The biggest killer among young black men

There is a vast, silent tragedy unfolding in this country whose scale is barely acknowledged, a scourge that has reached into the black community, particularly its poorest ranks, and is strangling it slowly, painfully, to death. AIDS.

While AIDS is declining in the white community its incidence in the black community (but not Hispanic or Asian) is soaring. AIDS is now the single biggest cause of death among African-American men aged between 25 and 40, who are now 10 times more likely to die of the disease than whites.

By the end of December 1999, the Centre for Disease Control had received reports of 733,374 AIDS cases in the US - of those, 272,881 cases occurred among African Americans.

While representing only an estimated 12 per cent of the total US population, African-Americans make up over one third (37 per cent) of all AIDS cases.

The rate of reported AIDS cases among African-Americans was 66 per 100,000 population, more than two times greater than the rate for Hispanics and eight times greater than the rate for whites.

Researchers estimate that 240,000325,000 African-Americans - about one in 50 men in their community and one in 160 women - are infected with HIV. By comparison, one in 250 white men and one in 1,000 white women are infected.

Of those infected with HIV, it is estimated that almost 118,000 African-Americans were living with full-blown AIDS at the end of 1998.

Almost two-thirds of new cases reported among women (63 per cent) and children (65 per cent) were African-American.

The causes are straightforward, the remedies less so and complicated by the community's own sense of isolation and oppression. Among African American men with AIDS, men who have sex with men represent the largest proportion (37 per cent) of reported cases since the epidemic began. The second most common exposure category is injection drug use (34 per cent), and heterosexual exposure accounts for 8 per cent of cumulative cases.

Among African American women, injection drug use has accounted for 42 per cent of all AIDS case reports since the epidemic began, with 38 per cent due to heterosexual contact, much of it apparently associated with the trading of sex for drugs. Public health messages are falling on deaf ears. Some simply distrust the government; within the community there are still strong prejudices against homosexuality, attitudes to condom use are extremely casual, and drug abuse is rampant in the ghettos.

Others believe that AIDS is a form of genocide aimed directly at them. Dr Abdul Alim Muhammad, a physician and minister of health for the Nation of Islam, has gone so far as to charge that: "Genocide is the policy of the US government."

History plays a large part in this distrust. Past policies of involuntary sterilisation and coercive birth control are viewed by many blacks as clear evidence of genocidal government policies. The most notorious example of medical abuse of black people in the US is well known, the Tuskegee Study of Untreated Syphilis in the Negro Male.

This infamous government experiment used black male syphilis patients in rural Alabama to "study" the natural course of the untreated disease. Without their knowledge, the men were treated with placebos instead of penicillin. They were even given burial money so their bodies would be available for autopsies. Disclosure of the study outraged African-Americans and created an atmosphere of suspicion that now clouds AIDS education, prevention and treatment efforts in the black community. The tragedy is that, once again in the history of AIDS, denial by a community of its own behaviour's contribution to its spread is feeding the epidemic. Bob Herbert, a columnist with the New York Times, argues that only a profound change of self-awareness, on a par with the rise of the civil rights movement, can put a halt to the scourge. The talk today at the presidential inauguration will all be about pulling the country together, uniting, one nation (under God). And the multi-hued Bush Cabinet, we are constantly being told, reflects the real face of America - three African-Americans, two Latinos, one Arab-American, one Chinese-American. . .

One nation. One America? In your dreams, W.