In Black America; HIV Among African Americans, with Dr. Donna Hubbard McCree

From the University of Texas at Austin, KUT Radio, this is In Black America. When we look at rates of HID, in 2008, compared to 2010, we saw a 21% decrease in new infections among African-American women. Of course, that's the first time we've seen that and we need additional data to look at whether this is an ongoing trend. We hope that it is. This is, we have more tools than ever out there to present HID. Testing is to keep knowing your status, getting linked to care, staying in care, getting your virus under control. And the main thing is that HID is entirely presentable. Other things all of us can do when we have to start doing it, to protect ourselves and our partners. And we really, really do need to talk openly about HID. That's the only way we can kind of bring it out of the shadows within our communities.

And stopping HID and African-American communities is really a key to ending what we see in terms of the epidemic in the United States. So I hope that the conversations that you and I are having and those that you'll have with your peers and others will continue. Dr. Donald Herbert McCree, Associate Director for Health Equity at the Centers for Disease Control and Prevention, National Center for HIV. Today there are more than 1.1 million people living with HIV A's in this nation, including more than 506,000 who are African-American. African-Americans have been disproportionately affected by HIV A since the epidemic's beginning, and that disparity has deepened over time. The epidemic has also had a disproportionate impact on African-American women, youth and gay and bisexual men, and its impact varies across the country. More with a number of challenges attributed to the epidemic among African-Americans, including poverty, lack of access to healthcare, heart race of some sexually transmitted infections,

lack of awareness of HIV status and stigma. Despite this impact recent data indicates some encouraging trends, including declining new HIV infections among African-American women, however, given the epidemic's continued and disproportionate impact among African-Americans, a continued focus is critical to address HIV in this country. I'm Johnny El Hanson, Jr. and welcome to another edition of In Black America. On this week's program, HIV A's with Dr. Donald Herbert McCree, Associate Director for Health Equity at the Centers for Disease Control and Prevention, National Center for HIV in Black America. About half of all the new infections that occurred here, about half of all of the people with AIDS who died each year, and the truth of the matter is that many of the same kinds of social and environmental factors that place African-Americans that risk for other chronic diseases, these are some of the same ones that places that increase risk for HIV.

And that's things like access to healthcare. You know, if you don't have the means to see a doctor, you may not get an HIV test or you may start a treatment at a later stage. And things like economic barriers, if you can't afford the basic things in life, that may put you in situations that cause you to engage and increase risk behaviors. And then there are some other factors like, you know, I just talked about the rates of HIV within our communities because of that kind of high level of HIV in our communities and sort of our communities are a little bit segregated, we're talking about these networks and that, you know, African-Americans are still more likely to have sex with other African-Americans. So that means we face actually greater HIV risk with every sex encounter, even if we have similar levels of individual risk behaviors or the population, that will put us at greater risk. HIV is a crisis in African-American communities, threatening the health and well-being of African-American men and women across the nation. African-Americans face the most severe burns of HIV AIDS of any ethnic group in this country.

Prevention efforts have helped to maintain stability in the annual numbers of new HIV infections among African-Americans for more than a decade. Additionally, recent CDC data found indicators of an encouraging decline in new HIV infections among African-American women. Still, African-American heterosexual women continue to be far more effective by HIV than women of any other race or ethnicity and young African-American gay and bisexual men now account for more new infections in any other group in this country. Dr. Donna Hubbard-McCree is the Associate Director for Health Equity at the Centers for Disease Control and Prevention, National Center for HIV. During our conversation, Dr. McCree talked about HIV problems in the African-American community, what individuals need to do to protect themselves, what recent research is showing, and what the CDC is doing to address HIV. It was during my pharmacy training, actually, that I became interested in sexually transmitted infections.

Now, when I was in school so long ago, they were not called sexually transmitted infections. It was really called the naryl disease. Right. And so I just was very much interested in the stigma that was associated with it and sort of not enough interaction between, you know, with persons who may be infected and after I started practicing pharmacy, then we started to hear about what is now known as HIV. And when I started to look at the disproportionate impact that it was having on some of the racial and ethnic minority communities, it just became a champion for really wanting to address those issues and making sure that individuals have the information they need to protect themselves and stay healthy. When we speak of public health, what are we in conferencing? Well, public health spans the arena, and we're just talking about making sure that individuals have access to all they need to have optimal care and optimal health care and being good health. And so it's a broad spectrum, you know, everywhere from, you know, health education, all the way down to what we think about medical care and providing medical care.

