"I know where AIDS come from," a caller to BCA insisted one day in the summer of 2000. Dale had recently been released from prison, where he spent a good deal of his time in the prison library, and on the internet, researching the origins of AIDS. He'd gathered reams of data, and supposedly had traced the disease back some 300 years. When he called BCA, he asked to be allowed to come in and present his findings to see if the agency would help him determine what to do with them. "Since I'm black, and BCA is a black agency, I figure you might be of more help to me." Referred to the agency's Director of Communications, Dale made an appointment to come in the following week and show what he'd found. Unfortunately, upon his arrival, he was quite distressed to discover that the Director was white. Barely able to mask his discomfort, Dale stated that he would "have to decline" speaking at this time and left the office. Later, it was said his theory boiled down to the white man bringing AIDS to Africa during the slave trade. Unfortunately, even today, many wild conspiracy theories abound in the black community regarding the possibility that whites and/or the U.S. Government developed the disease purposefully to devastate the black community. Early whisperings within the gay community suggested a similar thing. Considering the Tuskegee syphilis study where, from 1932-72, poor black sharecroppers were told that they were being treated for "bad blood," while actually being used as human guinea pigs to chart the untreated effects of syphilis, black concerns are understandable. As Shilts says in And the Band Played On, "most [people] remained uninformed as to the lasting legacy that prejudice imprints on an oppressed people. Humans who have been subjected to a lifetime of irrational bigotry on the part of a mainstream society can be excused for harboring unreasonable fears" (1987, 541). Unfortunately, this distrust would not help blacks in their fight against HIV/AIDS.

A sad corollary to black distrust of society's official structures and institutions is the fact that most institutions are deserving of that distrust. On a daily basis, blacks still must deal with a government and society that have been reluctant, to say the least, to accord them full integration and acceptance. This lack of integration into society exacerbates problems such as higher incidences of intravenous drug use and homelessness, which contribute to the difficulties inherent in the black community in dealing with HIV/AIDS. No one was more aware of this than Brandy Moore. His experience in city government working with housing issues enabled him to see first-hand the difficulties blacks faced in this arena (Brandy served in Mayor Agnos' Housing Department). Accordingly, at BCA, Mr. Moore was among the first and strongest proponents to push for housing for HIV-infected blacks in San Francisco. Because of the difficulty involved with setting such a program up, and the numerous people that would need such housing, he suggested limiting admission to those who were not only HIV+, but also homeless and at least dual or triple-diagnosed (i.e., they also had substance abuse problems, mental health issues, etc.). Thus, the "neediest of the needy" would receive help first. BCA's first transitional housing facility was opened in 1991 in the Bayview district of San Francisco. It was not an immediate success.

Even after BCA had been around for five years, and expanded from being at first simply an advocacy group to a provider of HIV prevention and awareness services, there was still an unwillingness among blacks to apply for help/services. The stigma was too great. Sharon, a former BCA client, says, "You didn't want nobody seeing you go into a place that had to do with AIDS. Better to be a junkie in the streets than have your friends know you got AIDS." Additionally, BCA was dedicating all of their limited funds to staffing and providing services. They could afford very little to no advertising and the HIV awareness campaigns that were being done in the city certainly were not "Afro-centric," and thus unable to reach the continually growing number of HIV-infected blacks. Sporadic attempts were made at reaching out to blacks, when money became available.

A $30,000 grant from the San Francisco Department of Public Health in early 1993 allowed for the production of an interactive video entitled, "Brothers," which targeted black gay and bisexual men. The project was developed by BCA and the National Task Force on AIDS Prevention (NTFAP). Response was tepid, and some involved claimed it was because the video was too much like a "white boy video game." NTFAP was disbanded in 1998 and many of its programs absorbed by BCA.

To this day, BCA continues to have difficulties in reaching potential clients to make them aware of services they could find helpful. When other city agencies, such as the San Francisco AIDS Foundation, have attempted marketing campaigns targeting blacks, they have basically relied on what has worked for the white, gay community (e.g., a guy, presumably HIV+, biking up a hill thanks to the wonders of Crixivan or some other drug). In numerous focus groups conducted by BCA, participants have mentioned time and again that they feel, to date, there has been no advertising whatsoever that speaks to them. Joy Rucker, a former Housing Director at BCA, states that she feels the organization's biggest shortcoming has been their inability to be able to fund a good marketing campaign aimed at San Francisco blacks. "The greatest thing BCA was able to do," states Joy, "was set up that first transitional housing facility. But the saddest thing was not being able to promote it." To provide an example of how this lack of appropriate promotion impacts service delivery, when Mr. Poe arrived at BCA in 1996, there were five people in the 14-bed transitional housing facility Brandy Moore had secured.

