Everyone who's gathered this morning has been handed the latest list of grim AIDS statistics from the Centers for Disease Control. The numbers are alarming: The virus is now the No. 1 killer of all African Americans between the ages of 25 and 44. Black women are 18 times more likely than white women to be infected with HIV. Fifty percent of the country's infected elderly population is black. Of all adolescent AIDS cases, 62 percent are African American. And in 1999, African Americans, who make up roughly 13 percent of the population, accounted for 54 percent of all new AIDS cases. What's equally disturbing, Washington knows, is that most members of these churches remain unaware of how deeply the epidemic has reached into their communities -- and how close it has crept to their lives.
Standing at a lectern to Washington's left, his friend, the Reverend Canon Frederick Williams of the Church of the Intercession, addresses the gathering. "Fifteen years of death," says Williams, a slight man with white hair. "I looked at my address book just this morning, and I don't have a page that doesn't have an rip on at least one line." Williams pauses, gathers himself, and then continues, his voice rising. "Fifteen years of friends, family, and loved ones struck down in the prime of life." A few "amens" filter back from the crowd.
As Williams speaks, Washington surveys the crowd. Some activists are here, but many of these people have come because they feel there's an epidemic brewing and they need to know more about it. He is happy with the size of the turnout, but he wishes that more clergy had shown up. Any effective effort to stop the spread of AIDS in the black population, Washington firmly believes, must include the black church, the one entity that has consistently served as the backbone, conscience, and support network for most of black America. But the black clergy has had a hard time addressing AIDS -- with its suggestions of homosexuality, drug use, and immorality. And the Centers for Disease Control, the federal agency in charge of AIDS prevention, has not effectively warned the black community about how the epidemic is changing. Until the African American church comes to terms with AIDS in its community, Washington fears the numbers are going to get worse.
Pastor Washington has reason to be pessimistic. At 51, he has witnessed wholesale losses from his generation. He has seen his fellow clergy -- people who have dedicated their lives to empowering and serving the most dispossessed African Americans -- condemn and turn their backs on people suffering from AIDS. And he saw his closest friend, George Edward Canton Jr., die, so ashamed of his disease that for a time he even hid his condition from Washington.
Pastor Washington himself was unaware of the epidemic and its impacts in his own community until one day in 1989 he was approached by Pernessa Seele, administrator of the AIDS Initiative Program at Harlem Hospital. She was concerned about the number of African Americans in the AIDS ward who were being left to die in isolation. She sought to organize Harlem churches to observe a week of prayer for AIDS victims and met with Washington at his church, Memorial Baptist, on 115th Street in Harlem. They talked about AIDS for three hours, and by the end of that time, Washington felt alarmed. "It became very clear to me that no one was dealing with this," he says. "It was like a hurricane was coming and everyone was going through their motions, business as usual." He agreed to help Seele and started listening for stories about the virus. He learned that some members of his own church were infected, some had already lost sons. He realized that if the congregation at Memorial, which was relatively accepting, was keeping quiet about AIDS, then the silence was likely to be even deeper in the larger black community.
With some help from Washington and other clergy, Seele created The Balm in Gilead, an organization designed to educate and engage the black church. Since then, Washington has worked with Seele and many others around the country to raise awareness and federal funding to fight AIDS. Over the past decade, Washington has fought the epidemic through Harlem Congregations for Community Improvement (HCCI), a corporation comprised of 90 New York churches. He founded HCCI in 1985 with a vision to rebuild Harlem, but since 1991, roughly half of its resources have been dedicated to AIDS work. This year, the staff of HCCI's AIDS division managed to parlay a $2 million budget into low-cost housing for 60 families living with the virus; prevention workshops in churches and community centers; an HIV resource center for the infected that offers the latest information on treatment; and a support network for other New York churches that are trying to develop AIDS ministries.
The work is exhausting, the funds are limited, and often Washington wonders why black church organizations like his -- which have the access and the cultural credibility to reach the most at-risk African Americans -- still have to battle for adequate government support. And often he contemplates how so many African Americans can remain unaware that they are living in the midst of a deadly health threat. So for Washington, the conclusion of Frederick Williams' address to those who've gathered for the Week of Prayer is especially poignant.
"For the next two minutes, I want you to think of someone you knew, someone close -- who has died of AIDS," says Reverend Williams. The room grows quiet. "Then I'm going to ask you to do something. Just stand and name that person you knew who died of this disease, and give thanks for them." He pauses again. "I thank God for Carl."
No one reacts right away. Then a woman rises and speaks the name of a loved one. Two others join her. A few more people tentatively follow. "James," "Morris," and "Patrick" can be made out. Then slowly, as though finding safety in numbers, almost everyone stands and a soft chorus of names fills the room.
Williams waits until there is silence.
"For those of you who are not standing, let me assure you that next year you will be standing."