When we speak of HIV AIDS, how back do we need to go when America first realized that there was an epidemic on the horizon? You know, it's been over 30 years, the first cases of what we now call, you know, human immunodeficiency virus was first recognized. And we used that term, HIV infection, AIDS is a stage of HIV infection. So, you know, and of course things have changed significantly since over the past 30 years, of course, we now know what causes AIDS, we know about the virus, we know how it is transmitted, we know how to prevent a treatment is available, yet we're still seeing some disproportionate impact in some communities. And with that, we know that African Americans still bear the brine of the HIV crisis in the United States. So I think when you talk about historical perspectives, you look at, you know, first recognition, but you look at where we are now and what we've done.

And one of the important points to make is that HIV is entirely preventable. And I think that's why messages and conversations like you and I are having today are so important. It's still around, and there's still a lot of misinformation out there, and we still need to have these conversations, so individuals have all of the knowledge they need to protect themselves. I want to get to prevention, but I want to piggyback on something that you just articulated. You said it's preventable. Yes, completely. Now that AIDS and HIV isn't a death sentence, have we got lack of days ago in our sexual practices and habits? I wouldn't say that, I think there's still a lot of misinformation out there. I think, you know, of course, we have a generation now who was not born when HIV was first recognized and, you know, they've always lived at a time when treatment was available. So of course, that might be an issue. I think there's still a lot of stigma around HIV in general, and I think that might present individuals from seeking information and from seeking help.

And I still think there's a lot that individuals don't know. Some people think that it's not a problem, and you know, no longer an issue, and it is, and I think that there's some misinformation about how individuals can protect themselves. There are things we can all do, and again, I keep going back to the fact that it's important to have conversations like you and I are having, talking openly about it. You know, that's the only way we can really bring this out of the shadows, particularly within our community. So that the time is right to speak to our children, speak to our peers, speak to our partners, speak out against that stigma talked about and create some real safe spaces within our homes, schools, places, or worship, to just talk openly and honestly about it and let individuals know that HIV is still having an impact on our communities, but they do not have to have it as preventable. Why is it such a prevalent virus and disease in African-American community? You know, that is an issue, and we do know just to talk about what's going on, African-Americans actually account for almost half of the 1 million plus people that are living with HIV

in the United States, and about half of all the new infections that occurred here, about half of all of the people with AIDS who died each year, and the truth of the matter is that many of the same kinds of social and environmental factors that place African-Americans that risk for other chronic diseases, these are some of the same ones that place their increased risk for HIV, and that's things like access to health care. You know, if you don't have the means to see a doctor, you may not get an HIV test or you may start treatment at a later stage, and things like economic barriers, if you can't afford the basic things in life, that may put you in situations that cause you to engage in increased risk behaviors. And then there are some other factors like, you know, I just talked about the rates of HIV within our communities because of that kind of high level of HIV in our communities, and sort of our communities are a little bit segregated. We're talking about these networks and that, you know, African-Americans are still more likely to have sex with other African-Americans, so that means we face actually greater HIV

risk with every sex encounter, even if we have similar levels of individual risk behaviors of the population, that will put us at greater risk. And we also have these sort of higher background of other sexually transmitted infections in our communities that may put us at greater risk for HIV. And then, you know, things like, I just talked about stigma, you know, there's still a great deal of stigma around HIV. And sometimes that prevents individuals from going in and being tested, nor in this status, and staying in care, protecting themselves, seeking support that they need, all of those types of things. So I think those factors together are what we believe are causing these sort of disproportionate rates of HIV within our communities. And I want to really talk about knowing your status. I mean, that's the first step. That's the first step you can take in protecting yourself and others. And the good news for us is that African-Americans are more likely to have been tested for HIV