As with Brandy, Duane realized the importance of housing. Being able to follow drug regimens, as well as avoid the problems associated with living on the street, means first having a decent place to live. Collaborating with the Bernal Heights Neighborhood Association, BCA expanded into co-facilitating permanent housing for its clients to transition into. Next, the agency worked on securing funding through federal grants connected with HUD. They used the money to purchase and renovate a larger house in the Western Addition. A local designer donated her services to provide a warm, homey feel to the building, and on October 21st, 1998—almost four years to the day after his death—the Brandy Moore house was dedicated. The transitional housing program still only accepts HIV+, formerly homeless, dual or triple diagnosed individuals. However, since its inception, the 11-bed facility has constantly been full and maintains a lengthy waiting list.

"The problem is," says Mr. Poe, "in dealing with this type of issue, and this population, you're only going to have success with programs and services that people particularly care about and are willing to put out an effort for." Duane, like Brandy, was concerned with housing. Accordingly, to date, it remains the most successful of BCA's programs. However, recognizing that quality services also need a quality marketing plan—particularly as the agency works to build capacity—Mr. Poe has re-focused BCA's efforts towards developing outreach campaigns that specifically target blacks with culturally sensitive messages, and towards working more with institutions such as the black churches (while also working to build more community institutions).

An example of this new strategy has just been unveiled with BCA's In the Spirit of Health campaign. In 1999, BCA established an HIV Ministry and was able to accomplish a goal many in the community had dreamed of for years: getting the black churches more actively involved in fighting HIV/AIDS. The HIV Ministry built on BCA's annual "pass the plate" campaign done the Sunday after Thanksgiving wherein local churches encouraged their congregations to become educated about HIV and then collected a special offering to support BCA's work. A campaign targeting older black women at risk for HIV was developed to utilize this new relationship between the agency and local churches. In the Spirit of Health incorporates positive imagery of older black women, enfolds the need for HIV testing within the general rubric of health issues these women face so as not to frighten them with a message only about HIV/AIDS, and distributes materials such as church fans, bible markers, etc. designed to reach this audience. The campaign has been hailed by all involved and continues to receive recognition and emulation from throughout California.

Challenge vs. Hope

Difficulties remain. Building a community—particularly among a population under constant attack—is not easy. Securing funding for culturally sensitive marketing remains problematic, as too many foundations consider such a thing as too nebulous and unable to produce quantifiable and trackable results. Overcoming the culture of distrust among blacks, as well as changing the harmful misconceptions within the community regarding AIDS as a homosexual disease, will take a lot of work. And, unfortunately, too many established institutions (such as the media) have demonstrated an inability, or perhaps a lack of desire, to help.

These challenges point to the need for continued hard work. Yet BCA and others remain optimistic regarding what they can accomplish and the progress that can be made. Sadly, there is no one on the scale of a Martin, or Malcolm, or even a Bobby Kennedy, to speak up for the black community today; to battle against the impact this disease continues to have on the community; to provide hope. So the fight must come from within. And though the struggle remains difficult, many within the community can envision a day when the spread of HIV/AIDS is halted in the black community. They feel, as Bobby did, when he said, "Some look at the world as it is, and ask: Why? I look at the world as it could be, and ask Why not?"

References

Broussard, Albert S. (1993). Black San Francisco: the Struggle for Racial Equality in the West, 1900-1954. University Press of Kansas.

Cohen, Cathy J. (1999). The Boundaries of Blackness: AIDS and the Breakdown of Black Politics. Chicago: University of Chicago Press.

Goldfield, Michael. (1997). The Color of Politics: race and the Mainsprings of American Politics. New York: The News Press.

Johnson, Dr. Pamela Blackwell. (2000). AIDS & African Americans: a Guide for Substance Abuse, Sexuality, and Care. Dallas: NCD Publishing.

Shilts, Randy. (1987). And the Band Played On: Politics, People, and the AIDS Epidemic. New York: St. Martin's Press.

Damon, Scott. The San Francisco Chronicle, November 11, 1991. A17

San Francisco Chronicle, November 8, 1991. A22

Personal interviews were conducted via phone, e-mail, and in person with various current and former staff, board, and clients of the Black Coalition on AIDS, from October thru December of 2000. "Raymond," "Dale," and "Sharon" are not the interviewees' real names.