Foreword: The Paradigm Shift - The Impact of HIV/AIDS on Black Women and Families: Speaking Truth to Power

When the United States Constitution was written, it described man’s (and ultimately woman’s) unalienable rights to equal treatment, but that right has yet to be achieved when it comes to health care. Since the arrival of African slaves in the 16th Century, the status of health care in American health care systems for African Americans has also included no care, inadequate, antiquated and substandard treatments, and hostile health professionals. Their exploitive and discriminatory practices have resulted in inequalities in health and a mistrust in the medical care system that deters efforts among some to seek care to this day.1,2 There is no question that America is still struggling to openly address the AIDS epidemic in the United States as the “greatest public health catastrophe of the twentieth century.”3 It was C. Everett Koop, MD who, in his two terms as Surgeon General, had the arduous task of providing a congressionally mandated brochure to the American public defining HIV and AIDS, identifying who was most at-risk and recommending steps to avoid transmission in 1988.4 This mailing to every household was an effort to demystify some of the hysteria around how AIDS was spread, to reframe AIDS as a chronic disease and to recommend testing and long-term management with drugs and behavioral approaches to reduce transmission risks. It was in this brochure that the Surgeon General stated that longer years of marriage could be a protective factor for women, depending on the behaviors of both partners.5,6 Unfortunately, women in longterm marriages breathed a sigh of relief because they assumed that their husbands and partners were transparent and monogamous. However, far too many women were in the position of Mrs. Smith, a middle-aged African American wife of a well-respected pastor of a mega-church with a star-studded congregation. On his death bed, her husband whispered in her ear, “I have not been faithful. Get yourself tested: I have AIDS.” The shock and disbelief that her marriage had been a lie was only made worse when she did get tested and found that she, too, had AIDS. It was not the number of years of her marriage that provided protection, but it was the Foreword: The Paradigm ShiFT–The imPacT oF hiV/aidS on Black women and FamilieS: SPeaking TruTh To Power