As AIDS takes a disproportionate toll on the black community, a historic mistrust of medical authorities bred by years of discrimination has kept many infected blacks from being tested and getting early treatment.
This was the view that a series of black doctors and community activists presented yesterday to the National Commission on AIDS, a presidential panel that opened two days of testimony on the impact of acquired immune deficiency syndrome on black Americans.
The meeting, held yesterday at Baltimore City Hall, will resume today at the Peabody Court Hotel.
"AIDS is one of many scourges affecting African-American communities, intertwined with poor education, drug dependence, inadequate health care and general malaise," said Dr. Mark Smith, associate director of AIDS services at Johns Hopkins Hospital.
"It affects a population already alienated from the system."
Many factors have contributed to the deep-seated suspicions among many blacks toward a predominantly white medical establishment, Dr. Smith said.
Suspicion has its roots in such events as a 40-year experiment, ending in 1972, in which federal health authorities continued to give useless treatments to blacks in Tuskegee, Ala., who suffered from syphilis even after the known cure of penicillin was available.
"So many old people I work with do not trust hospitals or so many other community health care providers because of the Tuskegee experiment," said Alpha Thomas, a health educator with the Dallas Urban League.
Dr. Smith said the widely publicized theory that AIDS originated in Africa has caused many blacks to feel that they are blamed for the disease.
And a long-standing pattern of discrimination against poor blacks seeking treatment for various conditions has made black Americans feel alienated from health care in general, he said.
The recent revelation that New York City health clinics have refused to perform abortions on women who are infected with the AIDS virus is an example of the type of discrimination that foments mistrust, he said.
Mistrust has reached such proportions, he said, that many blacks believe that the AIDS virus was "deliberately or accidentally planted" in the black community as a form of genocide. "Two years ago, I began to hear stories of parents who told their children not to be out on the streets after dark -- doctors would snatch them off the street and experiment on them," he said.
"I heard the bogyman story a lot, and I suspect it's being told by people in neighborhoods around other research institutions," Dr. Smith said.
Black Americans account for 28 percent of the 157,525 AIDS cases reported to federal authorities through November -- about double their representation in the population.
New treatments have enabled many AIDS patients to live longer. The drugs work best when they are given early in the course of a person's infection -- but many blacks don't show up for treatment until they have quietly suffered for a long time, the experts said.
Dr. Wilbert Jordon, chief of the AIDS service at King Drew Medical Center in Los Angeles, called on black physicians and community leaders to get involved in the fight against AIDS -- saying too many had left the job to white activists and doctors.
He recalled treating an infected woman who happened to have a scarstretching over one eye. When he learned that she had been assaulted while fighting for civil rights in the South, he said, it occurred to him that "she had paid her dues so others could go to medical school."
Several witnesses who testified yesterday told of the dedication many blacks have shown toward black Americans with AIDS.
Elsie Cofield, a minister's wife from New Haven, Conn., said she organized her church several years ago to "adopt" AIDS patients. Two and a half years ago, she widened her focus by organizing black churches across Connecticut to care for AIDS patients in their midst.
"We wish every church in the United States . . . would listen to the message that we've been trying to promote," she said. "We care for our own. We will be there to care for our own."
The desperation of many afflicted blacks can be seen in the eyes of young mothers who are sick with AIDS and passed the virus to their children.