responsible for decreased deaths were introduced in 1996, not 1998 as the articles states, which is a year after AIDS deaths had already peaked. Futher, there is still no published data in the mainstream medical literature showing that these new drugs increase life expectancy, improve clinical health, or prevent the illnesses associated with AIDS. And no AIDS drug since 1986 has ever been tested against a true placebo control.]

Clearly, a single death from this illness is one too many. But AIDS is not killing Americans at the levels of cancer (554,000 deaths in 2001), diabetes (71,000), or Alzheimer’s (54,000). In fact, the CDC has not put the disease on its list of the top 15 killers since 1998.

America may be winning the war on AIDS, but not without collateral damage. After two decades, we are still overwhelmed with misinformation and misconceptions about how the virus spreads. Straight men are still haunted by the notion that old-fashioned sex can be lethal. Among the biggest fear factors, some AIDS educators say, is shoddy federal health data. The CDC statistics are only good as the local health departments that gather them. But many of those departments don’t have time or resources for “surveillance” staff to investigate every person’s claim of how they contracted the virus. If a man wants to lie about having had sex with other men, he can, and that makes it look like more people get AIDS from straight sex than really do. By re-interviewing victims, their doctors, and their families, Chicagohealth officials found in 1997 that in 85% of the cases the city had blamed on heterosexual transmission, other risk factors were present. This phenomenon became a source of black humor at New York City’s overworked health department in the late eighties. “What do you call a man who got HIV from his girlfriend?” the joke went. “A liar.”

The truth is out there, but its not reaching people who have been needlessly scared—the result, some critics charge, of a conspiracy of silence. “It’s not in anybody’s interest to clear this up,” says Joseph Sonnabend, a physician who treated some of New York City’s first AIDS cases. Sonnabend, helped found what later became the American Foundation for AIDS Research (AmFAR), But he quit the group in the mid-eighties when it claimed—falsely, he believed—that a heterosexual epidemic could be coming. “Gay men don’t want it fixed because they’ll be blamed again for the disease,” Sonnabend says. “Charities like AmFAR don’t want it fixed because they’ll lose their funding. And “straight” men with HIV certainly don’t want it fixed because then everybody will know they’ve been having sex with men. Those are the ones who will scream bloody murder if you print all this stuff. You’re outing the poor bastards.”

Any overhaul in America’s AIDS policies has to begin with an overhaul of public perception away from the anyone-can-get-AIDS mentality. That means looking at the cultural forces that originally shaped that perception and continue to do so today. Many scientists now say that the first major public awareness program, 1987’s America Responds to AIDS campaign, was not only largely wasted on mainstream America but deadly to those most at risk, drawing precious funds from the very people AIDS was attacking: gays, bisexuals, drug addicts, and the poor.



Posted by Orrin Judd at July 13, 2010 5:09 AM
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