A speech by the Housing Works president and CEO at the 2007 National Conference on African Americans and AIDS (February 13th in Philadelphia)

In his epic book, Rising Tide, John Barry tells the story of the great Mississippi flood of 1927, the now-forgotten greatest natural disaster our country had ever known, at least until Katrina.  He tells of the levees throughout the region, from Illinois to New Orleans, giving way as community after community is inundated with water. He speaks of the decisions made by human beings that compounded the destruction of forces of nature…. This included the decision in various communities to deliberately allow poor and middle income neighborhoods to flood to alleviate pressure on levees protecting business districts, and it included the decision in Mississippi and other parts of the lower delta not to allow Blacks to evacuate for fear of losing workers who might not return after the waters had subsided.  

Not only were Black men held back, but Black women and children were also denied evacuation. Barry describes one scene where a steamboat capable of carrying over a thousand passengers pulled away from the dock carrying only 33 white women and their children while thousands of helpless, wet, and hungry Black Americans lined the now broken levee, appealing for relief.  It only added insult to injury that the steamboat, The Capitol, departed with its calliope loudly playing over and over the song “Bye Bye Black Bird.”

The great flood dramatically changed America, leading to a white populist movement in the south that spawned politicians like Huey Long, and leading a flood of African Americans to migrate from the delta region to Chicago and other parts of the mid-west. But this is not 1927. Everyone acknowledges that in almost every respect, from science and technology to socioeconomics and race relations, we’ve come a long, long way since then. Or have we?  

Hurricane Katrina formed over the Bahamas on August 23, 2005, and crossed southern Florida as a moderate Category 1 hurricane, causing a few deaths and some flooding there, before strengthening rapidly in the Gulf of Mexico. While at sea, it rapidly became one of the strongest hurricanes on record while at sea. The storm weakened before making its landfall as a Category 3 storm in the early morning hours of August 29th, in southeast Louisiana and then again at the Louisiana/Mississippi state line.

The storm surge caused severe and catastrophic damage along the Gulf coast, devastating the cities of Mobile, Alabama; Bay St. Louis, Waveland, Biloxi, and Gulfport, Mississippi.  But no city experienced more catastrophic and long lasting destruction than New Orleans.  Initially city officials celebrated the fact that New Orleans had avoided a direct hit, with the storm veering east. But then levees separating Lake Pontchartrain and several canals from New Orleans were breached by the surge, subsequently flooding 80% of the city and many areas of neighboring parishes for weeks, compounding the damage that had already been caused by the wind.

At least 1,836 people lost their lives in Hurricane Katrina and in the subsequent floods, making it the deadliest U.S. hurricane since the 1928 Okeechobee Hurricane. The storm is estimated to have been responsible for $81.2 billion in damage, making it the costliest natural disaster in U.S. history.  

There is no question that Katrina was a terrible natural disaster. But it was a disaster that was waiting to happen. From the 1960’s on, everyone from Federal officials in the White House, Congress and the US Army Corps of Engineers to the equivalent state officials, to local Parish Levee Boards knew that the levees would not hold against direct hit from a storm of this magnitude. Plans were drawn up to build the levees to adequate strength; but funds sufficient to the task were never appropriated. What funds that were available were used to build channels to aid the oil and gas industry instead. Yet few raised their voices in protest.

In fact, some twenty years ago, a collective decision was made that, since funding the rebuilding of the levees was politically unpalatable, New Orleans and the surrounding Parishes would prepare for a storm of category three or greater by requiring every Parish Levee Board to develop plans for evacuation rather than flood prevention. And what plans they were.

In New Orleans, Mayor Ray Nagin held off issuing the mandatory evacuation order until the day before the storm hit, thus giving people less than twenty-four hours notice that they needed to prepare to leave. But to make mattes worse, New Orleans evacuation plan did not contemplate the provision of transportation.  Instead, it was assumed that giving warning and reversing the in-bound lanes would be sufficient for everyone to drive his or her family to safety. Even if there had been plans for public transportation, it was too late. By the time notice had been given, both Greyhound and Amtrak had already stopped running, having withdrawn their buses and trains to safety.

