J. Lawrence Miller remembers the moment he began to feel hope that politicians were finally combating the AIDS epidemic among African-Americans - it came last Wednesday.
"It was 9:37 p.m.; I have TiVo, I recorded it," said Miller, a Baltimore AIDS-prevention advocate, who was watching President Bush's State of the Union address at the time.
Bush asked Congress to reauthorize the Ryan White CARE Act, with focus "on fellow citizens with the highest rates of new cases: African-American men and women."
Miller hopes that Bush's remarks start a reversal of an unnerving trend: lagging interest and funding to address HIV/AIDS as African-Americans become its biggest victims.
Tomorrow is Black AIDS Day, designated by activists to draw attention to the scourge of the HIV/AIDS epidemic in black America. A new report from the Los Angeles-based Black AIDS Institute called "The Time Is Now" underscores the problem by using statistics, suggestions for funding reform and personal stories.
According to the Centers for Disease Control and Prevention, blacks make up 13 percent of the U.S. population, yet they comprised 54 percent of all new HIV diagnoses in 2002, the most recent year for which data were available. Black women accounted for 72 percent of new AIDS diagnoses in women nationwide.
Baltimore ranked fourth in all cases in the nation's metropolitan areas in 2002, with 48.7 cases per 100,000 people. Blacks make up about 65 percent of the population and they account for 89 percent of the AIDS cases, according to the state HIV/AIDS Administration.
"The only way we are going to fight this epidemic and win is if we start a national black AIDS mobilization," said Phil Wilson, executive director of the Black AIDS Institute.
Wilson hopes his group's study jolts politicians, activists and caregivers into long-needed action.
"It is fantastic that the president raised the issue," he said, adding: "Show me the money."
Sparse funding for prevention and care remains the biggest complaint of community-based organizations.
Funding for the Ryan White CARE Act has remained flat at about $2 million for the last three years, according to a report last year from the Kaiser Family Foundation.
In 2002, Mayor Martin O'Malley declared an AIDS "state of emergency" and convened a city commission made up of service providers and premier researchers to confront the problem.
But some members complain that the group has no budget or staff.
Meanwhile, grass-roots programs rely on money from grants, which means that once the funding runs out, the program gets killed.
"The way in which the funding works, it doesn't allow the agencies and the community-based organizations to sustain these programs," said Dr. William Blattner, co-chairman of the city's AIDS commission and director of the Epidemiology and Prevention Division at the University of Maryland's Institute of Human Virology, which he co-founded.
Still, with a lagging deficit, there's only so much cities can do, say others.
"Cities are poor, in general," said Dr. Peter L. Beilenson, the city's health commissioner. "Major ills of society having to be dealt with by cities because there is no other funding.
"We are doing tons of outreach; we are testing 100 percent more people than three years ago," he said. "I'm not denying that it is a significant problem, but we have made significant efforts."
Miller thinks it can be done with vigilance and counseling, such as through the Black Educational AIDS Project, where he is executive director. He points to client-turned-volunteer Bernadette Foster, who had been an on-and-off crack cocaine user for half her life.
Foster, 45, who tested negative for HIV in December, considers herself lucky because she has close friends who are dying of AIDS.
"I was out there in the wilderness," said Foster. "When I would meet someone, the drugs came into play, we'd get together and the next thing you know, there was sex."
Miller's program uses counselors to teach drug users - particularly intravenous drug users, who are at greatest risk in the city of contracting HIV - the skills to change behavior.
"We try to help people not get HIV," he said. "And if they do have it, we teach them how not to pass it on. We help sit them down and teach them how to prioritize HIV in their life."
On-the-ground advocates have tried to address the epidemic in the city's hardest-hit ZIP codes - 21217, 21218 and 21215 - Park Heights, Waverly and the Arlington-Pimlico area.
In 2003, more than 11 percent of new HIV cases in Baltimore were found in 21217 alone.
Dr. Rena Boss-Victoria, a member of the city's AIDS commission and director of the HIV Prevention Research Center at Morgan State University, interviewed teens in those three ZIP codes to find out their attitudes about AIDS.