but there's about a third of us that's never been tested. And everybody should be tested for HIV between the ages of 13 and 64. Just get an HIV test. Just like you do when you think about your annual exam and you have all of your other screenings. Get a test for HIV. If, you know, if you had it, then treatment can improve your health and prevent transmission to others. So you need to know your status. That's a gateway. If you don't, if you find out you're negative, then you can get messages that you need to take steps to prevent from yourself from getting it. Are there any outward signs of the disease and virus that one can detect? Well, the key is you don't want to wait until there are signs and something. Exactly. You don't want to wait until then. If you believe that you've engaged in any type of behavior that might put you at risk, then you need to be tested. And again, as we said, as I just said, our guidelines say, go ahead, everyone. Recommended everybody between the ages of 13 and 64. Just get an HIV test, at least once in your life. What are those behaviors?

Well, if you have, let me talk about how you can prevent it. Okay. And that talks about the behaviors. Okay. So there are things we can all do to prevent it. The first thing is if you're not having sex, abstaining from sex or mutual monogamy with a partner that you know is not HIV-infected. And the only way you would know that is if the person has had a test, you know the results, you know you're not infected. If you are sexually active, if you decide to be correct, condom use can reduce your risk. You also want to reduce your number of partners. When you look at persons that are at high risk, such as those that have an HIV-infected partner, can consider other prevention options, things like pre-exposure prophylaxis, which can really help protect you from getting HIV from an infected partner. Individuals who inject drugs, and you know that's the route, clean needles, never sharing them. And if you've been diagnosed with HIV, what's important is to seek treatment and get on your treatment. Stay on your treatment so you can have your virus under control. We call that viral suppression measures under control.

In that way you can make sure that you can protect your health and you can reduce the risk of transmitting HIV to your partner. Is there any percentages that you all have looked at at the CDC about African-American men having sex with other African-American men or just men in general? You're talking about when you say the risk of transmission, you know what do we know? Yes. We have data around that, and when you talk about the risk group within communities that are at, you know, have the highest rates, we're talking about men who have sex with men. That's listed as the risk group with the highest. And when we look at the rates, we do know that young men who have sex with men, those between ages are like 13 and 24, actually have the highest rates than any other subgroup or category. And when we think about that, that is so important because we cannot afford to lose an entire generation to a preventable infection. That's the group you know we talked about that they weren't even around when HIV was first noticed.

And so they've always lived at a time, you know, when treatment was available, and there are still all of those factors that I mentioned to you that cause our rates to be higher in our communities, also makes it within that particular group. It's important though to say that within our community the disease really shows no favorites because it does affect men and women, gay and straight, young and old. And so that's why it's important to get the news out about that. I understand. If you're just joining us, I'm Johnny O'Hanston Jr., and you're listening to In Black America from KUT Radio, and we're speaking with Dr. Donna Hubbard McCree, Associate Director for Health Equity at the Centers for Disease Control and Prevention, the National Center for HIV. Dr. McCree, what is the center doing to, besides interviews and what have you to have the community, the African-American community understand that this is something that we can get our arms around and get a hold of? Well, at CDC what we're doing is focusing our resources in a way to where we can have the biggest impact for those who are most affected by this disease, including African-Americans.

So we're focusing on high impact prevention strategies. And what do we mean by that? Okay, that's scientifically proven cost-effective strategies that give us the most powerful prevention tools to address HIV and communities. So we're funding health departments and community organizations across the nation. And we're really focusing on improving linkage to care and treatment. Remember, we talked about you need to know your status, you need to get into care and treatment, remain there, remain on your therapy and get your virus under control. So we're focusing on that. Two things I do want to mention that are very important. We have a care and prevention in the United States demonstration project. And that project, which was a three year funded initiative, is really looking at reducing some of those social, structural, clinical, and economic barriers that I talked about earlier, but then communities that are most impacted by HIV. And what we're trying to do there is to increase that linkage to and retention and care, getting you in care, keeping you in care.

