In this paper, we argue that a disproportionate concentration of HIV/AIDS cases in many African American communities signals a significant collapse in the social structure of those affected communities. Specifically, the open, extensive sale and use of illicit drugs and high rates of unprotected sex--all of which serve as the foundation for HIV infection--are the "symptoms" of the loss of important social controls within affected communities. The solution to this set of problems requires more than interventions tailored to individuals at risk. The structural problems that created the epidemic must be addressed with equal, if not greater, vigor.
AIDS represents the end stage of HIV disease or, more commonly, HIV/AIDS. An AIDS diagnosis signals a significant level of deterioration of an individual's immune system and an increased likelihood that a variety of potentially fatal conditions will ensue. In this paper, we argue that a disproportionate concentration of HIV/AIDS cases in many African American communities signals, analogously, a significant collapse in the social structure of those affected communities. Specifically, the open, extensive sale and use of illicit drugs and high rates of unprotected sex--all of which serve as the foundation for HIV infection--are the "symptoms" of the loss of important social controls within affected communities. We also argue that public health interventions designed to change individual risk behaviors or to promote large-scale testing and treatment programs for individuals at risk will not suffice to decrease HIV infection rates in such communities. If further destruction is to be prevented, programs and policies designed to reverse the community decline that facilitates exposure to HIV/AIDS must be implemented as well. Changing the "structure of risk"--the goal of what are termed "structural interventions"--must become a priority for those in government who are charged with the responsibility of leading HIV prevention efforts (Sumartojo 2000).
Understanding the historical factors that transformed African American neighborhoods that once boasted of considerable social cohesiveness into HIV-risk environments is also critical. We suggest that one policy--a government-initiated structural intervention--that had drastic negative consequences in poor communities of color was the implementation of approximately 1,600 urban renewal projects in African American communities between 1950 and 1970 (Fullilove 2004). We argue that the long-term social and economic consequences of these programs resulted in a process of deterioration that ultimately affected the health of individual residents by destroying their neighborhoods and weakening the social networks that connected them to their families and to their neighbors.
HIV PREVENTION CIRCA 2005
The public health approach to AIDS is significantly influenced by what we will term the medical approach to HIV prevention and treatment. This approach focuses on the individual as the target of prevention campaigns as well as the target of medical treatments. The logic of such an approach is evident. It is the individual who becomes HIV infected, and the infection must be treated by tailoring medical interventions to all of the particular manifestations of HIV disease in each patient. Hence, many of the HIV prevention interventions in the United States are increasingly similar to the approaches we use to treat individual cases of many illnesses; namely, we test and we treat. Analogously, testing and treatment have been the leading themes in the efforts of the U.S. Public Health Service to prevent and treat HIV/AIDS here in the United States since the year 2000.
Specifically, in 2003, the U.S. Centers for Disease Control and Prevention (CDC) initiated a program entitled Advancing HIV Prevention (CDC 2003). Advancing HIV Prevention seeks to make HIV testing a routine part of medical care and implement new models for diagnosing HIV infections outside of traditional medical settings. …