America Living With AIDS

AM E R I C A Living With

bia, poverty, and unemployment-pervasive facShere were no tors that foster the spread
ips, no social of the disease. This web
y, so I retreated of associated social ills
ier into my has been referred to as "a
t even that was synergy of plagues."
eople coming to Poverty and unemploying to beat me ment in the inner cities of
t want AIDS in the United States entail
y-even though much more than an
Srelatives... inability to pay the bills.
ad AIDS I was In 1991 being poor is a
man. I was a generic risk factor, for it
o longer had is associated with inonger was given creased risks of becoming
ity to plan, to homeless, dying a violent
o contribute. death, and suffering and
perhaps dying from a
ELYOUN, M.A. multitude of preventable
ber 1989 illnesses. A 1990 study of
mortality in New York
City's Harlem found that
black men in that community were less likely to reach the age
of 65 than were men in Bangladesh.
The association of poverty, homelessness, and disease is perhaps best
dramatized by the impact of the HIV
epidemic on those in inner cities who
are living at the margins of society.
Without permanent addresses or
steady incomes, the homeless and
many of America's poor often are isolated from all but the most rudimentary health care. Public hospitals that
serve low-income communities and
the overwhelming majority of people
with AIDS in large cities are over
crowded, their staffs are beleaguered,
and their substandard funding is
shrinking with each additional municipal budget crisis. Those most in need
of health care are typically the ones
who can least afford it. When illness
strikes, the emergency room becomes
the "family physician." The increase
in numbers of HIV cases is placing a
strain on a system already on the verge
of collapse.
In some areas of the country the
sheer number of people with AIDS has
forced a greater awareness and understanding of the challenges people with
HIV disease face. However, although
recent opinion polls reflect a moderation of harsh attitudes toward people
living with HIV disease, HIV-related
discrimination has not disappeared.
This discrimination reflects the racism
and homophobia that pervade our
society and, like poverty, limit people's
access to care and compassion. AIDS
has been sufficiently controversial to
have earned the status of the most litigated disease in American history.
There is, moreover, a further disquieting trend. Surveys of court cases and
complaints to human rights commissions show that rather than disappearing, AIDS discrimination is changing.
Subtle prejudices involving denial of
basic health services are replacing overt
forms of bias, and these subtle biases
are more difficult to fight legally.
As the epidemic worsens, opportunities to mobilize effective responses
diminish each day that we fail to act
decisively. Education for prevention of
further HIV spread through the avoidance of risk behavior has been greatly

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