THE BIG READ: Living under the radar
As a gay black man growing up in Chicago's infamous Cabrini Green public housing project, Arick Buckles knows first-hand how the stigma of HIV can keep people infected with the virus from seeking treatment.
It took him six years after he tested positive for HIV to get care. By then, Buckles was frail and wore turtleneck sweaters to hide his severely swollen lymph nodes.
"I didn't want to accept that it was HIV that was disfiguring my face, my neck," Buckles said.
The predominantly black housing project where Buckles grew up was such a hub of crime and poverty that the city tore it down several years ago.
"We thought, growing up in Cabrini Green, that it was a gay disease. If I were to disclose my status, I felt my homosexuality would be outed," said Buckles, 40, who was so fearful of that prospect that he kept his HIV status, and his sexual orientation, in the closet.
"It's looked upon as disgraceful" in the black community, he said.
Buckles' tale is still all too common, despite widespread US efforts to foster awareness of the virus that causes Aids and its treatment over the last three decades, says Dr Kevin Fenton, director of the National Centre for HIV/Aids Prevention, at the US Centre for Disease Control and Prevention.
"Stigma is a huge issue," Fenton said.
He said stigma affects a broad swath of communities in different forms, but for many blacks in America it exists on top of poverty, poor access to treatment and poor prevention services.
HIV transmission has fallen from 130000 new infections a year during the epidemic's peak in the mid-1980s to 50000 a year, a level little changed since the mid-1990s.
Part of the problem is that many Americans are infected but do not know it. Of the estimated 1.1 million Americans living with HIV, about one in five are undiagnosed.
Up to 44% of new infections are clustered in 12 major cities, including Chicago, Washington DC, New York and Los Angeles, the centre's data show. Within these communities, HIV rates are highest among blacks and Hispanics, and gay and bisexual men of all races.
The centre's researchers will present the latest US data this week at the International Aids Society's 2012 conference in Washington DC, where scientists will gather to discuss better ways to prevent and treat HIV, and how to develop a cure.
According to a report released last week by the Black Aids Institute, black gay and bisexual men make up one in 500 Americans overall but account for one in four new HIV infections in the US.
It found that, by the time a black gay man reaches 25, he has a one in four chance of being infected with HIV. By the age of 40, he has a 60% chance of being infected.
Fenton said there was nothing unique about blacks that made them more vulnerable to HIV.
"What we believe is that the infection is becoming concentrated in these minority groups as a reflection of the social and structural drivers of health inequalities overall," he said.
A study by the centre published on Friday in the UK's Lancet medical journal found that black men who have sex with men in the US are 72 times more likely than the general population to be HIV-positive.
HIV-positive gay and bisexual black men in the US are 22% less likely than other HIV-positive gay and bisexual men to get treatment, the team said.
They are also less likely to have health insurance to pay for their treatment, which is means that they don't get HIV drugs that lower the amount of virus in the body and can significantly reduce the risk of transmission.
Lack of access is just part of the story in the African American communities.
Buckles is now an outreach worker at Chicago House, a social service agency that provides housing and support services to HIV-affected and at-risk families.
"We figure that if we get these people housed, they are able to address their HIV status," he said.
In Washington DC, a city with one of the highest infection rates in the country, the centre has been working with local health officials to increase testing.
Local health officials launched an HIV screening programme in 2006 that expands testing to places like the department of vehicles, where individuals can get tested while they wait for a driver's licence.
Since its start in 2006, HIV testing in Washington is up 400%, rising from fewer than 30000 tests in 2006 to 122000 last year.
At United Medical Centre, in the predominantly black, southeast part of the capital, nurses saw that they needed to reach a wide range of people who ordinarily would not get tested. They began offering free HIV testing 24 hours a day.
Patients get immediate results and those who test positive are given treatment before leaving.
Donna Landers, a 47-year-old grandmother, sought emergency care at the clinic in October and agreed to have an HIV test as well. She had had a negative test just two months earlier so her positive result was a shock.
"I was stunned," said Landers, who is black. She believes she got the virus from her husband.
Though she felt accepted by the clinic's staff, many others judge her, including some relatives, Landers said.
"My sister used to hug me; now she doesn't."
Dr Lisa Fitzpatrick, who sees patients at the centre, said the young gay men she sees are so convinced that they will get HIV anyway that "they're not terribly concerned about it". - Reuters