The burdens of race and history on Black Americans' attitudes toward needle exchange policy to prevent HIV disease.

We must enter the second decade of AIDS with the knowledge that existing public health efforts have failed to stop the disproportionate spread of HIV disease among Americans of African descent. This article presents the cold epidemiological facts which lay bare the moral tragedy that Black Americans are being killed by a disease which is almost totally preventable. This paper discusses the primary behavioral risk factors for HIV infection and the context in which HIV disease emerged in the 1980s. Additionally, we present results from cross-sectional surveys of selected black populations to demonstrate how AIDS knowledge deficits and attitudinal barriers have shaped the perceptions of Black Americans toward needle exchange programs as an HIV prevention strategy advocated by public health authorities. A model that may be utilized to educate the Black community and facilitate their involvement in the development of needle exchange policy is described.