Harm Reduction Coalition Statement: National Black HIV/AIDS Awareness Day, 2007 The HIV/AIDS crisis among African Americans demands increased commitment, innovative strategies, and coordinated action by government, community-based organizations, civic and religious groups, and the African American community. African Americans make up nearly half of all AIDS cases in the United States, and over half of new HIV diagnoses. The majority of women and infants living with HIV are African American. The most striking feature of the HIV/AIDS epidemic among African Americans is the role of structural factors that drive high HIV prevalence.? A range of studies indicate that African Americans across various categories - adult and adolescent heterosexuals, men who have sex with men, injection drug users - do not have higher rates of sexual and drug-related risks than whites. African Americans are just as, if not more, likely as whites to use condoms, limit numbers of sexual partners, avoid sharing syringes, and test for HIV. Higher rates of HIV among African Americans do not reflect higher levels of risk: the narrow focus in HIV prevention on individual behavior change has failed African Americans by ignoring the structural context of poverty and homelessness, disparities in education and health care, and high rates of incarceration among blacks. The cumulative and reinforcing impact of these social and political forces create a vortex of vulnerability directly responsible for the current HIV crisis among African Americans. Solutions to the African American HIV/AIDS epidemic must ultimately recognize and redress the lethal effect of these structural disparities. Such efforts demand courage and commitment; the recommendations below require significant investments matched with political will and leadership. Yet failure to act has already exacted too high a price. We cannot afford delay. Changing the Course of the African American HIV/AIDS Epidemic: Ways Forward Reduce the high rate of incarceration among black males. Research and experience demonstrate clear links between HIV prevalence and high rates of incarceration among African Americans. Incarceration results in disruption of families and communities, social exclusion and diminished life opportunities, and pervasive despair and fatalism - an ideal environment for HIV to flourish. Draconian drug laws and law enforcement practices targeting African Americans lead to astronomical numbers of black men caught up in the criminal justice system, with catastrophic results for public health, civil rights, and social justice. We must reverse this tide by challenging mandatory minimum sentencing that removes judicial discretion, disparities in sentencing laws between crack and cocaine, and racial profiling in marijuana arrests. We must broaden alternatives to incarceration for non-violent drug-related offenses, including drug courts and diversion to treatment. Combat stigma, promote HIV testing, and reduce disparities in HIV care and treatment. Interlocking forms of stigma surrounding HIV, drug use, and sex and sexuality perpetuate a climate of silence, fear, and self-hatred that deters HIV testing and disclosure. Disparities in health care access and quality and the scarcity of non-judgmental, culturally competent HIV clinicians result in poor HIV care and greater mortality among African Americans, further reinforcing stigma and hopelessness. We must simultaneously address the cultural and systemic barriers to HIV testing, care and treatment among African Americans. Increase knowledge, diagnosis, and treatment of sexually transmitted infections. Research indicates that sexually transmitted infections facilitate HIV transmission, and that rates of these infections are higher in African Americans. Efforts to address sexually transmitted infections include education on symptom recognition, screening in community settings, and expedited partner therapy (where patients deliver treatment to their partners). Increase availability of syringe exchange programs. Syringe exchange is highly effective at preventing HIV without increasing drug use. Greater access to sterile syringes among African Americans requires new and expanded syringe exchange programs and improved access to addiction treatment. The African American community and leadership has largely set aside historical debates and divisions around syringe exchange. Now, the federal government must act to lift the federal ban on syringe exchange funding; and criminal laws against possession of syringes and drug paraphernalia must be rescinded as inconsistent with public health. Address structural determinants of risk that fuel the epidemic. We cannot successfully implement HIV interventions in the black community without first addressing the structural, social and economic factors that perpetuate marginalization and risk. We must eradicate poverty by promoting economic stability and reducing income inequalities, providing quality education and job creation, ensuring universal health care, and creating affordable housing. These efforts must be grounded in a broad political mandate to address racism, gender inequality, homophobia and classism in the United States. Harm Reduction Coalition, February 2007