Thousands of people were left to simply pray that the levees didn’t break, a prayer that would sadly go unanswered. As it turned out, other than prayer, neither the City, nor the State of Louisiana, nor the Federal Emergency Management Administration had any plan for what to do when the levees inevitably gave way.  No plan for hospitals, no plan for nursing homes, no plans for food, water or even shelter on dry ground.

Who was left behind? Well, let’s start with the fact that before Katrina hit, 50% of persons living in New Orleans who had jobs had a household income of less than $28,000 a year.  Twenty-eight percent of New Orleans’ residents had an income below the federally ascribed poverty level. And 80% of those living in poverty in New Orleans were Black. Thirty-five percent of New Orleans households did not even have a car. And the order to evacuate came on the 28th of August…I know you all know the significance of that, don’t you? The order to get out came three days to go before SSI or SSD checks and four days before public assistance funds became available.  Not that money would have done a whole lot of good since the buses had already left town.

So the folk left behind were overwhelmingly poor and Black, the elderly, the disenfranchised, the mentally ill, the sick, colored in with a few tourists who couldn’t make it to the airport in time. Among them, of course, were many of the 7,400 people of that city living with AIDS and HIV.

This isn’t 1927. So in the days that followed the flooding of the City, our nation’s racism was for just a brief moment stripped bare for the whole world to see on CNN, Fox News, and a half a dozen other networks. From the comfort of our own homes we could see in living color as people found themselves stranded for days with no food or water, much less medication, diapers or baby formula, on highway overpasses, in the Civic Center, and that symbol of modern American opulence, the Super Dome. Images of people breaking into stores to secure vital supplies quickly got spun as “looting,” which quickly turned into lurid stories of shooting, rape, and mayhem, leading FEMA agents to refuse to enter the City with transportation or relief supplies for four days out of fear of their safety, thus exacerbating the situation.  

To be sure, as in any such story, there were many heroes, individual police and fire fighters who left their own families while the worked at rescue around the clock, fishermen taking their boats to pull people off of rooftops and out of attics without regard for race or color. But those individual tales were all too easily overtaken by the reality of massive gross incompetence and deliberate neglect.  

So it was that when the first evacuation buses finally arrived in the City, three days after the storm had passed, they went, not to evacuate the elderly or infirm, but to rescue some 700 overwhelmingly white tourists who had gathered at the Hyatt Regency Hotel. Meanwhile we watched as death began to set in for the very old, the very young, and the very ill, with that reality seared in our collective consciousness by the image of that elderly African American woman, nameless in death, sitting alone, abandoned in the Civic Center in her wheelchair. 

It’s not like Katrina brought out the worst in us. At least initially, disasters always tend to bring out the best in Americans. All Katrina did, as we all know, was to shine the spotlight on what already existed in a society where race and socioeconomic status still matter. Barack Obama probably summed it up best when he said “I hope we realize that the people of New Orleans weren’t just abandoned during the hurricane. They were abandoned long ago—to murder and mayhem in their streets, to substandard schools, to dilapidated housing, to inadequate health care, to a pervasive sense of hopelessness.”

Former First Lady and mother of George W., Barbara Bush, underscored Obama’s point in her own special way as she spoke of the evacuees who were eventually brought to the Astrodome in Houston. “What I’m hearing, which is sort of scary, is they all want to stay in Texas.  Everyone is so overwhelmed by the hospitability.  And so many of the people in the arena here, you know, were underprivileged anyway, so this is working very well for them.”  ….I’ll let Mrs. Bush’s words speak for themselves.

