August 06, 2004

AIDS and Personal Responsibility

I think about AIDS a lot. I have no personal connection to this disease. I know no one who has it or has died from it, to the best of my knowledge. So, that's not why I care. No, generally, I am concerned about the impact AIDS has on developing societies. I am fascinated by how this modern day plague is devastating the African Continent, how social norms appear to be in the process of being rewritten as a result, how prevention and treatment are advanced and thwarted, how Asia is responding in general and China in particular, and how this might effect the world beyond the borders of those countries and continents most particularly affected. Whole generations are being more than decimated and the impact of such a reordering of population norms may not be felt for years.

However, I never really thought much about the impact on US society in the same way, since it seems like the US has AIDS under much better control. I guess I was wrong, at least with respect to the black community here. And, if it concerns such an important segment of our society as a whole, it ought to concern everyone.

The NY Times today had an article on the spread of AIDS in the black community in small, Southern cities: Links Between Prison and AIDS Affecting Blacks Inside and Out. Again, as is my wont, I'll extract some of the statistics that caused my mouth to drop open on the train today:

*Blacks now account for more than half of all new H.I.V. infections, according to the Centers for Disease Control and Prevention. Black women account for 72 percent of all new cases among women. During the decades that the AIDS epidemic has spread, the number of people incarcerated has also soared, to nearly 2.1 million, according to the Bureau of Justice Statistics. Of that total, more than 40 percent are black.

*In North Carolina, African-Americans make up more than 70 percent of all existing H.I.V. and AIDS cases, and about 60 percent of the state's roughly 35,000 prisoners.

*The prevalence of confirmed AIDS cases in prisons is three times as high as it is in the general population, according to the Bureau of Justice Statistics. H.I.V. cases are harder to count, because only 19 states conduct mandatory H.I.V. testing of inmates. But many researchers believe the number of prisoners with H.I.V. to be far higher than the 1.9 percent most recently documented by the justice agency.

I'll put the rest of my observations below in the extended entry section.

One thing missing, that I’d be curious to see is what percentage of babies born HIV positive are black. If you go to the CDC website, though, you can look at some statistics through December 2002 which might give you an idea about how children, those under the age of 13, acquire HIV. Of the 9,300 children in the US with HIV, fully 8,629 of them became infected as a result of “mother with or at risk for HIV infection”. If it is true that black women account for 72% of all new HIV infections among women, then I assume that the number of children born with the HIV infection will also rise and the black community, and society as a whole, will be afflicted even worse.* (*see update below).

Here's the kicker for me. I've been chewing this article over all morning in the back of my mind and I went back now to re-read it. I am troubled by the rise of AIDS in the black community, but that's not what I mean by the "kicker". No, what also troubled me here was that nowhere in this very long article does anyone embrace the concept of personal responsibility, that just maybe you have an obligation to avoid engaging in high risk behavior that might get you infected.

The doctors conducting the study avoid the topic, instead seemingly cast blame on the "system" that incarcerates large numbers of convicts.

"H.I.V. is an opportunistic disease that thrives on disruptions of social networks," said Dr. David Wohl, an infectious disease specialist at the University of North Carolina, where several studies on the subject are under way. "You can hardly get more socially disruptive than removing double-digit percentages of men from communities for extended periods of time."

Why are double digit percentages of men removed from communities? First of all, that phrase is neutral and suggests no culpability on the part of those "removed". It's not their fault they've been "removed". No, blame the system. It's like that stupid phrase seen of late, "hate the game, not the player". No, these men are removed by the criminal justice system and sentenced to serve time in prison because they have been convicted of, or pled to, committing crimes in these very "communities" they've been removed from. Is the criminal justice system racist, as we’ve all seen suggested? Maybe. Probably not from where I’m sitting.

The article focuses on ways to keep released prisoners from spreading AIDS in their "communities" when they get released. I wonder if that's not the wrong place to concentrate all the efforts.

Maybe the key to AIDS prevention starts at first with turning around at risk teens, to convincing them that college and the pencil is a better choice than the State Pen. Maybe we acknowledge that there is at least one or maybe more generations we cannot help and we concentrate our efforts and our societal resources on the youth who are not yet criminally or sexually active and we try to save them. Is that heartless, the suggestion that we write off a generation? Maybe. But I'd sure hate to see us turn into a developing nation again and maybe we can save the next generation.

With a full-time job as a security guard, she is hoping to save enough money to pay for cosmetology school. Her current boyfriend was briefly in jail, but he has a good job in construction and a house, which they share. He knows she is H.I.V. positive, she said, and he is very supportive.

After a moment of hesitation, Louise admitted that they do not always use protection.

"He says if he gets infected he'll just deal with it," she said with a shrug of her shoulders and a raised eyebrow that hinted at disbelief.

The thing is, though, if he gets infected it's we as a society as a whole who will have to "deal with" the consequences of his outright rejection of the concept of personal responsibility.

Rant endeth here.

UPDATE: I went over to the National Institute of Health who had this statistic:

The estimated rate of adult/adolescent AIDS diagnoses in the United States in 2002 (per 100,000 population) was 76.4 among blacks, 26.0 among Hispanics, 11.2 among American Indians/Alaska Natives, 7.0 among whites, and 4.9 among Asians/Pacific Islanders.

The statistical breakdown presented there is chilling.

Posted by Random Penseur at August 6, 2004 09:36 AM

Interesting observations. Good food for thought.

Posted by: Mick at August 6, 2004 11:24 AM

Thanks, Mick. No matter how you slice it, it's terrifying, isn't it?

Posted by: rp at August 6, 2004 11:34 AM

"He says if he gets infected he'll just deal with it,"

Both of them using irresponsibility as a way of life. Unbelievable.

Posted by: Tuning Spork at August 6, 2004 12:48 PM

Amazing. I have a friend who confided to me in the last year that he is HIV positive. It took all my strength not to shake him by the shoulders and say, "How could you have let this happen NOW?!? With everything you know! With all the precautions you have been taught..."

Posted by: ensie at August 7, 2004 12:14 AM

I'm sorry about your friend, Ensie.

Posted by: RP at August 7, 2004 07:21 AM

Hi, I noticed you were talking about HIV/AIDS on this site. If you'd like to submit your page to SH Directory, please do ;-) (

Posted by: HIV/AIDS at September 12, 2004 12:29 PM
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