Sir Elton John thinks Kanye West is a musical genius. President Obama thinks he's a "jackass." I think the superstar rapper is an interesting case study in how the medical atrocities of the past are far from forgotten.
In the hit single "Heard 'Em Say," West states he "know[s] the government administered AIDS." West reaffirmed his position while passing through Philadelphia on tour for Live 8 (yes, the AIDS benefit...) and during an acceptance speech for an award, when he explained that the virus was planted in Africa to exploit the diamond trade.
But West says lots of things. What's the problem with this in particular?
The issue is that distrust in government and the medical establishment is a persistent barrier to the success of public health interventions. While West's conspiracy theories are likely hindering the success of well-intentioned public health efforts, distrust in medicine existed well before he appeared on the scene.
As Harriet Washington explains in Medical Apartheid, African Americans have been subjected to countless atrocities in the name of medical progress. In times of slavery, they were subjects of medical experimentation at their owners' will. During the American Eugenics Movement of the early 20th Century, African Americans (along with a diverse group of others) were sterilized on the premise of genetic inferiority. For nearly 40 years, 399 African American men were withheld treatment for syphilis at the hands of the U.S. Public Health Service during the Tuskegee Study of Untreated Syphilis in the Negro Male.
Kanye West's comments are presumably coming from a place of personal distrust in the medical establishment — fair enough. But his misguided claims about the origins of AIDS are not helping African Americans and others avoid infection.
A Chicago-based study found that racial and ethnic minorities had lower levels of trust in AIDS awareness messages than whites. There is no reason to believe that Philadelphia would be any different.
This is troubling. In 2008, two-thirds of all new HIV cases in Philadelphia occurred among African American males. Nationally, the Centers for Disease Control and Prevention estimates that 44% (21,200) of new HIV infections in 2009 were among African Americans.
Would censoring Kanye West result in more trust in the medical establishment and greater adherence to HIV prevention recommendations? Probably not.
What might be effective, however, is a frank and open discussion about the Tuskegee Experiment, other public health and medical atrocities, and the precautions in place to ensure that they don't happen again. Greater investment in culturally competent HIV/AIDS awareness initiatives, such as those supported by the Philadelphia organization Blacks Educating Blacks About Sexual Health Issues (BEBASHI), might also help.
Still greater trust in public health messages is by no means the magic bullet for the AIDS pandemic. Poverty, unemployment, lack of access to health care, poor education, discrimination, community disinvestment — these are among the determinants of HIV infection in Philadelphia and the world over.
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