DISEASE DENIAL DEVASTATING FOR AFRICAN AMERICANS

Blacks Are Most Vulnerable: Group Sustains More Than Half Of New U.S.
Infections, Deaths, But Effort To Inform Intensifies

When AIDS emerged 25 years ago, it was branded a gay white man's disease.

Millions of dollars poured into research and prevention efforts have
reduced the number of diagnoses and deaths in the United States over
the years. But that success hasn't touched African Americans, many of
whom have remained reluctant to acknowledge the disease's impact in
their community.

From the epidemic's start, black people have been disproportionately
likely to test positive for HIV, the virus that causes AIDS. African
American men, women and children now account for 51 percent of new
HIV diagnoses -- up from 25 percent in 1985 -- and 55 percent of
people dying nationally of AIDS, although they make up 13 percent of
the U.S. population.

The black community's high poverty rate contributes to this
disparity, because poor people have less access to medical
information, preventive health care and treatment, researchers say.
Higher rates of sexually transmitted diseases also contribute because
a person with genital lesions, for example, is more likely to
contract HIV and a person carrying another disease in addition to HIV
is more likely to transmit the HIV.

But AIDS activists, researchers and people with HIV say a much bigger
factor has been the ongoing reluctance by many African Americans to
address the disease at all.

More than 2 percent of all African Americans are HIV-positive, a
higher incidence rate than in any other group, according to a federal
analysis of cases between 1999 and 2002 cited by the nonprofit Henry
J. Kaiser Family Foundation. Black women make up two-thirds of new
HIV diagnoses among women, and black teens make up 66 percent of
cases among youth.

African Americans are the only group experiencing a continuous rise
in HIV infections, even though there is little difference from the
rest of the population in how black people contract it.

The decades-long lag in identifying AIDS as a black health crisis
results from both the disease's initial label as a white epidemic and
its association with homosexuality, which carries a heavy stigma in
the black community. Influential black people and black secular and
religious institutions have been slow to embrace black AIDS victims,
demand government aid or speak out.

"AIDS wasn't thought of as a black disease for a very long time,"
said Jennifer Kates, director of HIV policy for the Kaiser
Foundation. "The initial response was led by the white gay community,
and that defined what people thought of the AIDS epidemic."

Many thought that would change when basketball legend Magic Johnson
announced he had HIV in 1991. He created a foundation that put
millions of dollars into treatment centers and free testing, and he
continues to promote education and prevention.

But his was a lonely voice.

It wasn't until 1999 that the first national conference explored AIDS
as a black issue, even though it was the leading killer of African
Americans ages 25 to 44 from 1990 through 2000.

However, the community may be on the cusp of a new approach this
year, the 25th since the epidemic began. Several "Call to Action"
events are planned this month locally and nationally. For example,
the NAACP, Urban League, Black Entertainment Television and
celebrities plan to gather in New York today to "sound an alarm"
about the epidemic. Denial that AIDS is epidemic among blacks makes
people reluctant to be tested and treated, or to talk openly with
their sex partners about the disease. The stigma against gays in the
black community, especially within churches, exacerbates this
problem, experts say.

"People with AIDS have paid their tithes, and the pastor still beats
them over the head," said Sherry Thomas, coordinator at the Walker
House, an Oakland facility for the chronically ill that is funded by
the City of Refuge United Church of Christ in San Francisco. "It is
like if they keep them in a box, they feel safe."

Slowly, Thomas said, the box has started to open.

"People are leaving to find inclusive churches, and the dollars are
falling off, so it is starting to get attention," she said.

Still, many churches have been quiet about their AIDS ministries, and
the help centers they run can be hard to find. At funerals, the cause
of death for closeted blacks who die of AIDS complications often is
presented as something else, which perpetuates the belief that AIDS
is not a black epidemic.

Oakland resident Paulette Hogan knows this paradox firsthand. When
she started developing persistent flu symptoms five years ago, the
last thing on her mind was HIV. She didn't see a doctor regularly and
didn't think of getting tested until she got a job in a center for
gay youths and someone suggested HIV might be the cause of her ongoing illness.

"I took the test because it was clear to me that I didn't fit the
profile," said Hogan, 43, who picked up the virus through sex. "In my
mind, it was gay men. I was losing friends, but unless they were gay
men, it wasn't HIV, it was pneumonia or kidney failure. No one was
talking about it happening to people like me." Black health advocates
and community leaders say they often are asked to speak at schools
and community gatherings on AIDS Day or during Black History Month,
only to find the information they provide is not being incorporated
in the community.

"People under 30 have no idea that this is the No. 1 killer and still
tend to think they are invincible," said Terrance Hodges, a
43-year-old Oakland resident who was diagnosed with HIV three years
ago. "They don't have a sense of fatalism and don't think anything
can stop them. I know because I was like that. And I practiced unsafe sex.

"Violence is much more of a reality among people of African descent than HIV."

Robert Scott, an East Oakland doctor who specializes in HIV care and
treatment and sees patients ranging from 17 to 78, said even the high
death rate isn't enough.

"Whether it is a teen or a senior, folks don't take the disease
seriously," he said. "The taboos associated with it -- promiscuity,
drug usage and gay sex -- make people embarrassed to admit they may
be affected."

