In Missouri, blacks represented about 12 percent of the population in 2002 but accounted for 44 percent of AIDS cases and 57 percent of AIDS-related deaths. Deaths among blacks with AIDS rose a slight 3 percent between 2001-2002, although deaths among whites plummeted 39 percent.

The glaring racial disparity worries people like Carole Bernard of the National Minority AIDS Council. "We're seeing a disproportionate infection and death rate among minority populations in St. Louis and many other urban areas across the country," said Bernard. Along with other representatives from the Washington-based group, Bernard was in St. Louis recently conducting workshops for local health and social providers who care for people with HIV.

The reasons for the disparity -- economic, social, political and cultural -- run deep and are not easily remedied. For example, minorities use public health facilities at higher rates because many lack private health insurance. But the stigma surrounding public health clinics keeps many people from obtaining HIV testing and treatment. "The greatest tragedy for the African-American community is that so many people could be helped with their HIV infection but they never come forward to be tested and treated," said Dr. Darren E. Wethers, a local internist with a large AIDS private practice.

In June 1999, the St. Louis Department of Health declared a state of emergency, citing soaring HIV/AIDS rates among blacks. But many blacks do not see themselves at risk. Joan R. Ferguson, a public health consultant for the nonprofit Community Wellness Project said the black community continues to view HIV/AIDS "as a gay disease."

Gina Albritton, a service coordinator at Reach St. Louis, said her black clients juggle multiple problems, which can complicate HIV/AIDS care. "They don't come in with just one issue -- it's not just HIV," she said. "It's going to be no job, no income, no health care, homelessness, substance abuse."

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