The reality of day-to-day racism and social and economic injustice throughout or nation today probably isn’t so shocking to anyone in this room. What was so shocking, I think, is that for a brief moment Americans around the country recognized it exactly for what it was, to the point that Katrina has been cited second only to the dismal war in Iraq as they cause for the tidal shift in American politics that took place last November. So profound was the recognition, that, perhaps inspired by the nationally televised unscripted words of Rapper Kanye West, Secretary of State Condoleezza Rice felt compelled to declare to the national and international press that the President of the United States was not a racist, saying, “Nobody, especially the president, would have left people unattended on the basis of race.”

Katrina is now old news. Most of us have long ago moved on to other things.  New Orleans struggles to survive with less than half the population it once had and even fewer jobs. Frank Oldham has already eloquently described for you the conditions that persist there for poor people in general, and, in particular, for poor people struggling with AIDS and HIV. The President’s speech, made in the heart of the French Quarter with the Mississippi River as a backdrop, is all but forgotten.  As are the many unkept promises he made that night as he struggled to salvage his image as the Compassionate Conservative. If the rising rates of crime are any indication, the poor people who have remained in New Orleans or made their way back to their home, have only sunk deeper into despair. And the experts tell us that it may take a century or more for the City to recover, if it ever does.

That said, I think for those of us engaged in the fight against HIV/AIDS, there are critical lessons to be learned from Katrina and its aftermath. The truth is that the difference between the disaster attributed to Katrina and the HIV/AIDS pandemic is that Katrina’s damage was done in one small part of our country over a period of a few days, while AIDS is a disaster that was unleashed on the world more than twenty-five years ago and that continues to unfold.

Now don’t get me wrong. I am no more a conspiracy theorist around HIV/AIDS than I am regarding Katrina. But a natural storm could not have done its most devastating work had it not been aided and abetted by years of deliberate neglect clearly informed by  an utter disdain and disregard for the poor, and especially poor people of color. HIV is a virus, and it really doesn’t matter where it came from.  What does matter is that we have allowed this virus needlessly to spread throughout the world, fueled by deliberate neglect that is clearly informed by an utter disdain and disregard for the poor and the marginalized, especially poor and marginalized people of color.

I am convinced, however, that the difference in timing between the unfolding of Katrina and the unfolding of AIDS is critical. Katrina hit so quickly and the devastation caught folk so off-guard that it captured the eye of the news media and the attention of the world.

HIV doesn’t cause the wind to blow, the rain to pour or the waves to crash. It sneaks from one person to the next in the most intimate and secret of encounters.  But it continues to reap a devastating whirlwind, more than 40 million dead, more than 40 million infected, around the globe even while leaving most of us sleeping.  Even worse, because the virus makes its way in an unseemly manner, you know, sex and all of that, all too many of us who know what’s going on refuse to speak up, much less claim and own the reality is destroying our communities.  

All too many people believe that to get AIDS you have to have done something wrong. And all too many people in the Black community, even leaders in the Black community, deep down really believe that the reason that Black folk have a grossly disproportionately higher rate of infection than other folk is because Black people live a so-called “looser lifestyle.” Sadly, all too many of us who are infected with HIV have bought into the shame, blaming ourselves and suffering in secret instead of demanding the resources we need to end the epidemic and to live our lives whole.

(Let me put on my Reverend hat on here to get one thing clear: Sex is a gift of God that is built by God into our biology for our enjoyment not for our shame. And the virus can’t distinguish between the innocent victim and the sinner. As for transmission related to drug use, you show me one person who says he or she has never misused an ingestible substance and I will show you a liar. We don’t demand that people with cancer or hypertension or diabetes hide in shame, and we shouldn’t put that on people living with HIV and AIDS either.)
After Katrina, how many churches, schools and civic groups, white and Black, mobilized to do something to provide relief? Yet how many stand on the sidelines when it comes to AIDS because we are ashamed, embarrassed or feel too awkward to speak out. And because of our shame and discomfort, we utterly fail to realize that the devastation of AIDS, just like the devastation of Katrina, does not have to be. Now, more than at any time in the history of the pandemic, we know how to end AIDS here in the United States and around the globe. That’s right, my friends, even without a vaccine or a cure, we know all that we need to know to end the AIDS epidemic and stop the damage before more is wrought. It’s not rocket science; it’s common sense.