And we also have another project that was recently funded that's going to create partnerships between health centers and health departments and communities that are most impacted in that way. And we're improving access to and retention in care. And we have a flagship campaign out there that are raising awareness and increasing testing. We're funding, increasing testing initiatives as well. We talked about what's going on with African-American men who have sex with men. We have a campaign that's directly targeting African-American MSM called testing makes a stronger, it's a national campaign to increase testing among African-American men who have sex with men. We also have a campaign that's focused on African-American women who among women are disproportionately affected, making up about 64% of the cases among women. And it's a 15-city campaign to increase awareness and testing among African-American women. We also have campaigns that address the stigma that I talked about. And remember, still there's a lot of stigma, let's stop HIV together is a campaign that is addressing some of the stigma and complacency that you talked about in this show that, you

know, as I said, the HIV has no particular face. It's our moms, our fathers, our brothers, our sisters, our cousins, people within our communities. And so we're trying to raise awareness about that. We have a campaign that's targeting providers, prevention is care, and what we're trying to do there is give providers the information that they need to help people who are living with HIV adopt healthy behaviors. And we have a $55 million initiative that was funded in 2011, and this is over five of your periods, to about 34 community or based organizations that are expanding their prevention services for young gay and bisexual men of color, transgender youth of color and their partners. And again, I mentioned that group is particularly hard to set. So we have several initiatives that are focused on addressing the epidemic in African American communities and other communities that are hard to hit. I do want to go back to making sure that we keep the message about knowing your status on the table, you know.

I mean, I think that's critical. And talking about it, you know, remember I did speak about stigma for the homophobia piece as well. I mean, there has to be a dialogue so we understand first how to protect ourselves. And then to get information about HIV in general, how does it transmit it? What does that mean? How do, you know, what do I need to do to protect myself and protect my partners? So those are some of the factors that need to be addressed as well as some of the social and environmental factors I talked about earlier. If one doesn't have a private physician, are there clinics and health centers that one could go to in their cities? Oh, certainly. That information. And if you check on our website either, and Selena can also provide you with some additional information, www.cdc.gov and there's an entire section on HIV. And it also talks about treatment and some of our federal partners, other partners that deal with care also have that information on their websites as well. When we look at HIVAs, how important is the national black HIVAs awareness day for you as efforts?

Oh, it's very important. That's a day, of course, that set aside where we recognize the impact of HIV on African and African American communities and it's a day where we can increase awareness also among the community and among organizations that work within the community. But every day, every day is an opportunity to really talk about what's going on and to keep the conversation about HIV on the table. So while we do engage in those activities and we work with partners across the nation, we do that on a regular basis as well. And just like this conversation that you and I are having, which is just one piece of the puzzle and all that we do to address HIV and community standard impacted. Now we all want individuals to understand that they need to be safe with their sectional partners and we want them to understand and know their standards. But what has transpired over the years for those who have contracted HIVAs and some of the medications that are allowing people to live longer or live a productive life with the disease and virus?

Yeah, what's critical to know is that we have more tools than ever now and not only to prevent HIV but also to maintain health and persons that are living with HIV. The anti-retroviral therapies that you're talking about, the sooner an individual knows their status and their length of care, they get on their meds and they stay on the meds, the better the outcome for those individuals. And also, we know treatment is a prevention effort as well because, again, if an individual is treated not only will they remain healthy but they also reduce their risk of transmission to others. And we know about another new tool, pre-exposure prophylaxis and that is basically giving individuals who do not have HIV but maybe at risk of HIV, a med that's used to treat HIV to prevent them from getting it. So you talk about people living with HIV, let's say you are in a situation where your partner is HIV positive, you're in that kind of relationship and you want to prevent getting HIV then prep, pre-exposure prophylaxis is of course one method that may be used for

prevention along with the other methods that we talked about like condom use. One thing about prep is that it does not protect against other sexually transmitted infections so it's important to use both. So we've certainly come a long way since the first case was recognized in terms of treatment efforts but, again, people have to know their status and they have to get into care and stay in care to show the benefits. When did we move beyond the stereotypes of thinking that HIV AIDS was a gay disease? Well, certainly in the beginning of the epidemic when we saw that the majority of the individuals that were infected were gay and bisexual men but as we had more tools to understand how the virus was transmitted, then we began to realize that of course it was possible for other individuals to get it as well. That's when you see about the ability for a perinatal transmission which we made tremendous strides in addressing that but women to get it as well, babies to get it from their mothers, injection drug uses to get it because of blood, that kind of thing.

