Julie Davids is the Executive Director of CHAMP (Community HIV/AIDS Mobilization Project).

Imagine that you live in a country where HIV infection rates are on the rise. In your nation's capital, one out of every 20 people is HIV positive. In some socially marginalized communities, nearly half of people are HIV positive.

In this place, about half of all people who need to be taking HIV medication to stay healthy are unable to access medication on an ongoing basis, and some have died while on waiting lists for drugs. Hundreds of thousands of HIV positive people pass through prisons and jails each year, and no effort is made to coordinate education, prevention or social services for them.

If you are reading this post from the United States, you live in that country. The epidemic in Washington, DC rivals that of some African nations; people in South Carolina and West Virginia have died on waiting list for AIDS drugs; and Black gay and bisexual men, at the intersection of the gay and Black epidemics that comprise the majority of cases in our nation, have rates of HIV that average 46% across urban centers.

The epidemic in the United States is diverse and complex, but is most prevalent in African American communities, where rates of HIV are eight times higher than in whites, and in gay men of all races, who still make up over half of new infections. And Black gay and bisexual men—at the intersection of these hard-hit communities—have rates of infection that are among the highest in the world.

So what's up with this epidemic in the United States??

For 27 of his years living in this country, Dr. Harold Jaffe worked at the Centers for Disease Control and Prevention (CDC). Yesterday at the Conference on Retroviruses and Opportunistic Infections in Los Angeles, Dr. Jaffe—now ex-patting at the University of Oxford in the UK—reflected on the U.S. epidemic in a plenary session entitled "Status of the US HIV/AIDS Epidemic: Is it Changing and If Not, Why Not."

You can join thousands of researchers, clinicians and a smattering of community activists who heard it live by checking out the webcast, where you can also find other sessions offering a heady mix of supergeeky lab science, late-breaking medical news, and prevention research that is fueling some of the most exciting debates in HIV/AIDS policy in recent years—more on that in Friday's post!

Jaffe was in the thick of it at CDC when the epidemic was first noted in the United States, and has now joined the ranks of ex-CDC employees who, to a greater or lesser degree, now speak more freely about what they've seen and where they think we need to go.

In this case, Jaffe focused on data that show that abstinence-only education does not work, citing studies like one that showed that over 13,000 youth enrolled in these programs had "no significant risk reduction indicated by self-reported behavior or by biological outcomes." That means that the young people said they weren't abstinent, which was then backed up with irrefutable stuff like pregnancy, a "biological outcome."

Saying that "funding risk reduction programs makes a lot more sense than wishing risks away," Jaffe noted that Bush's proposed budget for 2007 calls for $204 million to support abstinence-only education at the same time that federal funding for needle exchange is zero. No administration, Democratic or Republican, he added, has put "any money whatsoever" into needle exchange programs.

But there are a few other places we need to go to look at the real roots of the epidemic in the United States. CHAMP has endorsed the National Minority AIDS Council (NMAC) report, African Americans, Health Disparities and HIV/AIDS: Recommendations for Confronting the Epidemic in Black America.

The report points to four key areas needed to cut to the roots of the Black epidemic in the U.S.: access to housing; incarceration issues; needle exchange; and marginalization of gay men and other men who have sex with men.

Jaffe used his time to speak out for needle exchange and against abstinence-only programs, and stressed the epidemic in the gay community. But he missed the opportunity to laud leaders like Phill Wilson, right here in Los Angeles, and the new National Black Gay Men's Advocacy Coalition—Black gay men fighting in the epicenter of the epidemic in this country. Instead, Jaffe made a call out for leadership that only cited white gay men leaders of 25 years ago, Nelson Mandela, and Magic Johnson.

But incarceration and housing loom large indeed in the lives of Black people at the core of this epidemic. What public health people refer to as "structural interventions," and what many of us would call plain old "social justice"—stuff like affordable housing and sentencing reform so that less people are locked up and their communities are not left in turmoil—are a key part of what it would mean to really attack the epidemic in Black communities.