Better late than never: On Tuesday, the White House launched a national strategy to fight HIV and AIDS, vowing to cut HIV infection rates by one quarter within five years. Astonishingly, this marked the first time that a U.S. administration has formulated a comprehensive plan to battle a disease that has killed more than 575,000 Americans. The strategy came with some fine-sounding words from President Barack Obama by way of introduction. “Our country is at a crossroads,” he stated. “Right now, we are experiencing a domestic epidemic that demands a renewed commitment, increased public attention and leadership.” Few would quarrel with that, and Obama deserves credit for ordering the strategy drawn up in the first place. But the president’s own statements were lacking in one crucial area: As is his wont, he drastically downplayed the importance of race, referring to it not at all in his introductory statement to the strategy, and giving it only the briefest of mentions in his White House remarks.
This evasion verges on the indefensible. To speak of the HIV/AIDS crisis and not give due emphasis to the vast racial disparities that characterize it is absurd. African-Americans number around half the people currently living with HIV or AIDS in the U.S., despite representing only about 13 percent of the total population. Almost 40 percent of those who have died from AIDS in the U.S. have been black. The rate of AIDS diagnoses is approximately ten times higher among blacks than among Caucasians. A black man in the U.S. has a one in 16 chance of becoming HIV positive in his lifetime, compared to a one in 104 chance for his white compatriot. For women, the figures are even more shocking: one in 30 for a black woman compared to one in 588 for a white woman.
If Obama required further grim proof of the racial dynamics at work, he need only look at the city in which he resides. Last year, a Washington D.C. Health Department study found that at least 3 percent of the residents of the District of Columbia were HIV positive or had full-blown AIDS—a statistic that easily meets the technical definition of an epidemic. Around 76 percent of those infected with HIV in Washington are African-American, according to the National Institutes of Health. “Our rates are higher than West Africa,” Shannon L. Hader, the director of the District’s HIV/AIDS administration, told the Washington Post. “They’re on par with Uganda and some parts of Kenya.”
To be fair to Obama, the new national strategy does refer to some of these issues. And Obama has occasionally engaged indirectly with the broader issue of race and HIV. Back in 2006, before the White House loomed, he and his wife took HIV tests during a trip to Kenya, with the intention of lessening the stigma around the virus. And just last month, various experts assembled for a White House meeting on black men and HIV—though the president himself does not appear to have attended.
What has been missing most of all, however, is precisely what might have the greatest effect: a sustained and candid discussion, led by the president, on the destruction wrought on black communities by AIDS—and how to ameliorate it.
Obama is, for obvious reasons, better equipped than anyone else to wade into these waters, in which so many turbulent currents of ethnicity, racism, sex and poverty swirl together. When he has forsaken his “post-racial” approach in the past, the effects have been deeply impressive—not just in the case of the famous Philadelphia speech during the 2008 campaign, but in, for example, his speech on fatherhood to a black church congregation that same year.
Think, then, how great an impact Obama could make were he to undertake, say, a series of town hall meetings or events in African-American churches to address the enormously painful and complex issues that lie at the heart of the black AIDS crisis. There is the stigmatization of homosexuality that feeds into the phenomenon of covertly bisexual black men “on the down low.” There’s the startlingly higher rates of sexually transmitted diseases of all types among African-Americans. The incidence of gonorrhea is 20 times higher among black Americans than white Americans. And a companion study to the one which uncovered epidemic levels of HIV infection in DC last year found that almost half of the people in the areas of the district most intensely afflicted by HIV/AIDS—those areas were located in black neighborhoods—had overlapping sexual partners within the previous year. Only three in ten had used a condom the last time they had sex. And there are the social patterns, such as high rates of male incarceration and an erosion of the nuclear family, that can leave African-Americans at greater risk. The international AIDS charity AVERT has variously noted that men in prison have typically had a high risk of HIV infection; that “women with incarcerated partners were more likely to have other sexual partners”; and that “women, especially those who were poor or had lower educational attainment, were believed to feel dependent on men and more likely to tolerate their partner having concurrent partners.”
The precise effect of some of these factors in relation to HIV and AIDS remains a topic of heated scientific debate. And many in the African-American community are understandably sensitive to commentary that appears to either blame the victim in general or perpetuate dehumanizing caricatures of black sexuality in particular. But it is for this very reason that leadership from the president could be so effective.
Obama’s popularity in the black community could also be utilized to dismantle dangerous myths. Seven years ago, an Oregon State University study found that 48 percent of African-Americans believed that HIV was a man-made virus, and 27 percent thought AIDS was produced in a government laboratory. In one of the Reverend Jeremiah Wright’s infamous sermons, he asserted that the U.S. government had “lied about inventing the HIV virus as a means of genocide against people of color.” In his later, disastrous 2008 appearance at the National Press Club, he continued to hold the door open for such an explanation, arguing that “I believe our government is capable of doing anything.” Obama could shut it.
Finally—and not inconsequentially—the AIDS issue is a perfect if grim illustration of the ongoing inequalities in access to health care that the president’s landmark reforms should, in time, address. African-Americans are roughly twice as likely as Caucasian-Americans to lack health insurance. The difference is thought by many experts to be a major factor causing African-Americans to typically seek medical help only at a later stage of HIV infection than whites—a delay that can have predictably catastrophic consequences.
It is self-evident that the death of anyone from AIDS is a tragedy, irrespective of the color of their skin. It is equally obvious that part of Barack Obama’s political success has stemmed from his ability to present himself in a more nuanced, less racially-charged way than any previous African-American politician. But the AIDS crisis calls for him to take a different approach. Racial disparities are at its core. They must be tackled head-on.
Niall Stanage is a New York-based writer and the author of Redemption Song: Barack Obama—From Hope to Reality.