Three years later, Dinell is still the one taking care of her kids. Thanks to her five pills a day, she feels -- and looks -- completely healthy. And she expects to be around for many, many years.

Of the 1.2 million Americans living with the AIDS virus, HIV, in 2003, 47 percent were black -- a massive over-representation considering that blacks account for 12.3 percent of the U.S. population.

Whether it's HIV/AIDS, heart disease, stroke, diabetes or cancer, African-Americans are almost always hit harder than whites. They are diagnosed later; they die younger.

In the case of AIDS, the answer is clearly no -- there is no genetic component in contracting the AIDS virus. Rather, HIV/AIDS is a disease of behavior.

The answer is not so obvious with other diseases, though. Although genetic links have been discovered with diabetes, cancer and other diseases, it's not always clear whether disease is brought on by behavior, environment, genetics or an amalgam of all three.

More often, though, diseases -- such as depression and diabetes, alcoholism and asthma -- are caused by a complex relationship of genes, environment, culture and behavior.

Although researchers have uncovered genetic links that seem to put African-Americans at greater risk of high blood pressure and diabetes, genes are not destiny, said Keith E. Whitfield, a professor of biobehavioral health at Duke University. Genes are not a guarantee of things to come.

Carrying a genetic mutation does not mean a person will develop a particular disease. What it means is that the gene carrier is at higher risk, if he or she doesn't make the necessary lifestyle changes to avoid the disease.

In the case of diabetes, for example, people can decrease their risk -- even if they carry a genetic marker -- by exercising, eating healthful foods and losing weight.

Unlike most scientists and researchers involved in the debate about racial and ethnic health disparities, Whitfield takes the view that genetics do, in fact, play an important role.

Take high blood pressure. Some blacks may carry a genetic predisposition for the disease, he said, although the genetic factor can't be considered in a vacuum, without taking into account other factors that can raise blood pressure, such as racism, poverty, crime and family relationships.

Dr. Ashwini Sehgal, director of the Center for Reducing Health Disparities at Case Western Reserve University, is among those who believe the focus needs to be on social factors such as income, housing, education and race.

Doctors have long accepted the theory that genetic differences cause blacks to respond differently to hypertension drugs than whites do. Sehgal wondered exactly how large the difference is, so he looked at 15 studies over the past 20 years that included 9,307 white patients and 2,902 black patients.

What he found was that between 83 percent and 93 percent of whites and blacks responded similarly to the same drugs. So this so-called difference in how whites and blacks responded to medication was a small fraction based not on race, but on individual response.

The point, Sehgal said, is that even within races and ethnicities, there are differences. Not all blacks responded similarly to the same drug. Nor did all whites. So for doctors to prescribe medications based on the color of a patient's skin is misguided, Sehgal said.

An editorial in an April 2002 issue of the Journal of the American Medical Association said that it is ``both scientifically more promising and ethically more demanding'' to turn the disparities spotlight on health care systems and societal factors rather than genetics.

When whites and blacks received comparable care, there was little difference in the groups' five-year survival rates, the researchers found. The problem is that blacks tend to get different treatment and receive that treatment later, while also being more likely to succumb to other diseases while fighting the cancer.

In the United States, AIDS began in the 1980s as a ``gay, white'' disease, but in the new century, it has morphed into a ``black, female'' disease with no hint whatsoever of a genetic link.

In sheer numbers, white men -- most of them infected through sex with other men -- still are the largest segment of U.S. HIV/AIDS patients: 51 percent.

However, in terms of rates of infection, black men and women are being infected in astounding numbers. In Akron, Summit County and Portage County, 447 per 100,000 black men and 335 per 100,000 black women are living with HIV or AIDS.That compares with 106.4 per 100,000 white men and 13.9 per 100,000 white women.

From 2001 through 2004, in nearly every demographic and transmission category, the largest percentages of HIV/AIDS cases diagnosed were among blacks, according to the U.S. Centers for Disease Control and Prevention.

AIDS is now the top cause of death among African-American women ages 25-34 and is among the top three causes of death among black men 25-54. Overall, blacks are seven times more likely to die from AIDS than other at-risk groups are.

Last month at the international AIDS summit, NAACP Chairman Julian Bond said it is time for the African-American community ``to face the fact that AIDS has become a black disease'' and to find ways to defeat it.

Among HIV-positive black men, 49 percent were infected through sex with men, 25 percent through sex with women, and 19 percent through intravenous drug use.

By contrast, most black women -- 78 percent -- contracted HIV through sex with men, while 19 percent were infected through intravenous drug use.

Dinell, who doesn't want her full name used for fear that her children could be teased, traced her infection back five years before her diagnosis to a former boyfriend.

``He was cheating with a girl who had AIDS,'' she said, before adding, ``I really don't blame him. It's just as much my fault. I should have protected myself, too, just like he should have protected himself.'' local, state and national -- agree that the crisis in the black community is driven by four key problems: ignorance about how the virus is spread, an unwillingness to use condoms for protection, an unrealistic attitude that AIDS is no longer a deadly disease, and homophobia and the stigma of HIV/AIDS in black society.

Janet Black, a deacon at Akron's Emmanuel Fellowship Church, said it's important that people, especially women, take control of their health. And that could include having uncomfortable conversations with husbands or boyfriends.

Two statistics reported by the CDC make this a particularly scary scenario: 34 percent of HIV-positive African-American men who have sex with men reported also having had sex with women -- probably without the woman knowing about the other men, considering that just 6 percent of African-American women reported having had sex with a bisexual man.

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