Some 10,000 African Americans who inject drugs are becoming infected with HIV each year.⁽¹⁾  As the years pass, a number of them may well stop injecting drugs, but the HIV/AIDS disease will stay with them.

The number of current and former African American injecting drug users living with AIDS is increasing.  Between 1994 and 1998, the number of African Americans infected through use of a contaminated needle and living with AIDS increased by almost 50 percent.(2) (See Chart 1.)  Additional thousands of African Americans are living with HIV, infected through a dirty needle, but they have not progressed to AIDS.  Some of them are aware of their illness, others are not.(3) With improved medical treatment, AIDS deaths among African Americans infected through use of a dirty needle have been falling since 1995. (See Chart 1.)   But AIDS deaths are still a serious problem.  In 1998, AIDS was the second leading cause of death among African Americans between the ages of 25 and 44.(4) Half of those deaths were caused by injections with contaminated needles.(5)

The HIV/AIDS epidemic has fallen much more harshly upon African Americans than on whites who inject drugs.  Among those who inject drugs, African Americans are five times as likely as whites to get AIDS.⁽⁶⁾

The AIDS epidemic among African Americans infected through use of a dirty needle does not stop with them.  From them, the AIDS epidemic spreads outward to non-drug-injecting wives, husbands and lovers and then to newborn babies.

The role of racial profiling and needle possession laws in the spread of AIDS

Permitting access to sterile needles could substantially reduce the spread of HIV among injecting drug users.  No research has ever shown that making needle possession illegal is effective in reducing drug use in the United States.  Our needle possession laws have been effective, however, in making sterile needles scarce and in creating the circumstances in which people who inject drugs share their infected needles, resulting in the further spread of HIV and other blood-borne diseases.  In this way, an ineffective policy of drug control – denying access to sterile needles – has become a major factor in the spread of deadly disease.⁽⁷⁾

People can avoid arrest for possession of an illicit drug by buying the drug immediately before they plan to use it.  In the many states where needle possession is illegal, those who carry their own clean needles are vulnerable to arrest at any time.

African Americans are more at risk in this regard because African Americans frequently have been the target of police drives to enforce drug laws.⁽⁸⁾  This shows up in the federal government’s own data which indicate that blacks who use drugs are 2.4 times more likely to be arrested on drug charges than whites who use drugs.⁽⁹⁾  Official arrest records understate the situation.  News stories show that, in at least some cities, police do not record the stops they make, if the stops do not result in arrests.⁽¹⁰⁾ 

We can now begin to see why the number of injection-related new AIDS cases is so high among blacks: being stopped and searched is much more common among blacks than among whites.  This means that the legal system, via the police, is more likely to confiscate the personal needles of blacks.  Also, because black users know (correctly) that they are vulnerable to arrest, these users are likely to “choose” not to carry their own clean needles.  Users who do not carry their own needles all too often end up sharing the needles and blood-borne diseases of others. 

Spreading HIV among African Americans who inject drugs is not the deliberate policy of any state government or police department.  Nevertheless, by restricting the access to sterile needles and by targeting blacks for arrest, that has been the result.

The infamous Tuskegee syphilis “experiment”

In our society, medical intervention goes far beyond the use of pills, bandages, and surgery; in the name of public health we remove asbestos and lead-based paint and treat water.  Given the medical consensus that has emerged on the effectiveness of sterile needles as a way to avoid the spread of injection-related AIDS, it is difficult to see the denial of access to sterile needles as anything other than the denial of access to a lifesaving medical intervention.

