World AIDS Day is this weekend, Dec. 1. More than 15 years after the dramatic breakthroughs in treatment science that greatly slowed the grim pace of death from HIV infection, the contours of the epidemic remain largely unchanged. Globally, those who have access to social and economic capital avoid the virus or, when infected, live healthy lives with it. Elsewhere, infections and deaths continue to mount.
Progress certainly continues and must be both noted and celebrated. As the graphic below illustrates, UNAIDS reports this month many indicators of an epidemic in retreat, in countries where we've applied the necessary pressure to control it. In the United States, the Obama administration has fulfilled its promise to develop a national strategy for confronting the epidemic, federal funding for doing so has increased (though, largely driven by the growing number of people who need treatment in the Medicare and Medicaid programs) and we're gathering a wider range of tools for preventing infection, even if debate rightly rages about how to use them well.
But the essential truth of the U.S. epidemic is unchanged, and the stark disparity that defines it is only worsening. As Hatty Lee's infographic below illustrates, new infections are coming in greatest number among black gay and bisexual men and black women. Transgender people don't exist in this data, as they don't in many data sets, but every study that has paid attention to the trans community has found horrifyingly high rates of infection, particularly among black folks. Disturbingly, AIDS diagnoses have been on a steady incline among gay and bisexual men, and more granular studies suggest those men are disproportionately black.
Black communities and individuals have in recent years engaged remarkable, life-affirming efforts to reverse these trends. That, too, must be noted and celebrated. But I offer no epiphany in saying that these three slices of black America--queer men (however we identify), women and transgender people--hold some of the least social and economic capital in this otherwise wealthy and comfortable nation. In fact, what's true in HIV is true in just about every other aspect of life in the U.S. Pick the indicator of distress, and you'll find these groups ranking near the top of those who struggle. HIV is and has always been an excellent measure of who societies value and who they don't. The world's earliest AIDS activists made this point, and it remains the most crucial point to make about the epidemic today.