The increased incidence of Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) among the African-American population is an alarming issue. 35% - more than one third - of all cases reported in the United States and 43% of newly reported AIDS cases are among African-Americans, even though this population only comprises 12% of the American population (PR Newswire, 1998). Among all new AIDS cases reported by women, African-American Women account for 60%, and African-American men comprise 39% of all new cases among men. This latter rate is six times the rate of reported AIDS cases by white men (PR Newswire, 1998). Overall, African-Americans have the highest transmission rates of HIV in the United States (Adimora & Schoenbach, 2002), and AIDS is the leading cause of death of African-Americans between the ages of 25 and 44 (Hodge, 2001). What are the factors underlying these distressing statistics, and what can be done to alleviate the widespread occurrence of AIDS among African-Americans? Several elements must be examined including social, economical, and health influences in order to understand the causes of this pervasive epidemic. It may be suggested that misconceptions about AIDS and lack of prevention knowledge are factors putting African-Americans most at risk, and these factors may stem from inequality. However, all possible circumstances must be explored in order to fully understand the scope of this problem.
Certain factors have been found that contribute to a higher risk of HIV among African-Americans. Two of the most common behavioural risks for women are intravenous drug use and prostitution related to drug use (Sanders-Phillips, 2002). Among African-American college students, where the heterosexual transmission of HIV is significantly higher, certain barriers were identified that prevented this population from practicing safer sex. These issues, in order of importance, were negative views of condoms, trust issues, living for the moment, and feelings of invincibility (Duncan et. al., 2002). Another suggested factor contributing to the AIDS epidemic among African-Americans is the social stigma attached to homosexuality, and furthermore HIV, in this population. In a study by Kennamer et al. (2000), African-American men were found to be less likely to disclose their sexuality and associate with homosexual groups. This apparent stigma would furthermore result in African-American gay men being less likely to seek information or attention regarding HIV and AIDS.
Although all of the factors discussed thus far are relevant to understanding causes of the AIDS epidemic among African-Americans, one must examine the underlying issue of inequality as a key component of this problem. According to a study of HIV / AIDS coverage in Black newspapers in the mid-nineties (Pickle et. al. 2002), the African-American community is often conveying the message that "fighting HIV / AIDS first requires substantial action regarding the larger contextual issues - economic, political, and social - that cause health inequities." Some of these inequities include racial disparities in care access, differences in economic factors such as type of health insurance and homelessness, as well as availability of accurate information.
Access to proper care is limited to some African-Americans, and this contributes to the increasing rate of HIV and AIDS. For instance, there have been insufficient intervention programs among Blacks living in rural areas of the Southeastern United States (Brown, 2002). Rural African-American Women were also found more likely to not be counselled about HIV during pregnancy (Crosby et al., 2002). This population, according to Crosby et al. (2002), were also more likely not to be concerned about HIV and to not use condoms. Furthermore, the lack of care programs for these African-American Women are putting them more at risk of contracting HIV.
Economic barriers play an important role in the HIV / AIDS epidemic among African-Americans. Poverty alone has a significant relationship with the occurrence of HIV and AIDS. A study by Culhane et al. (2001) found that African-American race is related to the incidence of homelessness, and homelessness is related to the incidence of AIDS diagnosis. Homeless people were found to have an AIDS diagnosis rate nine times that of the general population. Other factors found to be related to the risk for homelessness were history of intravenous drug use and lack of private insurance. Interestingly, not having private insurance has also been identified as a risk factor for poor health status, and therefore, an increased risk of HIV / AIDS (Stoskopf et al., 2001). These researchers discovered that "(h)aving private health insurance is associated with a 5.3-fold greater chance of having good or excellent health status." Therefore, economic disadvantages among African-Americans are related to an increased risk of HIV / AIDS.
One of the most important factors influencing the high risk of HIV / AIDS among African-Americans is the lack of information and the presence of misinformation. Morin et. al (2002) suggest that the access African-Americans have to AIDS medication is limited by social barriers such as "lack of information, distrust of government, and HIV-related stigma." This lack of information often takes the form of myths and misperceptions about HIV and AIDS. Essien et al. (2002) identified misperceptions regarding HIV / AIDS most common among African-Americans. These included
That HIV is an agent of genocide, suspicion of government information, belief that one can identify risky partners by odor and appearance, that partners' reported histories are accurate, significant misperceptions as to the meaning of "safe sex" (particularly in women), and belief that specific classes of people (not including oneself) are at risk for HIV.
Misinformation regarding HIV / AIDS is prevalent among the African-American population, and it spans all age groups. Adolescents were found to hold several misconceptions regarding HIV and AIDS, and in a study by Dilorio et al. (2002), many did not know which type of condom effectively prevents the transmission of HIV. On the other end of the age spectrum, the number of AIDS cases in African-Americans is increasing, and a distinct lack of information among this age group is noticeable. Moreover, There is a critical need for accurate information about HIV and AIDS to be available to African-Americans.
With all the risk factors in mind, it is necessary to explore ways of preventing the occurrence of HIV / AIDS among African-Americans. Research has shown that targeted interventions work in reducing risky behaviors, and the most successful interventions were "culturally sensitive, of longer duration, and included skills training" (Aids Alert, 2002). Overall, prevention and intervention programs executed within a proper ethnic, racial and cultural context are most effective in reducing the incidence of HIV and AIDS among African-Americans.
The disproportionate number of African-Americans living with HIV / AIDS is alarming, and the problem must be addressed. Several factors, including social, economic, and political disparities, require attention in examining this epidemic. Above all, education and accurate information about the prevention of HIV / AIDS is pivotal in curtailing the spread of this preventable disease among African-Americans.
Adimora, A.A., Schoenbach, V.J. "Contextual Factors and the Black-White Disparity in Heterosexual HIV Transmission." Epidemiology 13.6 (Nov. 2002): 707-12.
Authors Unknown, "Research Shows Targeted HIV Prevention Succeeds." Aids Alert 17.3 (Mar. 2002): 33-6.
Brown, E.J. "Recruitment Feasibility and HIV Prevention Acceptability Among Rural North Florida Blacks." Journal of Community Health Nursing 19.3 (Fall 2002): 147-60.
Centers for Disease Control and Prevention (CDC). 31 December 2002. http://www/cdc.gov/hiv/stats.htm#cumrace
Crosby, R.A., Yarber, W.L., DiClemente, R.J., Wingood, G.M., Meyerson, B. "HIV-Associated Histories, Perceptions, and Practices Among Low-Income African-American Women: Does Rural Residence Matter?" American Journal of Public Health 92.4 (April 2002): 655-9.
Culhane, D.P., Gollub, E., Kuhn, R., Shpaner, M. "The Co-Occurrence of AIDS and Homelessness: Results from the Integration of Administrative Databases for AIDS Surveillance and Public Shelter Utilisation in Philadelphia." Journal of Epidemiology and Community Health 55.7 (July, 2001): 515-20.
Dilorio, C., Van Marter, D.F., Dudley, W.N. "An Assessment of th HIV / AIDS Knowledge, Attitudes, and Behaviours of Adolescents Living…
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