In the history of modern medicine in the United States, there is only one other instance where a lifesaving medical intervention involving the spread of a deadly infectious disease was deliberately denied a group of people.  That instance is the infamous Tuskegee syphilis “experiment.”  The originators justified themselves by saying they wanted to study the course of untreated syphilis.  The unfortunate victims of this study were 400 black men from Alabama, who were denied medical treatment for their syphilis from 1932, when the study began, until their deaths or, if they lived, until 1972, when the “experiment” was exposed and stopped.⁽¹¹⁾

The absence of genetic protection

Scientists have discovered that certain genes offer protection against the initial infection with HIV and/or slow the speed with which HIV/AIDS progresses.  This genetic protection has been found in between 4 and 17 percent of whites and 2 percent of Puerto Ricans.  So far, this genetic protection has been found to be almost nonexistent in Africans, Asians and Pacific Islanders.⁽¹²⁾ 

Footnotes

(2) Excludes heterosexual partners of IDUs.  Unpublished data from the CDC.  Definitions are the same as in CDC,  HIV/AIDS Surveillance Report, Cases Reported Through December 1999, vol. 11, no. 2, tables 26-31.

(3) Data from emergency departments in hospitals in areas where the prevalence of HIV infection is high indicate that half of infected persons are unaware of their HIV infection. CDC, Morbidity and Mortality Weekly Report, “Anonymous or Confidential HIV Counseling and Voluntary Testing in Federally Funded Testing Sites – United States, 1995-1997,” June 25, 1999, vol. 48, no. 24, pages 509-513.

(4) CDC, “Deaths: Final Data for 1998,” National Vital Statistics Reports, Hyattsville, MD: National Center for Health Statistics, by Sherry L. Murphy, vol. 48, no. 11, July 24, 2000.

(5) For African Americans, this estimate is based on the number of IDUs living with AIDS plus 39 percent of the number living with AIDS exposed through heterosexual sex in 1998 as taken from a special tabulation from the CDC.  The “39 percent” for those exposed through heterosexual sex with an IDU is derived from the distribution of cumulative AIDS cases among African Americans reported in CDC, HIV/AIDS Surveillance Report, Cases Reported Through December 1998, vol. 10, no. 2. 

(6) See Dawn Day and Reuben Cohen, “Race and the Spread of HIV/AIDS Related to Injection Drug Use,” Princeton, NJ: Dogwood Center, April 1996, 11 pages; and a CDC survey of HIV seroprevalence among persons in drug treatment in 1991 and 1992. In that study, the median HIV seroprevalence for blacks was 18.4 percent; for whites, it was 3.8 percent. CDC, National HIV Serosurveillance Summary: Results Through 1992, 1994. vol. 3, page 19.

(7) David R. Holtgrave, Steven D. Pinkerton, T. Stephen Jones, Peter Lurie, and David Vlahov, “Cost and Cost-Effectiveness of Increasing Access to Sterile Syringes and Needles as an HIV Prevention Intervention in the United States,” Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, vol. 18 (supplement), 1998, pages S133-S138.

(8) For more information on racial profiling and its consequences, racial profiling.

(9) Based on unpublished arrest data from the FBI, blacks were about 4.4 times as likely to be arrested on drug charges than whites.  Based on data from the National Household Survey on Drug Abuse, blacks were about 1.8 times as likely as whites to use heroin or inject drugs in the past year. Taken together, this means that black drug users were about 2.4 times as likely to be arrested as white drug users. The drug use data are from U.S. Dept. of Health and Human Services, Substance Abuse and Mental Health Services Administration, National Household Survey on Drug Abuse: Population Estimates 1998.

(10) William K. Rashbaum, “Review Board Staff Faults Police on Stop-and-Frisk Reports,” New York Times,  April 28, 2000, page B1.

(11) J.H. Jones, Bad Blood: The Tuskegee Syphilis Experiment, New York: Free Press, 1993, 2^nd edition.  For more information, go to the Tuskegee syphilis experiment.

(12) Y. Lu, V.R. Nerurkar, W.M. Dashwood, C.L. Woodward, and others, “Frequencies of the CC Chemokine Receptor 5 Delta 32 Allele in Various Populations of Defined Racial Background,” International Journal of Infectious Diseases, Summer 1999, vol. 3, no. 4, pages 186-191; F. Libert, P. Cochaux, G. Beckman, M. Samson, and others, “The Deltaccrt Mutation Conferring Protection Against HIV-1 in Caucasion Populations Has a Single and Recent Origin in Northeastern Europe,” Human Molecular Genetics, March 1998, vol. 5, no. 3, pages 399-406.

For a list of other materials used on this website, see References.