DETROIT -- As the city of Detroit struggles to find a way out of a massive funding crisis -- one that has left parts of the city streets without cops or street lights -- another crisis has been brewing.
While the city is likely to enter into a consent agreement with the state and thus avoid the appointment of an emergency manager, it is still facing cash shortfalls and has a budget deficit of $200 million. Under all of these financial issues lurks a familiar but formidable opponent: HIV.
The disease has reached critical levels in parts of the city.
"The overall HIV prevalence rate in Detroit is .6 percent," writes Loretta Davis, director of the Detroit Department of Health and Wellness Promotion and the city's health officer. "The rates by zip code vary from .02 percent to 1.88 percent." The percentage of the overall US population living with HIV is also .6 percent. [See correction below.]
But the zip codes don’t show the whole picture. Laura Hughes, executive director of the Ruth Ellis Center, which works with LGBT homeless youth in Detroit, says that “nearly 40 percent” of the youth who utilize the center's drop-in services self-identify as HIV-positive. Last year the group served 4,309 youth.
“I always talk about our youth being at the intersections,” Hughes says. “Those intersections are race, gender, sexuality, and poverty -- all of which can increase the chances you become HIV-positive.”
Yet with these staggering numbers, the epidemic has been silently festering. Some leaders have spoken out about the epidemic -- Detroit City Council President Charles Pugh called it a “crisis,” while progressive activist Van Jones said, "If it gets worse, they could send in blue helmets from international relief sources.”
“Detroit has to recognize the HIV epidemic as an epidemic that Detroit needs to address uniquely to this region,” says Curtis Lipscomb, executive director of the African-American LGBT group KICK. “The numbers aren’t shocking. What’s shocking is the lack of response from the black community about those numbers.”
But Mayor Dave Bing and Gov. Rick Snyder have thus far remained silent on the crisis -- and activists and community leaders say their leadership on this issue is urgently required.
Understanding the epidemic
The risk category of men who have sex with men (MSM) looms large over all other risk categories in Detroit. Those men account for 43 percent of all cases of HIV in Detroit, while an additional 4 percent of men have the dual risks of needle-sharing and being men who have sex with men.
The numbers are even more revealing when viewed through the prism of race. While the U.S. Census reports that 82.7 percent of city residents identify as black, 89 percent of all HIV cases in the city are found in people who identify as black. Black men account for 88 percent of all male HIV cases, while black women account for 91 percent of female cases.
[caption id="attachment_213916" align="alignright" width="181" caption="This table shows HIV prevalence rates per Detroit zip code as of January 2012 (source: Michigan Department of Community Health). Click to enlarge."][/caption]
The Ruth Ellis numbers reflect a national trend of high levels of new HIV infections in young black MSM. The Centers for Disease Control and Prevention in Atlanta reports that young black MSM (ages 13-29) account for 75 percent of the new HIV infections among young black men each year. In addition, a 2008 study of 21 major U.S. cities, including Detroit, found that 21 percent of black MSM under age 30 were HIV-positive, while of those, 70 percent were unaware of their status. Studies have found that between 50 and 90 percent of new HIV cases are caused by people who are unaware of their HIV-positive status.
Young black men are also taking the brunt of the deaths in the U.S. The CDC reports that in 2006, 63 percent of the young people 13-24 who died from AIDS complications were black.
Many people interviewed by The American Independent said it was time for leaders to take action on the crisis. And not just political leaders. The LGBT community has to take action as well.
“It’s not even that it’s time now [to address the crisis], it’s something we should have done,” says Hughes. “But it most certainly isn’t too late, and the opportunity is in front of us for folks to step up.”
Lipscomb says that the history of the HIV epidemic has been the history of the modern gay rights movement. He says that HIV drove the movement to create responses to the tidal wave of deaths in the 80s, and the community should be proud. But he says the movement has moved away from that history, leaving HIV to AIDS service organizations (ASOs), and creating a “wall” between HIV and the gay civil rights movement.
“I think that it is an epidemic that has moved to black and brown people, and it’s an issue that’s believed black and brown people should address,” says Lipscomb. “I don’t have any immediate solution, but I do know that there has to be ownership from the gay and lesbian movement. It can’t be left to ASOs. It can’t.”
For Lipscomb, another key ingredient in addressing the HIV epidemic is the black church in Detroit. He says many “still believe that gay men deserve to get HIV,” and a result, the church has not fulfilled its usual role in addressing issues within the community. He says he is only aware of two mainstream black churches that are open and affirming of people living with or at risk for HIV, out of “hundreds” of such institutions in the city.
“If a church isn’t welcoming, it leaves a person wondering where they can get help,” he says. “That’s why the black gay community has to strengthen its own faith institutions.”
[CORRECTION: In the original version of this story, we wrongly reported that statistics from the Michigan Department of Community Health indicated that at least 3 percent of the population in half of Detroit's zip codes was living with HIV. This was based on a misreading of the MDCH report. We regret this error.]