The Changing Face of AIDS

Late morning. Harlem Hospital. Doris White (not her real name), 32, pulls her thin robe across her narrow, bony chest and lights a cigarette. Her dark arms are riddled with small, round scars, the hieroglyphs of chronic heroin abuse. She is here for the seventh time in two years. In 1982 she brought her four- year-old son Rashan to this same hospital. The boy was listless, losing weight; he had white spots on his lips and tongue. The boy's father, a drug addict, had recently come out of prison and was not at all well himself.

For the next few years, Rashan fought a battle he did not understand. "Mostly, my mother took care of him," says Doris, crossing her skinny legs. "It was hard. I'd have to get high before I could go see him." Rashan died a year and a half ago of AIDS, about the same time Doris was diagnosed as having the disease and two months after the boy's father succumbed to the illness, known in the ghetto as "the AIDS." She squeezes her brimming eyes shut. "I will feel the guilt the rest of my life," she says. A month ago Doris' five-year-old daughter Jamille received the deadly diagnosis. So far, only her 15-year-old daughter has been spared. Doris says the disease has changed her; she no longer shares needles. "It seems like every day someone else I got high with is sick," she says. But she still shoots up. "If I can get high," she explains, "I can push things to the back of my mind."

The face of AIDS in America is changing; it is getting younger, darker, more feminine. Stories like Doris White's are becoming common in inner-city ghettos: every day someone else who got high is getting sick. So are their - lovers, and so are their children. Although nearly two-thirds of AIDS victims so far have been homosexual men, the rate of new infection among gays has declined. At the same time, the rate among blacks and Hispanics, particularly those who are intravenous drug users, is rising alarmingly. Medical experts warn that unless urgent actions are taken, AIDS may become a predominantly minority disease. That prospect is frightening not only to health officials but also to civil rights advocates, who fear a backlash of racism.

This past weekend the Centers for Disease Control in Atlanta held its first national conference on AIDS and minorities. According to CDC statistics, although blacks and Hispanics constitute only 12% and 6% of the U.S. population, respectively, they currently account for a disproportionate 24% and 14% of the more than 39,200 reported AIDS cases in the U.S. For women with AIDS, the numbers are even more striking: some 52% of them are black and 20% Hispanic. Nearly 80% of all children with AIDS are either black or Hispanic.

In absolute numbers the problem of AIDS among minorities hardly compares with other enduring inner-city health-care problems such as hypertension, drug abuse and teenage pregnancy. But the future may tell a different tale. Testing of military-service applicants for exposure to the AIDS virus has revealed an incidence that is four times greater for blacks than for whites. If present trends continue, blacks and Hispanics might constitute as much as 40% of the predicted 54,000 AIDS deaths in 1991. Warns Dr. Wayne Greaves, chief of infectious diseases at Howard University Hospital: "Unless we can interrupt this pattern of transmission, this disease could potentially affect the size of the black population."

While the largest percentage of minority AIDS victims have been homosexuals or bisexuals (40% for blacks, 49% for Hispanics), the growing infection rate among IV drug abusers threatens to alter those proportions. The National Institute on Drug Abuse (NIDA) estimates that 70% of the nation's 1.28 million IV addicts are black or Hispanic, and according to the CDC, about a third of AIDS cases among those minorities have been linked to drug abuse, in contrast to just 5% of cases among whites. The virus spreads easily in urban shooting galleries, where a contaminated needle may be passed among a dozen addicts. Some 70% of New York City's quarter-million IV addicts may already be infected. The skyrocketing incidence among IV drug abusers worries experts because of the difficulties of bringing information to this notoriously recalcitrant community. "Their lives are relatively disorganized," observes Surgeon General C. Everett Koop, "and they are not the best recipients of any educational programs." While the nation's homosexual communities, particularly in New York and San Francisco, have effectively mobilized to confront AIDS by lobbying for federal funds, creating group homes for AIDS sufferers and recruiting volunteers to staff hot lines, there is almost no support for AIDS sufferers who are addicts. A 34-year-old black homosexual in Manhattan says he was able to "plug into" gay support groups "for emotional and physical help." But in Harlem, he laments, afflicted addicts "just wait for death, which often comes on the street because so many of them are homeless."

