A tradition exists within some African American families for identifying solutions to a crisis. Senior family members will convene a consultation. Key members of the family are summoned to this mandatory meeting, which is usually held around the dinner table. The purpose of the meeting is to state the problem, gather recommendations for potential solutions, and develop a plan of action. Disagreements are expected, but the richness of the discussion and the passion generated from the interactions create an environment ripe for commitment and ready for action. Successful consultations conclude with an agreement on the plan of action, and a commitment to do whatever it takes to save the family unit.
The African American community is now confronted with such a crisis: it is at the center of the HIV/AIDS epidemic in the United States. Of the more than 1 million persons living with HIV in the United States, almost 50% are African American. Rates of new HIV infections among African Americans are the highest in the nation. African Americans represent 13% of the total US population, but account for about half of new HIV infections, with nearly 25 000 becoming infected each year. Men who have sex with men and women are the most disproportionately impacted subpopulations among African Americans. The available data suggest that 1 in 16 African American men and 1 in 30 African American women will be diagnosed with HIV in their lifetimes.
In recognition of the disproportionate impact of HIV/AIDS among African Americans, the Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), and Health Resources and Services Administration (HRSA) convened a collaborative research consultation on October 17–18, 2007, in Atlanta, Georgia. An ethnically diverse, multidisciplinary group of 20 researchers and providers were invited to the proverbial table for a discussion of the problem and to provide recommendations around future HIV/AIDS prevention research initiatives. One outcome of the consultation was this important theme issue of the Journal, which focuses on novel intervention strategies for preventing HIV/AIDS.
At the close of the consultation, there was agreement that HIV/AIDS is only one of a myriad of health issues that negatively affects African Americans. Significant health disparities exist within the community in rates of other sexually transmitted infections, cancers, and cardiovascular diseases. Further, the causes of these disparities are interrelated and are fundamentally caused by social and structural factors in society, including poverty, limited educational opportunities and attainment, high rates of incarceration, unrelenting stress, lack of access to medical and dental care, and racism in its many forms. The best plan of action for tackling HIV/AIDS is an integrated approach that addresses the social, structural, and contextual environments in which health disadvantages accrue to African Americans.
I was privileged to serve as the CDC cochair for the consultation and as guest coeditor for this theme issue of the Journal. Serving as my guest coeditors are NIH colleague Victoria Cargill, MD, MSCE, and HRSA colleague Laura Cheever, MD, ScM. Throughout this process, we witnessed the amazing dedication and commitment of the researchers and providers who met with us in Atlanta and submitted manuscripts for this issue. The solution to this epidemic will require a national plan that includes individual, community, and societal support. We look forward to continued collaborative efforts and doing whatever it takes to end the crisis.