Later that evening, Preston Washington is back in his large, cluttered office at Memorial Baptist. His doctorate from Columbia University's Teachers College and framed photographs of his wife and five sons hang on the wall behind him. Washington has a small build, thinning hair, and a Duke Ellington mustache. He has the eloquence and energy of a strong leader, but also a weariness that makes him seem older than his years. "What kind of damn God is this that allows this damn stuff? Babies dying from AIDS?" he asks. "I have to constantly check in with my own faith because this disease threatens every aspect of faith." Over a fried chicken dinner left over from a church meal for the homeless, he explains his sense of the epidemic's impact.
"What AIDS does is exacerbate the problems that already exist in poor, black communities," he says. "We're dealing with an epidemic where every issue related to poverty comes to fruition."
In many ways Washington is right. The AIDS epidemic was inflamed by a number of crises that still afflict low-income African Americans: Heroin addicts infect each other by sharing needles and then bring the virus home to their loved ones; mothers pass HIV on to their babies; inmates contract AIDS in prison. A significant number of young African Americans were infected in the sex-for-drugs trade that exploded with the crack scourge in the late 1980s.
AIDS continues to cross every boundary of age, gender, and sexual orientation in the black population. The CDC estimates that 1 in 50 black men is HIV positive, whereas the infection rate in the general population is roughly 1 in 300. African American women -- who are the fastest growing group of AIDS victims in the country -- are infected through heterosexual contact an estimated 50 percent of the time.
These numbers have long been rising. As early as 1983, the CDC reported that blacks accounted for 26 percent of the country's infections. And yet, while there has been a massive, 20-year campaign to curtail infection rates among gay white men, the epidemic in the black population has been largely ignored by both the black community and mainstream America.
When AIDS struck inner cities, Reaganomics was just getting into full swing, the welfare mother was being held up as a symbol of ridicule, and there was a growing movement afoot to cut "wasteful" federal social programs. African American communities, often fragmented and poor, were already overwhelmed by other crises. They simply did not have the resources, the information, or the political will to mobilize against the slowly unfolding epidemic.
Today, the problem facing health care workers fighting AIDS in black neighborhoods is that, in many instances, such services as counseling and treatment for sexually transmitted diseases and for substance abuse, don't exist. Or where they do, they're not utilized by low-income African Americans, who are often uninsured, don't have primary physicians, and distrust the medical establishment. As a consequence, black Americans frequently fail to get tested, don't seek early medical care, and have a difficult time maintaining the complicated and expensive medication regimens that an HIV infection demands.
Washington has tried to address those problems in Harlem by offering an AIDS program run for and by African Americans. William Lilly, who almost died in 1993 shortly after he was diagnosed with AIDS, credits HCCI with saving his life. When his wife heard about HCCI, Lilly, who was 45 at the time, had wasted from 200 to 98 pounds. "I didn't have the knowledge I have now," recalls Lilly. "All I could see in front of me was dying. I never thought I was going to gain weight again. I gave all my clothes away, and I just stayed in the house." An HCCI counselor, though, visited him several times and convinced him to attend a support group. In the following months, HCCI set Lilly and his wife up in low-income housing and later employed him as a "peer educator" -- one of a group of volunteers that HCCI has trained to administer instant AIDS tests.
Such humane treatment by a black church organization has been rare. Many of the clergy have accepted the conventional wisdom that AIDS is a gay disease. The intense stigma that surrounds homosexuality in the religious community has slowed the church's response to the epidemic. Often, men have told Washington how they've hidden their illness from friends and family to avoid being branded as gay. And repeatedly, he's heard HIV-positive black men describe to him how they've been frozen out of their churches and isolated from their communities. In large cities like New York that kind of ostracism is abating, but even now Washington knows of Harlem mothers who have recently cremated their sons so that their wasted bodies cannot betray their disease at a funeral. He remembers his friend Bruce Wilson. "I watched him deteriorate. I was with him [one night] until four in the morning," says Washington. "I found out he died the day before his funeral. Nobody told nobody about it. Family wanted to keep it a secret."
Washington has taken a radical stance in welcoming gay men to Memorial, one of the most established midsize churches in Harlem. He knows that despite being married and having five children, this has sparked rumors about his own sexuality. But that does not bother him. "The tragedy of all this is [that] the healing of AIDS is not just for the person with AIDS," says Washington. "The healing of AIDS is when everything comes out in the open."
Slowly, though, as more and more African Americans have been personally touched by the epidemic, the silence around AIDS is beginning to break in the black community. This year 7,500 congregations participated nationally in the Week of Prayer. The Congressional Black Caucus pushed the House to appropriate $245.4 million for fiscal year 2000 for AIDS treatment, education, and research in minority communities. Washington hopes that these are signs of a sustainable political mobilization. "This ain't no play stuff," he says grimly. "This is big time. This is warfare."