Organizations that traditionally offer aid and support to minorities, such as civil rights groups and the church, have been sluggish in acknowledging the epidemic. For them AIDS presents a disturbing dilemma: the disease threatens to increase racial discrimination and further distance blacks and Hispanics from full participation in mainstream society. "We don't want to get to the point," says Dr. Reed Tuckson, public health commissioner of Washington, "where people say to any black, 'You can't come into my restaurant, and you damned sure can't come into my swimming pool.' "

It was not until January of this year that the National Urban League addressed the problem in a report on AIDS and American blacks by Dr. Beny J. Primm, executive director of Brooklyn's Addiction Research and Treatment Corp. Primm is furious about the foot dragging and denial among blacks. "There is a complacency," he charges, "and perhaps a fear of being called a racist if they point the finger at their own. Better to be called racist now than conspiratorially genocidal five years from now."

For the church, so often a source of strength and shelter in the black and Hispanic communities, AIDS is a prickly subject. Both the black churches and the Roman Catholic Church have traditionally been bastions of conservative values on sexual and social matters, and the idea of preaching the use of condoms and clean needles is difficult for many clergymen. In the Hispanic community, moreover, where the cult of machismo still reigns, men regard even the discussion of condoms as a diminishment of manhood.

But some groups are gearing up for action. The Southern Christian Leadership Conference has held two national seminars on AIDS in the black community. Last week 40 clergy, under the auspices of the Congress of National Black Churches, met with federal public health officials to discuss what they could do to stem the spread of the disease. This fall both the Congressional Black Caucus and the N.A.A.C.P. will explore the issue at conferences.

Various efforts around the country are targeted on IV drug abusers, though most of them are small and poorly funded. In San Francisco, Vicente ("Chente") Matus, an ex-addict who now works for Midcity Consortium to Combat AIDS, ambles along the rough-and-tumble streets of the city's Mission District, his white plastic bag bursting with 1-oz. bottles of household bleach and packets of condoms. His message to IV addicts is blunt and simple: Don't share needles, but if you have to, clean the "works" twice with bleach, a procedure that reduces the risk of exposure to the virus. While the rate of new infection among the city's mostly white homosexual community has slowed to about 4%, the rate among San Francisco's estimated 18,000 IV addicts is 15%, up 50% since 1985.

In New York City, with the nation's largest IV addict population, Stephan Sorrell, a streetwise physician at St. Luke's-Roosevelt Hospital Center, calls for more radical interventions. "If we want to stem the tide of this epidemic," he says, "we have to open more methadone-treatment slots. I'd suggest that we go to Needle Park and give away methadone and syringes rather than letting the dealers sell heroin." Currently, there are only 30,000 methadone slots for the city's 200,000 or more IV addicts. Last week New York Governor Mario Cuomo announced that the state would be expanding the number of openings by 5,000.

Federal efforts to reach drug abusers are just beginning. This October NIDA will embark on a three-year pilot program in 15 cities aimed at reaching IV drug users, their sex partners and prostitutes. They will be urged to enter methadone-treatment programs, use condoms and get AIDS-virus testing and counseling. Some black leaders complain, however, that too much of the federal AIDS-education programs and funds is aimed at white, middle-class students, rather than at the young, inner-city IV addicts and their sexual partners, who are much more at risk. For the moment the Reagan Administration resists the notion that it should appropriate funds for programs designed specifically for < minorities. "We are strongly opposed to earmarking funds in that way," says White House Domestic Policy Adviser Gary Bauer.

Among those working hardest to contain the spread of AIDS in the urban ghettos, there is often a sense of despair. Drug addicts are tough subjects for reform. "We need to stop the recruitment of young people into IV drug use in the first place," says Don Des Jarlais, of the New York State division of substance abuse services. Working with youths who are sniffing but not yet injecting heroin, Des Jarlais says, "We get them thinking about AIDS and what to do to prevent themselves from becoming exposed."

For Doris White the message is far too late, but she prays that her 15- year-old daughter will learn from her family's tragedy. "I try to point out everything about drugs as clearly and truthfully as I can," she says. "She understands. She says, 'Mom, why you mess with drugs? You got to be strong. You can't be weak.' "