The HIV/AIDS epidemic has undergone a profound change in the last decade. It has changed from primarily impacting gay white men to devastating communities of color, particularly African American and Latina women.

According to the Centers for Disease Control and Prevention (CDC), the proportion of AIDS cases among whites has decreased over time, while it has increased among African Americans and Hispanics. As of 1996, a greater proportion of AIDS cases was reported among African Americans than among whites.

More African Americans were reported with AIDS than any other racial/ethnic group in 2000 based on CDC data; 19,890 cases were reported among African Americans, representing nearly half (47%) of the 42,156 AIDS cases reported that year. Almost two-thirds (63%) of all women reported with AIDS were African American.

Some experts believe, however, that the HIV/AIDS epidemic has taken a heavy toll since the very beginning on people of color and that the increase in cases can be attributed to underreporting and healthcare system disparities in minority communities.

"Communities of color have always been very much affected by this epidemic; that they were invisible is something we need to clarify. I don't think the issue is when the epidemic started to affect these communities but when the epidemic started to be visible under the inefficient healthcare system that we have and why explosively it showed up later," said Moises Agosto, member of NMAC's Treatment Education Advisory Board.

"The social and cultural factors that are integral to the spread of HIV/AIDS in communities of color are [those related to] sexuality, injection drug use, and limited access to health care. These translate to risk factors that have always been present in these communities, but were not documented from the beginning when cases started to be reported," said Agosto.

In 1992, women accounted for 14% of adults/adolescents living with AIDS; by 1999, the proportion had grown to 20%. The dramatic increase among women has particularly affected women of color. African American and Hispanic women together represent less than one-fourth of all women in the United States, yet they account for more than three-fourths (78%) of AIDS cases reported to date among women in the country. In 2000, the figures were even more staggering, with African American and Hispanic women representing an even greater proportion (80%) of cases reported in women.

"There are many complex reasons why women of color are being affected by HIV/AIDS in ever-increasing rates. The reasons include the systematic lack of access to health care for women of color and the fact that most young women access health care as a function of their reproductive capacity, not as a comprehensive healthcare strategy," said Carlos Arboleda, NMAC's Director of Treatment Education.

Reducing the toll of the epidemic among women will require efforts to combat substance abuse, in addition to reducing HIV risk behaviors. According to the CDC, many HIV/AIDS cases among women in the United States are initially reported without risk information, suggesting that women may be unaware of their partners' risk factors or that the healthcare system is not documenting their risk.

"The impact that we are observing among people of color is the result of the negligence of the system to address the health needs of this communities and not a shifting of the epidemic," said Octavio Vallejo, MD, MPH, member of NMAC's Treatment Education Advisory Board.

Arboleda added, "People of color were always affected by the epidemic but because their reported numbers were small by comparison to the white, gay epidemic and because people of color did not have a voice, they were ignored and overlooked. People of color were also overlooked despite the fact that most pediatric cases since the beginning of the epidemic occurred among communities of color."

The National Minority AIDS Council (NMAC) is a Washington, DC-based nonprofit organization that was founded in 1987 to help confront racial and ethnic disparities among communities of color. The organization develops leadership within communities of color to address the challenges of HIV/AIDS. NMAC also works with many agencies across the country that are involved in the fight against HIV/AIDS; it has responded to the needs of communities of color by developing programs aimed at enhancing the skills necessary to confront this health crisis. Today NMAC is an association of more than 3,000 AIDS service-providing organizations, minority community-based organizations, hospitals, clinics, and other groups assisting individuals and their families affected by the AIDS epidemic.