And I think that's just an understanding of how the virus is transmitted. That's how we learned who would be most affected and the critical tool there is to know how the virus is transmitted. And when it comes to sexual practices, it's important to know your partner's status and to talk about it and to have open and honest conversations about it. And one of our campaigns I talked about that take charge, take the test campaign that's targeting African American women actually seeks to empower women to refuse to engage in practices that might put them at risk for HIV. How important is for our religious community to understand that this is a crisis and it is important for them as an institution to be a part of the solution? Well, one important prevention effort is community mobilization. Getting communities involved. You talked about national black HIV AIDS awareness day and one of the main efforts that's pushed during that day is to get communities involved and have communities.

And that's all aspects of the community, including the faith community. So I think it's very important for the faith community, the public health community leaders, teachers, business leaders, everyone to continue to bring greater awareness about HIV and this impact within the community and creating faith spaces where we can talk about it, including our places of worship. And we have work with faith-based organizations to get the message about HIV out in the table. So it is critical just as other aspects of our community are as well. As a nation, are we putting our money where our mouth are? And by that you mean? Seeing the CDC and the programs in which are necessary to attempt to eradicate the situation? Of course. Now we find, based on the epidemic, remember we find health departments and community-based organizations and the high impact prevention strategies that we use for targeting communities that are most affected by HIV.

So yes, we find based on the epidemic. Are there any particular sections of the country that are more prevalent than others? Or is it equal opportunity? And there are differences in terms of geographic distribution and HIV. And I think we do have some of those maps on our website. It's very interesting. You know, the south, of course, there are some, we look at rates in the south, we look at rates in the northeast and some of the urban areas and definitely there are differences. And so I think, you know, that information is also critical to know, but the main thing is knowing the facts about how it's transmitted. That's the key thing and knowing how to protect yourself. And if I have two questions, Dr. McCree, how long does the test take for one individual to go into to know their status? Well, you know, there are testing sites available. First of all, let me make sure I say that. You can get information about testing at 800 CDC info, that's a number you can call. Or you can get it also at www.hivtest1word.org. And there are rapid tests that are available that take as little as 10 minutes to 20 minutes to get your results.

Now, those are, of course, preliminary, and you'd have to get a confirmatory test. But it's certainly because of the availability of testing now, it's quite easy. And again, I gave you the information in terms of where individuals can locate testing sites. They're interested. Are there any national campaigns on the Iranians? Oh, we have several that we've released, are you talking about for us in general? Because the campaigns I spoke to you about are all national campaigns. And all of that materials that we have are available on our website for individual organizations. Any groups that are interested in using those materials can download them from the website. Everything is made available. And we can, and it's through our Act Against Aids Leadership Initiative. And that information is also available at www.cdc.gov. Just click on HIV and the campaigns and all of that information is available. So, and it's nationally available for any organization that would like to use it and brand it as they see it. Dr. McCree, in your final comments, what do you want listeners to come away with? Well, at first, I'd like to say, I mean, there are still some good news.

When we look at rates of HIV in 2008 compared to 2010, we saw a 21 percent decrease in new infections among African American women. Of course, that's the first time we've seen that and we need additional data to look at whether this is an ongoing trend. We hope that it is. This is, we have more tools than ever out there to prevent HIV. Testing is the key, knowing your status, getting linked to care, staying in care, getting your virus under control. And the main thing is that HIV is entirely preventable. There are things all of us can do and we have to start doing that to protect ourselves and our partners. And we really, really do need to talk openly about HIV. That's the only way we can kind of bring it out of the shadows within our communities. Dr. Donna Hubbard McCree, Associate Director for Health Equity, at the Centers for Disease Control and Prevention, National Center for HIV. If you have questions, comments, or suggestions asked your future in Black America programs, email us at jhansetthans.org at kut.org. Also, let us know what radio station you heard us over.

The views and opinions expressed on this program are not necessarily those of this station or of the University of Texas at Austin. You can hear previous programs online at kut.org. Until we have the opportunity again for technical producer David Alvarez, I'm John L. Hanson, Jr. Thank you for joining us today. Please join us again next week. CD copies of this program are available and may be purchased by writing in Black America CDs. KUT Radio, 300 West Dean Keaton Boulevard, Austin, Texas, 78712. This has been a production of KUT Radio.