October #148 : Amazing Race - by Kellee Terrell

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AIDS in the White House

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October 2008

Amazing Race

by Kellee Terrell

As HIV rates in black communities soar, a genetic discovery may help explain why. But are we ready to talk about it?

This summer, at the XVII International AIDS Conference in Mexico City, the Centers for Disease Control and Prevention (CDC) announced that the rate of HIV incidence in the United States in 2006 was almost 40 percent higher than previously reported: 56,300 estimated cases versus 40,000. But even more dramatic is the fact that 45 percent of those infections were among
African Americans—despite the fact that African Americans comprise just 12 percent of the U.S. population.

While many in the HIV world anticipated these high numbers, the question remains: What causes the disproportionately high rates of infection among this particular community? Several studies indicate that black people have no more, and sometimes even fewer, risk factors than white people. For example, black women report fewer lifetime sexual partners than white women, yet they are more likely to be diagnosed with an STD. So the myths of black irresponsibility, promiscuity and rampant drug use are exposed: None of them truly explains the numbers. While we know that certain social conditions and systematic oppression play a role in fueling the epidemic in black America, new rumblings suggest that something else could be in play.

The culprit, it turns out, may be genetic. Matthew J. Dolan, MD, with the Uniformed Services University in Bethesda, Maryland, and a team of doctors conducted a 25-year-long study of HIV-positive Americans and found that a gene, DARC, that once protected Africans against malaria may cause people of African descent to be 40 percent more likely to contract HIV than people of other races. “The impact of this gene is huge. It has accounted for almost 2.7 million infections in Africa,” Dr. Dolan told POZ. Ironically, the study also suggests, carriers of DARC are more likely to suppress symptoms of HIV.

While this is a significant scientific discovery, these conversations may stir up mistrust within the black community—based on a history of scientists and doctors using DNA to label people as pathological and inferior in order to justify abominable treatment such as slavery, the Tuskegee experiments (a 40-year study that left 399 black men untreated for syphilis) and forced sterilizations of black women in the ‘50 and ‘60s. More recent reports—like one this year in The New England Journal of Medicine about implicit doctor bias toward African-American patients—intensify  fear and undermine the medical community’s inclination to discuss genetics in the black community as it relates to HIV/AIDS.

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