What do we need to do to end AIDS as an epidemic. Well, first we need to ensure that every person who is infected with HIV here in the United States and around the globe has access to treatment, vital services, and housing assistance if they need it. Right here in the United States, some 50% of all people living with HIV don’t even have regular primary care, much less access to HIV specialty care. Some 50 % of people living with HIV and AIDS in the United States have experienced homelessness at some time in their lives. We can’t end AIDS if we aren’t committed to getting people into care and stably housed.

The second thing we need to do is to ramp up prevention guided by science rather than ideology. In our culture, we use sex to sell almost everything. And then we expect people not to do it. It boggles my mind to think that we are so resistant to telling our children how to protect themselves if they have sex. And God forbid that we give people clean needles lest anyone think that we might be approving illicit drug use. Even at a medical conference like this, we still here people talking about needle exchange as a mixed message that’s bad for Black people or bad for our children. 

My friends, the research findings are clear: Access to clean needles saves lives without increasing drug use. Having access to a needle is no more likely to cause someone to shoot up than having access to condoms is going to make someone have sex. What perverted sense of morality leads us to let our own children die because we don’t approve of their lifestyle? 

The third thing we need to do is to increase research to find a cure, more effective treatments and better prevention tools. Already research has led to the key to prevent almost all perinatal transmission, if only all women had access to medication at the time of childbirth. Whether it is vaccines that reduce the likelihood of transmission, or circumcision, or microbicides, research holds the key not only to healing the immune system, but also to preventing infection in the first place. But, as Reverend Jesse Jackson pointed out yesterday, we would rather invest our money in research on smart bombs than on smart treatment and prevention.

Lastly, if we are serious about ending the AIDS epidemic, we need to end stigma against people living with AIDS and HIV and ensure the full panoply of civil rights protection for people who are infected. Those of you who do outreach every day know as well as anyone that stigma is the single biggest barrier to getting people tested and the single biggest barrier to getting people into treatment and care.  Until we end discrimination and prejudice against people living with AIDS and HIV, we will not end the pandemic.

So if we just have to do those four things, why haven’t we done them? Well, some of you have heard me say this before.  It for sure isn’t the lack of resources. This year the President is asking for $125 billion dollars on top of a dramatically increased military budget to wage war in Iraq and Afghanistan. And he is calling on Congress to appropriate that money without raising a single dime in new taxes.

If we want to know what the obstacle is, just look at the story behind Katrina.    Folk knew the levees wouldn’t hold that they were poorly designed, and that they hadn’t been well maintained. But there simply wasn’t the political will to get the levee’s fixed. In this, the wealthiest nation in the history of the world, the fact that we have not ended the AIDS pandemic speaks not to a lack of resources, but a lack of political will.

The truth is that the United States ranks among the poor and developing countries today in its response to AIDS by almost any measure:  One out of every seven African American men living in DC are infected with HIV, a statistic that measures up with the worst countries in southern Africa.  More than 250,000 people in the United States today who are in need of anti-retroviral drugs don’t have access.  Nearly fifty percent of Black men how have sex with men in this country are infected, but we lack the political will to do anything about it.

Why didn’t we protect the 9th Ward? And why didn’t we have a real evacuation plan? I would argue that the reason has everything to do with who and what was at risk. And so the story goes with AIDS. At first it looked like AIDS was just killing gay men, and, after all, they were certainly expendable. Then it was just gay men and Haitians, (and who are the Haitians anyway?). Then it was gay men, the Haitians and drug addicts. And now it is very clear that AIDS has penetrated from the most marginalized and stigmatized segments of our communities to include the most vulnerable, including so many women and even our youth, particularly among African Americans and other people of color.
So what is our response to this?  Well, I would suggest that the first thing we need to do is to stop talking about AIDS as if it is just a public health problem.   Standard public health measures are not the solution. If we want to end the pandemic, we need to understand that medicine alone is not the answer either.  And, as good as it is to call for individual behavioral responses from using condoms to getting tested, that’s not the whole solution either. The reality is that HIV is a virus that is effectively fueled by racism, sexism, homophobia, and poverty on a systemic level. And if we are going to end the pandemic, we have to look at what is fueling it. 

