The drug use epidemic also contributed to the rise in HIV rates with needles being shared in shooting galleries. It was the unexpected consequence of paraphernalia laws across the country. Interventions, including syringe exchange programs in cities such as Atlanta, attempt to stem the spread of HIV and some even have HIV testing vans nearby. However, the political fallout of needle exchanges creates political fallout that is too much for local pastors.
It is at this point in Simone's documentary that a fascinating coalescence takes place. Beginning with a discussion of babies born to mothers with HIV, "Endgame" traces a line from the crack epidemic of the 1980s and 90s to the present day. With crack promoted as an aphrodisiac, it's not surprising that crack and sex work, as a means of paying for the drug, often went hand-in-hand. Crack-related arrests and imprisonment then created a large African-American prison population. And while most people in positions of authority in the prison system would be quick to deny the existence of homosexual activity among the inmates, but a doctor, such as Earl Joyner, MD, knows differently.
Paroled inmates with HIV then return home to their wives and girlfriends, as well as male sex partners, and a new cycle of transmission begins. Because of the large number of incarcerated men, the number of available men dwindles and the competition between women is intensified. Women are then willing to do things they wouldn't ordinarily do, including having unprotected sex, if there wasn't a shortage of men.
The effect of HIV on women and the importance of women being counted in the stats reached its peak in the early 1990s through a lawsuit against the US Secretary of Health and Human Services and demonstrations at the CDC, claiming "murder by omission." Because of such activism, the definition of AIDS was revised to include women's diseases, too.