Kendra Outler, MD, MPH
Founder, Uzima Health & Wellness
Lessons Learned from the Aids Epidemic
COVID-19 & HIV
COVID-19 has been dominating the media and minds of everyday Americans. December 1st is World AIDS Day. Throughout the month of December, the Center for Disease Control and Prevention (CDC) is asking health outlets such as Uzima, community-based organizations and faith-based organizations to encourage people to get tested for the human immunodeficiency virus (HIV) that causes AIDS. The challenge with continuing to make sure the HIV epidemic is addressed is that we are in the midst of a pandemic. For communities of color, the fight to keep down our HIV numbers while the corona virus rages across America is critical. With limited resources, families facing eviction and unemployment in 2020 are not able to think about prevention strategies for other preventable diseases, such as AIDS.
In 2018, HIV statistics per the CDC, show that more than 37, 986 people were diagnosed with the virus. Black men and women continue to account for more than 42% (forty-two) of newly diagnosed cases for the year 2018. Black men who engage in male-to-male sex have the highest rates of infection. Although epidemiologists are not finding that a person who has COVID-19 and HIV is more susceptible to death, COVID has caused a huge problem that is rarely mentioned. The limited public health resources crucial for preventing HIV in communities of color are at risk of being depleted due to our fight with coronavirus. This could translate into more AIDS cases in communities of color in the near future.
Young people today who are missing out on in-person high school and college cannot even image the fear that ran through communities like the Bronx in New York, down through Atlanta, and west to my neighborhood in Houston. My dance teacher died my senior year of high school, I watched this giant of a man who dared to bring a piece of Alvin Alley to inner-city Houston just die. I remember the whispers around his death and the questions about his sexuality. I was too young to know why the secrecy but later I put it together. In the late ‘80s and throughout the ‘90s, the AIDS crisis decimated Black families. As the CDC grappled with its’ poor handling of the disease, the stigma and shame of the disease caused people to suffer and die at home or alone in hospital. In 1990 I was working as a medical records clerk in a large teaching hospital and the death charts would be stacked tall on the desk. Mrs. Silvia, the hospital’s grey-haired social worker with the glasses that sat on her nose would patiently go through the charts. She was a pretty fair-skinned black woman who was as stern as she was beautiful. She called every number listed on those old -style hospital phones with the big buttons to find a legal next of kin listed in those charts. The shame of dying with AIDS made her job incredibly hard. Often times a family member could not be found.
Youtube: Nucleus Medical Media
Given all the bandwidth that COVID is occupying in my brain, I had to think hard on a defining moment when HIV and AIDS became real for me as a young woman coming of age. The first thing was Magic Johnson’s admission. This fine athlete stood before the cameras and lights with his wife beside him and stated that he was HIV positive. The media blitz, the comedic jokes, the admission about sex and athletes on the road were rampant. Next, I thought about the death of rapper Easy -E, the godfather of gangster rap who died of AIDS. His death was fast and caught everyone who loved his album “Straight Out of Compton'' by surprise. There was a minute when the rap music all around just went silent with the announcement. There were no words. There was only fear. These announcements made young Black men realize AIDS was not a gay white man’s disease. This was not happening only to the “down-low” brother. Everyone has to have a moment that the fear becomes real enough for them personally. We see that now with the reactions to COVID-19 as various deniers have become believers.
Mine came when I was walking through the airport, and the eyes stopped me. The caption read: “I am young, educated and I am dying of AIDS.” I stood there looking at the Essence cover. I studied her face, the sexy red dress and that stare. I always bought my monthly Essence to read about life and relationships. This time as I stared back at the woman in the red dress, I hesitated on my purchase. I continued on down to another newsstand and her eyes stood firm. I could not pass this month’s Essence magazine. I remembered thinking how she did not look like a drug addict-and she denied using drugs. She became infected through unprotected sexual activity. I followed her story for years, reading about her marriage, how she found someone who accepted her and her disease and then her divorce. The struggle to date and the struggle to fight to live. Rae Lewis courageously put a face to AIDS for Black women. Today, her Instagram states she is living with HIV over 20 years later. She still has that diva stare. http://www.raelewisthornton.com/p/about-rae-lewis-thornton.html
Youtube: 1995 News Clip
As an intern at a large public health teaching hospital in Atlanta, Georgia, I chose to do the AIDS service. Just like we have COVID floors in hospitals today, we had AIDs floors -and even AIDs hospitals. It was busy and it was stressful. I remember the first time I had to draw blood, empty a urinal, do a lumbar tap to get spinal fluid on an AIDS patient. The first time I got a call to go pronounce a patient dead. These patients were young, Black and hopeless. Often times they were bitter and mistrusting. My favorite insult was “damn doctor don’t know shit.” On the other side, I saw the sunken eyes, the temporal wasting, the thin curly hair. Next to follow I would hear the stillness combined with the struggle to breath. Finally, I saw death.
The CDC got off to a horrible start in the 1980s with tackling this disease. Similar to the beginnings of the COVID-19 outbreak, our government did not address this as a public health issue. It was described as only a “gay white man’s disease.” Eventually, the messaging was corrected, and funding led to strategies to fight AIDS such as following Ryan White’s death that began helping communities. Effective antiretrovirals, starting with AZT, and then combination pills that allowed for better compliance and fewer side effects that were created. Today, the ability to offer PEP, post- exposure prophylaxis if you think have been exposed to HIV is helping to drive down the cases of HIV. Also, if you engage in high-risk behavior, such as unprotected sex with multiple partners, intravenous drug use or have an HIV- positive partner, it is recommended that you take PrEP; pre-exposure prophylaxis. PreEP is a game changer. The winning combination to combat HIV disease has been successful in all but one main group, Black men and women. The group that is also adversely affected by COVID-19.