As the International AIDS Conference prepares for its first gathering in America since the ban on HIV-positive travelers was lifted by President Barack Obama, Phill Wilson, president and CEO of the Black AIDS Institute, is positioned to chart the course of testing and treatment negotiations among lawmakers, physicians, and social workers and the millions of African Americans living with HIV and AIDS. Wilson represents a slowly disappearing vanguard of warriors battling as hard the misconceptions of HIV preventions, treatments, and access as the stigmas associated with them. In the first of a two-part series, Shantella Y. Sherman talks one-on-one with Wilson about the challenges and victories of his 30-plus year battle to end HIV and AIDS in the black community.
It only takes the slightest mention of HIV and AIDS to move the quiet reserve of Phill Wilson's voice to a fervent crescendo. At 56, Wilson has witnessed a metamorphosis among political and medical bodies which once struggled to classify the virus and produce proven and affordable treatment options. He has watched the infection go from a bizarre white, gay man's disease to a near pandemic among people of color – particularly African Americans. He is neither softened nor hardened by statistics that ebb and crest, but remains resolute at continuing the fight for equal access and an eventual end to the epidemic. Of great concern for Wilson, as D.C. prepares to host the 2012 International AIDS Conference this month is the city's rates of infection.
Wilson notes that the District's epidemic HIV levels – while a point of concern – offer an opportunity for residents to speak truth to power and hold leadership responsible.
"The rates are more about D.C.'s poor leadership, not its transient population as some speculate since long-time residents are the heaviest portion of the infected population. Part of the numbers being high is the bizarre political place that D.C. occupies. Taxation without representation undermines the ability of city agencies and health workers to fight HIV and AIDS and the city has not had the type of leadership on this issue that it could have from the health department in its history," Wilson said.
However, Wilson said that even with the precarious leadership and financial deficit, the city has managed a "robust response" to testing and treatment in some areas.
"Some major changes took place under former Mayor Adrian Fenty's leadership with the health department and under Gray's current leadership as well. I believe the epidemic in some areas does rival and even surpass rates in developing countries, but there has been a lot of tremendous work in an attempt to turn that around," he said.
"Those labors are becoming evident and now the focus should be on a sustained effort. If this current effort is sustained, we will begin to see the light at the end of the tunnel. This conference will allow us to shine light on both the dangers and opportunities in D.C. today," Wilson said.
Still, the numbers nationally for new HIV cases among African Americans give rise to concerns that messages of prevention, testing and treatment are missing their targets in black communities. Wilson suggests that the lack of services may be due in large part to the taciturnity of those most in need.
"Many black Americans find themselves seeking care late in the disease because of late diagnoses which means we need to increase demands on treatment, as well as increase testing. At present, we don't have that sustained, loud, demand. If you ask for it; you can get it. It demands a demand to get services needed and a sense of urgency for facilities that provide services," Wilson said.
Hindering that demand in some instances is the long-held stereotype of black wantonness that precipitates careless, indiscriminate intimate relations and an aversion to condom use. Wilson sets the record straight on the fallacy, attributing the growth of cases to a lack of awareness.
"It is not my experience that people will not and cannot use condoms. If you compare condom use now with when the AIDS epidemic started, there was no condom culture and the worst a person would get from unprotected sex was a sexually transmitted disease (STD). They'd get a shot and it was all done. Now, we have a huge condom culture, where you have commercials and ready access to them. There is noticeable growth in use, but still it is not enough," he said.
Wilson attributes the rise in infections, particularly among young adults to setbacks caused by politicians who turned the emphasis of HIV and AIDS education from condom use to abstinence and the Centers for Disease Control and Prevention's turn away from condom use and distribution. He said the media blackout on HIV and AIDS-related stories also contributed to a popular belief that HIV and AIDS infections were a thing of the past.
"HIV and AIDS literally fell off the media radar. People began to believe that HIV and AIDS had disappeared. But as we cut back the attention of HIV and AIDS in the media, we realized that a new generation was coming into their sexuality," Wilson said.
"That decline in media attention and condom programs meant that the 20-year-olds of today were only about 10 when strong media messages were common. They never got the message. The answer: Go back to some of the things we knew worked, while coming up with new technologies to engage young people today," he said.
The Black AIDS Institute, under Wilson's leadership, has been extremely forward-thinking in its incorporation of teens and young adults in HIV and AIDS awareness and prevention messages by creating vehicles for open expression and exchange. Among its stellar efforts was the 2004 launch of Ledge magazine, the nation's first and only HIV/AIDS awareness and general health and lifestyle magazine written by and for students at Historically Black Colleges and Universities.
The free publication, distributed to more than 80 black college campuses and community centers, gives the nation's up and coming black intellectuals a creative space to dispel HIV and AIDS-related myths and promote healthy sexual attitudes among their peers.
Wilson remains cautious about the Institute's achievements in reducing infections and spearheading detection and treatment among African Americans.
"We have had some successes but our successes have in many ways turned into our worst enemies. Because the infection rates are not where they used to be, the epidemic is believed to be over and it is important to know that we are not where we need to be and could return to the days of old if we do not pay attention," he said.
But then, like a flash, Wilson's crescendo returns and there is hope, however cautious in his intonation.
"We have the potential to act and we have tools at the ready that we never had in the past. These are highly effective measures but we will have to make the requests and exert the energy, time and resources to actualize the results. Some believe that the AIDS epidemic is over and at this point in time, we are at a place where the epidemic can be over ... if we renew our efforts and make it happen," Wilson said.