I can already hear some folk in the room thinking to tell me to get practical. Just like folk were practical about the difficulty in moving the political will to repair the levees in New Orleans. In hindsight, everyone would have saved a whole lot of time, money, and heartache by fixing the levees years ago rather than to pay the price that the people of New Orleans, and the American taxpayers, for that matter, are now paying. The truth is that the end to AIDS sits at the nexus not just of good science and good health care, but at the nexus of social and economic justice. That is why I firmly believe that AIDS is the most important civil rights issue of our time. And that is why I firmly believe that we must build a new civil rights movement that is dedicated not only to ending the AIDS epidemic, but also to ending the conditions that have for so long allowed the epidemic to rage unchallenged.

So how do we build a movement that can actually do this? Well, I would be foolish to think that I have the whole answer. But I do have some thoughts on the subject. For one thing, I think it starts with an acknowledgment of our own participation in the existing culture.  Whether doctor, nurse, activist, or peer educator, we have all learned to play our roles to well, doing exactly what is expected of us.

Second, I believe we need to resist the temptation of the norm. For too many of us, AIDS has become a normal way of life. We have gotten used to the pills, the memorials services, and all the rest, accepting the abnormal as if it is the way things are supposed to be—almost celebrating, as it were, that we troop to Philadelphia every year in the bitter cold of February for another National African Americans and AIDS Conference.

Third, I believe we need to acknowledge our own marginalization. We too badly want to fit in, too not rock the boat, as if we believe that if we are well behaved enough, if we talk nice enough, if we learn to fit in, they will see the need to do something.  I’ve never been invited to the White House, or to meet with the Secretary of Health and Human Services or the Director of the Centers for Disease Control, and I’m not looking for my invitation.  Psalm 84:10 says, “Better to be a doorkeeper in the house of the Lord than to dwell in the tents of the wicked.”

I mean no disrespect to those who want to work on the inside or be on good terms with those on the inside. But we need to calculate the price. Refusing to rock the boat for fear of losing funding or access will not end this pandemic. We need to recognize that society and government will not respond to our plight without political force and public embarrassment. Given where we stand, particularly those of us who are living with this virus, it’s not like we have a lot of face to loose. But the powers that be really do.

Fourth, we need to acknowledge that we can’t count on AIDS, Inc. to lead the way. We’ve hear a lot of talk about the interest that drug dealers—I mean the pharmaceutical industry—has in treating AIDS as opposed to curing it.  But let’s tell the truth.  A whole lot of us have a stake in AIDS at this point, and many of us have made our careers out of it.  One way or another, every single one of us is a part of a system that now has a huge investment in maintaining this disease.  Every one of us ought to at least be open to being challenged on our commitment to bring the epidemic to an end.

Fifth, we can’t end AIDS by itself.  It’s not just about changing government’s response to one disease. It’s about changing a government that doesn’t believe in core principles like universal health care or the right of every human being to safe secure housing and the means to secure ones livelihood. We need to understand that in many ways AIDS is just the metaphor. Somewhere in the universe, there is a cure, and somewhere there is another virus lurking, waiting to take advantage of our own inhumanity.

Sixth, we must build a new movement that is grounded in civil rights and social and economic justice for everyone. The truth is that without justice for everyone, there is justice for no one.  And if my trangendered sister is belittled, I am belittled.