However, the higher African American HIV infection rate is not driven
by intravenous drug use or risky sexual behavior, according to medical experts.

"There is not a significant difference between African Americans and
other ethnic groups with regard to risky behaviors," said George
Lemp, an epidemiologist in Oakland who directs the University of
California's AIDS Research Program. "The riddle is why there is such
a rate when the risk behaviors appear to be similar."

Poverty plays a significant role by reducing access to health care
and adding challenges to all aspects of a person's life.

"When you are focused on basic needs like paying the rent, buying
food and the electric bill, the last thing you are thinking about is
HIV," said Lisha Wilson, medical director of the Magic Johnson AIDS
Clinic in Oakland. "There are so many other issues. Poverty can lead
people to do things they wouldn't normally do, and that can involve
unsafe sex." Acceptance among African Americans that AIDS is epidemic
in their community, experts agree, will be critical to the success of
prevention programs.

"We can't continue to try and use programs that were piloted and
developed for white gay men," said Roosevelt Mosby, a founding member
of the State of Emergency African American Task Force in Alameda
County. "The methods do not transfer to black people.

"We have to develop different methodologies. You can't use the same
forms of treatment and prevention for young people, men, women, black
or white. If the black community can't even admit that AIDS is an
issue, how are we going to talk about preventing it?"

Phill Wilson, who founded the Black AIDS Institute in Los Angeles in
1999, has been pushing for influential African Americans to take a
major role in starting the community's conversation about AIDS.

"My sole purpose is to get black folks involved, faith leaders,
business leaders, celebrities and elected officials," said Wilson,
who has been living with AIDS for 15 years. "AIDS in black America
has never benefited from the power of celebrity in the way other
communities have.

"It has taken 25 years, but we now have the first mobilization of any
magnitude, the first collective coordinated effort," Wilson said of
today's gathering in New York. "I think black America is ready to
respond and take ownership."

Many of this country's black leaders -- including NAACP President
Bruce Gordon, Urban League President Mark Morial, BET Vice President
Kelli Richardson Lawson, actor Danny Glover and Rep. Charles Rangel,
D-New York -- plan to announce an alliance committed to stopping the
spread of HIV and AIDS.

The information must come from trusted organizations in the African
American community, said Myisha Patterson, the NAACP's new national
health coordinator, who is making HIV a priority for the organization.

"If we have learned anything over the last 25 years, it is that the
black community doesn't respond to government reports," she said.
"Unless your eyes are open and you are looking for information, you
are not going to see it."

Some black clergy, celebrities and media have pushed for change in
past years. The Rev. Al Sharpton and San Francisco's Bishop Yvette
Flunder gathered with church leaders in Atlanta in January to promote
acceptance of gays. Before she died this spring, Coretta Scott King
- -- the Rev. Martin Luther King Jr.'s widow -- condemned homophobia as
an obstacle to AIDS prevention.

"We can't even get to AIDS without talking about homophobia first,"
said Sylvia Rhue, director of religious affairs for the National
Black Justice Coalition, which organized the Atlanta meeting.
Although hip-hop artists such as Common now actively promote
preventing AIDS, the limited use of popular culture to address AIDS
in the black community -- like hip-hop artists rapping and singing
about safe sex in the early 1990s -- has not had much impact in the past.

Even the legacy of 31-year-old N.W.A. rapper Eric "Eazy-E" Wright,
who died of AIDS in 1995, centers more on "gangster rap" than AIDS.

Alameda County was the first in the nation to address the
disproportionate impact on the black community. County supervisors
declared a state of emergency regarding AIDS in 1998. Emergency task
force members keep politicians updated on the demographics of the
disease, and work with the California HIV Prevention and Education
Project and the AIDS Project of the East Bay in Oakland. However,
members say they still are not reaching enough black residents, who
account for 41 percent of the county's AIDS cases but are only 18
percent of the population.

Wilson hopes today's meeting will change that.

"In 2006, AIDS is a black disease, full stock, through all lenses,"
he said. "Black people bear the burden, and people are now going to
realize that the only way to stop it in America is to stop it in
black America." How to get help

- -- Magic Johnson Foundation in Los Angeles: (310) 246-4400,
www.magicjohnson.org -- runs four clinics with the AIDS Healthcare
Foundation. Oakland clinic: 411 30th St., Suite 200, (510) 628-0949.
San Francisco clinic: 1025 Howard St., (415) 552-2814.

- -- Black AIDS Institute in Los Angeles: (213) 353-3610,
www.blackaids.org -- offers resources, including news articles, links
to data and an HIV test center locator.

- -- AIDS Project of the East Bay: (510) 663-7979, www.apeb.org --
offers testing, prevention education and a wellness center, 499 Fifth
St., Oakland.

- -- City of Refuge United Church of Christ: (415) 861-6130, 1025
Howard St., San Francisco, www.sfrefuge.org -- provides housing,
medical services, prevention, youth programs and other services
through its Ark of Refuge, www.arkofrefuge.org/resources.html

Today is the second of The Chronicle's two-day report on the AIDS
epidemic 25 years after it was first recognized in the United States.