The 10-year-old African American girl with HIV sat beaming in front of the doctor at the Yale Health Clinic. She made an unforgettable impression on Dr. Garth Graham, a medical student at the time and now the head of the Office of Minority Health (OMH) at the U.S. Department of Health and Human Services.
What surprised Graham the most was the girl's attitude toward her treatment. "She was very vocal," he said. "She had very definite ideas about how she should be treated, and she was a wonderful inspiration to the other children. She embodied the attitude of strength and resilience that we need if we are to face what this disease is doing to the African American community."
Feb. 7, marks the eighth observance of National Black HIV/AIDS Awareness Day, and it is a day for concern. Blacks are the racial group most affected by HIV, accounting for 49 percent of new HIV diagnoses in 2005 while representing only 13 percent of the U.S. population.
Graham believes the silence and stigma about HIV in the African American community remain as significant barriers to prevention, testing, and treatment. "We are still trying to get the message across to people that, where HIV is concerned, silence is not golden. It's a killer. We estimate that one in four people who are infected do not know it, because they have not been tested for HIV. We have a responsibility to talk about how people can protect themselves from HIV, including what to do when they are tested and diagnosed. "
The most vulnerable populations are adolescents and young adults, says Graham. "I am deeply concerned about the devastating number of young African Americans who are HIV positive. We have to make sure that we educate our young people about the impact of HIV on our communities."
AIDS is now the leading cause of death for African American women aged 25-34. A 2005 five-city study by the U.S. Centers for Disease Control and Prevention found 46 percent of black men who have sex with men (MSM) were HIV positive-- double the rate of white MSM. The majority of these men were unaware of their HIV positive status.
Graham recalled what a woman working in HIV prevention said to him recently: "At one point people didn't know what to do to prevent HIV infection. Now they know what to do, but they choose not to do it."
Graham acknowledges the challenge inherent in the woman's statement. "We can't treat our way out of this epidemic," he says. "Without a vaccine or a cure, prevention and other positive public health messages such as the ABC strategy: Abstinence, Be faithful, and use Condoms, are our only real hope of stopping the spread of HIV."
To support that effort, OMH works with organizations around the country, providing grants and technical assistance to develop locally based HIV prevention, testing, and treatment strategies. For example, OMH provides Nashville's Metropolitan Interdenominational Church with a grant that includes support to run an HIV testing van. The church works with other community faith leaders to identify locations where people they serve gather– then in the evenings and weekends, the van bring HIV testing and other services to community members often missed by conventional testing programs.
While Graham may not know what happened to the young girl after she left the Yale Health Clinic that day, he is sure she will continue to inspire others. Graham believes we can all learn from her strength. "What we need is the courage and honesty of that little girl. She was not afraid to talk about HIV," Graham said. "We stand at a critical moment in the history of the HIV/AIDS epidemic in the United States. We need to make sure we respond to the rise in the rate of new HIV infections aggressively and effectively — before it's too late to stop it."