Seventh, in building our movement, we must embrace diversity and be radically inclusionary. AIDS has brought together a collection of some of the most diverse and marginalized peoples around.  It’s a coalition which, if it could ever come together as one, has to potential for real power to challenge the system. Instead, we look for so many petty ways to distinguish ourselves. I am reminded of an argument between two residents in one of our housing programs for active users.  “Well, at least I ain’t no junky like you,” said the one.  “Well, at least I ain’t no crack head like you,” said the other in turn.”

So it is that with our complicity, the government keeps us divided, doling bits and pieces of support to keep us scraping with each other, fighting like dogs over a bone, instead of fighting collectively for a real seat at the table with enough to satisfy everyone. And if you think I’m lying, just look at the most recent Ryan White reauthorization process in which people living with HIV/AIDS and providers all over the country fought one another for formula crumbs instead of banding together to demand full funding for everyone.

Eighth, to build a successful movement to end AIDS, we must intentionally foster indigenous leadership. We need to stop looking for someone else to be our Moses.  I certainly have no beef with demanding that folk who call themselves leaders of our communities fulfill that role when it comes to AIDS. But Harriet Tubman was never elected to office and didn’t get given a fancy title, much less a car and driver. She was a leader because she led. And without her having to flash a single credential, people followed her leadership. Her life experience gave her the authority to take on the role. Too many of us fail to recognize that we must lead.  And I say that in particular to people who are working in the trenches or are living with this virus.  

Ninth, to build a successful movement together, we must afford more opportunities for learning from each other. None of us has the whole answer or solution, and none of us, me included, is completely right or wrong. Refusing to hear others because they are somehow different from us or because we disagree on some things, deprives all of us the opportunity to learn and grow.

Tenth, we must build and foster a strong community that loves and values and celebrates its members. Too many of us have become burned out or given up because we have felt for too long that we were fight alone or that we didn’t have the support of our comrades.  We need everyone.

Eleventh, if we are to build a strong movement, must be frank and honest about our differences.  Disagreement is healthy and even productive when done honestly and with respect.

Twelfth, we must be self-sustaining.  Too many of our organizations are just scraping by, dependent on government contracts or the beneficence of drug companies or other sources of charity.  All to often, we don’t even wait for our funders to censor us.  We sensor our selves for fear of giving offense, when we really need to speak up and even act up.

I’m almost done with my list, but 13th, we must be global. AIDS is a global crisis that cries out for global leadership and a global response.  There should be no division between domestic aids advocacy and global aids advocacy, and we cannot allow our selves to be pitted against people suffering in Africa or other parts of the world.  Our nation has the resources to address AIDS in the United States and to provide its rightful share of the resources and leadership to end AIDS around the globe.

Last, but not least, if we want a successful movement to end AIDS, we must be a part of a broader coalition that is based on a struggle for social and economic justice. We must be a part of the movement for health care reform in this country, for starters. We must be a part of the movement for jail reform and the movement to end the war on drugs. We must be a part of the housing movement and much more. 

That’s my prescription for building a radically new movement to end the AIDS pandemic.  You can feel free to add to it or to even disagree here and there. What you should not feel free to do is to ignore it. For you do so at our collective peril.

After Secretary of State Condoleezza Rice made her public statement absolving President Bush of racism for his utterly inadequate response in the aftermath of Katrina, one African American Parish Commissioner in New Orleans responded by saying, “I’m not saying that the President or his people didn’t care.  I’m just saying that they didn’t care enough.”

Of course, when it comes to the AIDS crisis, the same could be said about every President of the United States since the onset of the epidemic, from Ronald Reagan to George Bush the elder, to Bill Clinton, through George Bush the junior….well, ok, Reagan really just didn’t care.  But every president since him has done something to show compassion and concern…just not enough.

So that is the challenge I would like to leave you.  I am sure that each of you here today cares about ending the AIDS epidemic. Otherwise you wouldn’t even be in this room. The challenge is not whether we care, but whether we collectively care enough to do what needs to be done to bring this epidemic to an end once and for all, and to bring an end to the conditions that have allowed it to flourish and destroy so many lives around our globe