This year, former Surgeon General Joycelyn Elders spoke about the epidemic to the National Black Ministers Conference at Covenant Church in Harlem. Two days after Washington's breakfast meeting, she was welcomed to the pulpit with loud applause by 40 or so pastors and reverends. "We can't have any more missed opportunities," said Elders, sounding like a preacher herself. "Now we've got to get out during this very important political season and push for the [government funding] that we need." Later, she observed, "The CDC makes it their responsibility to keep data and inform the health practitioners of what's going on, but the places where they're putting the statistics are not often read in the African American community."
The CDC has not focused its AIDS prevention efforts on knocking on church doors or hitting the inner-city streets. Instead, CDC administrators have chosen to devote most of their attention to facilitating the work of government agencies and AIDS organizations. Last year, for instance, the CDC gave around 70 percent of its $656 million AIDS prevention budget to state and city health departments, which, in turn, distributed money to existing health care providers.
The CDC has been operating on the premise that, with some guidance, local governments know best how to fight AIDS locally, and therefore should be given the latitude to spend prevention money as they see fit. As a consequence of this ad hoc approach, the CDC seems to be operating -- two decades into the epidemic -- without a clear national strategy to fight AIDS.
Recently, a panel of public health experts and activists -- convened by the CDC to assess the effectiveness of its HIV and AIDS programs -- criticized the agency for failing to track how its AIDS prevention money was actually used and for having insufficient means to assess the effectiveness of its expenditures. The head of CDC's HIV and AIDS unit, Dr. Helene Gayle, says that the agency has heard the criticism and is developing a new strategy for AIDS prevention. But even a new plan may not have much impact, as the agency is still beholden to Congress for funding. And since 1994, the CDC's prevention budget has been raised only 9 percent in real dollars.
Our public health system failed to respond adequately to AIDS when the disease first devastated gay men in the early 1980s. Since then, billions of dollars have been spent on research, services, and prevention. Now, when AIDS is mentioned to people on the street, they often respond with surprise that it's still a crisis. Two of the largest AIDS organizations in the country, AIDS Project Los Angeles and the Gay Men's Health Crisis in New York, report that private donations for AIDS services and prevention are declining. When AIDS took its first casualties, gay white men organized quickly and won not only the support needed to combat the epidemic but also the country's tolerance and compassion. By the 1990s, virtually every American, having lost loved ones or perhaps seen Tom Hanks in the movie Philadelphia, had read, heard, or seen how gay white men had suffered from AIDS. Ironically, one of the obstacles African Americans now face in fighting the epidemic is the very success of the gay community (where infection rates have plateaued), which has given most Americans the false impression that AIDS is now under control.
But in the black community, AIDS is far from being under control. It will be instructive to see how the nation and the government -- and African Americans themselves -- respond to AIDS now that it is increasingly seen as a black crisis. The funding to fight the epidemic will probably not be wrenched from Congress without the full-fledged support of powerful black organizations like the Urban League, the NAACP, and the Southern Christian Leadership Conference. Pastor Washington believes that what will eventually bring these groups into the fight against AIDS is a growing sentiment in the black community that, "the most important human rights issue facing African Americans today is the equitable distribution of health resources."
One immediate problem in combating the epidemic is that the CDC has not yet fully utilized the black church in the AIDS prevention effort. Elders, for one, believes that's a critical mistake: "The faith-based community reaches a lot of people that the health community doesn't reach," she said recently from her home in Little Rock. "The church is the one organization that African Americans trust. When they're in trouble -- grandma's sick, they need to go on welfare -- they go to the church."
The closest the CDC has come to working directly with the church has been to establish a "faith initiative." But that agency program is currently limited to one employee and a budget of $2.7 million for the entire country. So, even when faith-based organizations like Pastor Washington's have organized against AIDS, they've been forced to compete with established health care providers for CDC grants. And as a practical matter, most churches don't have the grant-writing teams, the expertise, or -- as in HCCI's case -- the staff needed to win those awards.
Still, Washington believes that the church holds a key to solving the AIDS crisis in the African American community. It has a role as political advocate -- and Washington himself is prepared to go to Capitol Hill the next time the Congressional Black Caucus asks for more AIDS funds. But the church also has a crucial spiritual role to play: to empower people to cope with the issues of poverty, addiction, broken families, and homophobia that have enabled AIDS to spread so rapidly and so deeply. "What we're dealing with now," says Washington, "is the reality of disenfranchisement, the reality of disempowerment, the reality of dehumanization."
When it is time for Pastor Washington to deliver his sermon at Memorial Baptist Church during the AIDS Week of Prayer, he preaches about the biblical story of the nameless man who lay in his own feces and urine just steps from the healing pool of Bethesda. Washington is in the pulpit and sweat is dripping from his face. A choir of 30 singers is behind him, dressed in white and gold robes. The sanctuary is packed. Washington has just described how the nameless man, after decades of being "disempowered, seemingly unable to help himself," is bathed by Christ in the healing waters. Then Washington compares this nameless man to everyone in the congregation. In the back row, a woman weeps openly. "It's time," Washington says. "It's time. It's time to be healed."