By Amy Nunn, Gary J. Bell and Robert K. Burns
Some 30,000 global AIDS activists, scholars and people living with HIV/AIDS gather together at this week’s International AIDS Conference in Vienna, Austria. While the conference focuses on the global AIDS epidemic, it’s also important to remember that nearly 1.1 million individuals in the United States live with HIV, and 1 in 4 HIV-positive people are unaware of their status. HIV-positive individuals aware of their status tend to reduce numbers of sexual partners and increase condom use; however, the CDC estimates nearly 70% of new sexually transmitted HIV infections are unintentionally spread by people who don’t know they’re infected.
Philadelphia is among six major US cities with the highest HIV infection rates in the nation. Philadelphia’s HIV infection rates are five times higher than the national average and one and a half times those of New York City, which historically been considered the epicenter of the US HIV/AIDS epidemic. The face of the local epidemic has changed: what began in the 1980s as a disease that disproportionately affected white gay men has become a heterosexual epidemic; more than half (55%) of Philadelphia’s new infections are among heterosexual individuals. Nearly 70% of new infections are among African Americans.
In spite of these high infection rates and shocking health disparities, too few Philadelphians have tested for HIV. This can be attributable to several factors. First, most Philadelphians underestimate their own HIV risks, in spite of studies that document high rates of high-risk behaviors. In recent years, there has been little local media coverage about HIV/AIDS, which contributes to lack of awareness about the severity of the local epidemic and the community’s perceived HIV risks. Perhaps most importantly, there is still an overwhelming amount of stigma associated with HIV/AIDS, particularly in the African American community; this also contributes to low testing rates.
Young people are increasingly at risk for HIV infection in Philadelphia; 15% of all new infections are among individuals age 13-24. In spite of these alarming trends, sexual education is not routinely offered in Philadelphia public schools. One thing the city must do to address these trends is to integrate comprehensive, routine sexual education into health curricula in public schools, starting in junior high school. High-risk sexual behavior among high school students documented in the CDC Youth Behavior Risk Survey prompted the Department of Health to offer gonorrhea and chlamydia screening to Philadelphia high school students. This program is now recognized as a national model. The same high-risk behaviors that put young people at risk for gonorrhea and chlamydia also place them at risk for HIV; the city should add HIV testing into its routine high school STD screening programs.
The city urgently needs to expand HIV testing in high incidence zones. Historically, CDC interventions to address the AIDS epidemic have focused largely on behavior and how people become infected, including heterosexual sex, homosexual sex, and injecting drug use. However, behavioral interventions alone have failed in stemming the widening racial disparities in HIV infection, both in Philadelphia and nationally. Moreover, a mounting body of evidence suggests that social and structural factors are driving racial disparities in HIV infection more than behavioral factors. For example, geography and sexual networks, or people connected directly and indirectly through their sexual partners, may be equally, if not more important, than behavioral risk factors. The importance of sexual networks in HIV transmission in Philadelphia is illustrated in the geographic clustering of new HIV infections in North Philadelphia, Southwest Philadelphia and Germantown, all of which are underserved communities. We call on the city to address the critical role of sexual networks in the city’s HIV prevention strategy. A good start would be undertaking new efforts to dramatically expand HIV testing in high prevalence zones in partnership with community-based organizations based or already working in those areas.
In recent years, public officials in New York City and Washington DC have taken extraordinary measures to address their local AIDS epidemics, launching media campaigns and massive HIV testing programs in the hardest hit areas. These programs help raise awareness and destigmatize HIV/AIDS. We believe Philadelphia should also launch an aggressive media campaign to address alarming rates of HIV infection. This campaign should be culturally tailored to address the populations most affected in Philadelphia, including African Americans, heterosexual men and women, men of color who have sex with men, and increasingly, children and senior citizens. An AIDS media campaign should use conventional media outlets, including television, newspapers, billboards, buses and radio, but should also employ “new media” such as social networking websites and cell phone messaging.
Thirty years into the AIDS epidemic, we cannot sit idly by while our communities are devastated by HIV/AIDS. Washington DC, our nearby neighbor, now has HIV rates on par with parts of sub-Saharan Africa, and parts of inner-city Philadelphia have similarly high rates of infection. The time to act is now, before our city-wide infection rates reach pandemic proportions. This week, we join the rallying cry of global AIDS activists and call on Mayor Nutter to declare a state of Emergency about Philadelphia’s AIDS epidemic. We also call on Mayor Nutter, elected officials, and clergy to publicly take an HIV test, which will go a long way to help destigmatize HIV and raise awareness about the gravity of Philadelphia’s AIDS epidemic.
Amy Nunn is an Assistant Professor at Brown University Medical School and conducts HIV prevention research in Philadelphia. Gary J. Bell is the Executive Director of BEBASHI and Robert K. Burns is the Executive Director of COLOURS.