Noting that African-Americans in Baltimore have been and continue to be disproportionately affected by HIV, Mayor Martin O'Malley in November 2002 declared an AIDS-related state of emergency in the city. Although the timing of the declaration was long overdue, it had become clear to city leaders, the Baltimore HIV Council, and AIDS advocates that measures needed to be taken to stop the spread of HIV and to address other related issues, like substance abuse and hepatitis C.
So what has been the response to this declaration? Nothing. Baltimore has received considerable financial resources from federal, state, and local governments for over 20 years, suggesting that community, familial, and individual health care prevention and treatment in the city should have been more than adequate. But a lack of government coordination that fosters the duplication and fragmentation of city services created gaps that allowed thousands of residents to fall through the cracks and led to our state of emergency.
City officials know where the prevalence and incidence of HIV is in Baltimore'right down to the zip codes. Most of these communities have large African-American populations. But efforts to fund programs for these communities are not easily sustained, and no effort is being made to assess existing programs to determine what's working, what programs might need additional resources, what areas need more focus, or where services gaps are glaringly visible.
An example of this gap can be seen with the city's mobile HIV and STD testing and information service, which is funded through the Centers for Disease Control and Prevention, the state AIDS administration, and the city health department. When I contacted the program'after learning that the Mount Vernon area of the city had a high incidence of HIV and syphilis infections'to ask that the vans visit that neighborhood, I was informed the program wasn't funded to operate there.
It makes no sense to me to ignore communities that obviously need assistance and intervention because of red tape and funding restrictions. Have we become so bureaucratically motivated that the lives of the people are subordinated to program design? Programs should be created and operated to ensure that every at-risk community is served.
There must be a paradigm change in Baltimore. The city health department, the CDC, and the state AIDS administration must begin to better coordinate their efforts to ensure that services are available to everyone who needs them, particularly in African-American communities that are being devastated by HIV. Programs that work should be strengthened, and new ones should be launched to address unmet needs.
Outreach efforts also must cease being based solely on risky behaviors'like gearing programs toward sexually active gay men or injection-drug users'and instead focus on entire communities that are disproportionately affected by HIV. How can labeling, stereotyping, and categorizing individuals possible benefit prevention and intervention efforts? How many people do we alienate or overlook when we specifically focus on certain risky practices?
And we, as advocates, must in a coordinated and collaborative effort ensure that these necessary improvements are supported by pushing for changes in regulations, policy, and law.
These are just a few early strategies that may help us in Baltimore in our fight against HIV. Without them, the state of emergency will continue'and the lives of our people will continue to be lost.
Paschall is the executive director of the Baltimore Prevention Coalition, a nonprofit group focusing on HIV prevention for African-Americans.
