"Education," says Dr. Joseph Nkwanyuo, an AIDS (Acquired Immune Deficiency Syndrome) specialist at Maryland General Hospital, is the key to fighting the spread of the disease in the black community.
"We must quickly circulate information that this virus is spreading rapidly in the African-American community. It is no longer the problem of only gay people or street people. When this epidemic started, it was primarily noticed in the gay community, where it infected mostly young white males. Now I am seeing more and more cases of the virus among heterosexuals and intravenous drug users in the African-American community. Also, a growing number of children are being infected."
Johns Hopkins Hospital did a study in which it was found that 6 to 10 percent of women going to the hospital's prenatal clinic were testing HIV positive.
"Let me emphasize," says Dr. Nkwanyuo, "we are talking about regular working people making reasonable incomes with a home or a nice apartment. The woman is usually shocked, because to her, her partner is a good man who does everything he is supposed to do. Often women will say, 'No way, doctor. He is a good man. He goes to church and sings in the choir. Or they will say 'He's a good Muslim brother.'
"But if you call him in and say we've got a problem, your wife is sick and she has tested positive for AIDS -- and then ask if he has ever slept with a man or if he has ever been involved in intravenous drug use, he will usually blink and tell you the truth. I'm telling you what I see as a practitioner seeing hundreds and hundreds of people.
"People need to be aware and engage in truthful, open discussion with each other before beginning an intimate relationship," says Dr. Nkwanyuo.
According to Dr. Nkwanyuo, many men and women conceal their drug use from their partners. Also, many black males who live an overt heterosexual lifestyle continue to fulfill their homosexual inclinations secretly because homosexuality in the black community is a cultural no-no. So in order to fit in, many gay or bisexual men go ahead with the facade of marriage.
"You should not reduce your level of alertness just because someone seems like a nice guy and has a good job and goes to church and tells you I don't do drugs and I'm not gay. It is not enough," Dr. Nkwanyuo says.
"Reasonable people, especially those considering having children, should go see a doctor and get tested. It only takes one person. You do not have to be promiscuous. Because of this virus, sexual behavior is never going to be the same again."
The high rate of violence in the black community is another contributing factor because it relates to the frequency of blood transfusions, which may be tainted, according to Dr. Nkwanyuo.
Critical in the black community is the problem of awareness, and economic and social attitudes as well.
"I see a lot of infected people come to get treatment too late. Some never come because they can't afford the treatment," says Dr. Nkwanyuo. "Then there is the issue of abstinence as a form of prevention, which we have to consider, especially for young people. We need to encourage healthy monogamous relationships as the way to go these days."
"We have very limited resources and health dollars," says Dr. Nkwanyuo. "If AIDS is allowed to spread it will exhaust the health care opportunities to treat all the other ills in the black community."
There are new medical findings that most doctors are unaware of that every community should know about.
"Information which has been gathered in Africa, Haiti and Europe is not circulating well here," says Dr. Nkwanyuo. "For example, there is evidence in Haiti which indicates that cigarette smoking might alter the biology of the female's cervix and increase the risk for developing the virus."
"There might also be a relationship between AIDS and the use of birth control pills, which alter the walls of vagina and the cervix, making users more vulnerable," he said.