HIV, the epidemic that seems to have no end, rears it head year after year causing catastrophic damage. Now more than ever, all individuals regardless of race or demographics must be weary of the devastation this virus can cause. One social economic class that is particularly prone to this epidemic is that of the homeless community. According the center for disease control and prevention, the African-American community accounts for nearly 46% of people living with a HIV diagnosis (1). Of those, 23% are homeless. What is even more mindboggling is the fact that the African-American community only accounts for 13% of the current U.S. population.
Estimated Rates of New HIV Infections,
by Race/Ethnicity and Gender, 2006
(Source: CDC. Subpopulation Estimates from the HIV Incidence Surveillance System -- United States, 2006. MMWR. 2008; 57(36):985 -- 989)
Obviously, the best way to mitigate the risk of HIV is through abstinence. More individuals within the homeless community are becoming sexually active. Over the course of a lifetime, it is estimated that 1 in 16 black males and 1 in 30 black females will become infected with HIV. This is in direct contrast to their white counterparts who are significantly less likely to contract HIV with a 1 in 104 and a 1 in 588 chance respectively (2). This is of particular importance to homeless teenagers who engage in sexual behavior at early ages. For one, these activities develop habits that are inherently risky in regards to contracting general STDs. Also, many young teenagers are not properly educated on proper protection techniques. Within the homeless community more emphasis must be placed on proper education from the society itself. Often, the community relies on the government or other third party organizations to alleviate societal problems. These programs to a certain extent have created benefits for the entire society.
The nation is, however, realizing a decreasing trend in AIDs within the homeless community. For example, between the years of 1993 to 2003, sexual intercourse between the homeless overall have decreased from 53% to 47% respectively. Even more favorable, in 2003, more that 65% of all homeless teenagers were abstinent (3). This trend is even more dramatic within the African-American community with sexual intercourse rates declining from 59% in 1991 to 47.7% in 2009. Among African-American males, who are the most prone to HIV infection, the trend is also declining from 64% in 1991 to 50% in 2009 (4).
In regards to AIDs among the homeless community, low social economic status plays a role. There is a direct correlation between high school drop out rates and wealth. Only 47% of African-American males graduated from high school in 2010 (5). This is compounded by the fact that many of these drop outs becoming unproductive members of society, thus engaging in unproductive activities. These activities including drugs, sex, and other substance abuse practices can potentially lead to an increase likelihood of HIV infection. Nearly 23% of African-Americans live in poverty as mentioned above, with another 40% with only a single parent. According to the center for disease control, rates of imprisonment, death and drug use among men influence patterns of sexual behavior that spread HIV (6). The African-American community has both the highest rate of imprisonment within the United States and the highest high school drop out rates both or which contributes to high rates of HIV among the homeless.
Definition and description of epidemiology in general related to your topic / Discuss steps and methods used in epidemiology as it relates to your topic.
Epidemiology is defined by Webster's Dictionary as, "A branch of medical science that deals with the incidence, distribution, and control of disease in an entire population (7)." In regards to the homeless population, the incidence from 2006 through 2009 of HIV infections among adults and adolescents remained stable. In 2009, roughly 43,000 adults and adolescents were diagnosed with HIV infection, 5300 of which were homeless. Of these, 76% of diagnoses were among males and 24% were among females. What is interesting is the amount of homeless males diagnosed between 2006 and 2009 went up 5%, while female diagnoses decreased by 9% (8). Below is a chart depicting the above data in numerical form. These figures are from the CDC for the year 2009.
Type of Transmission
Number of HIV infections reported
Overall Percentage of the total population
Male to Male
Injection drug use
Both Male to Male contact with Injection Drug use
How is HIV spread among the homeless populations? According to the CDC, The percentage of diagnoses of HIV infection among adults and adolescents exposed through male-to-male sexual contact has increased by 6% from 2006 to 2009. The total percentage now stands at 56% with the trend increasing with male to male intercourse (10). However, the total overall percentages of diagnosed HIV infections through the use of injections, homosexual contact, and heterosexual contact have remained relatively stable for the same period. This is somewhat reassuring as the trend overall has been stable recently. In terms of percentages, an overwhelming 74% of infections were attributed to male-to-male sexual contact and 8% were attributed to injection drug use. Meanwhile, only a mere 14% of diagnosed infections were attributed to heterosexual contact. In regards to the homeless population, a trend is starting to form. First, contrary to popular belief, homosexuals contribute a disproportionate amount to the total HIV cases in the United States. In fact, of the homeless population, male to male contact constitutes a vast majority of cases not female to male as many individuals would think. Now in regards to heterosexual contact among the homeless, an estimated 85% of all diagnosed FEMALES contracted the disease from a member of the opposite sex (9). The remaining 15% was attributed to drug use. As I have eluded to earlier in the document African-Americans constituted the largest percentage of diagnoses of HIV infection each year. From 2006 to 2009 nearly 50% of all HIV infections were from African-Americans, 28% were white, and 19% were Hispanic. The remaining portion was spread equally between Asian, Native America, and multi-racial (8).
Explain the type of epidemiology used for your topic (descriptive or analytical).
The epidemiology used for this particular paper was both descriptive and analytical. First the descriptive portion (mentioned above) described the characteristics of the homeless population who were susceptible to the given disease. I also went into detail explained how the disease was contracted and where it was most prevalent. I also went into detail describing the characteristics of those who are engaged in such activity and what activities constitute how the disease is transferred. On the analytical aspect, the research provided gives statistical accounts of how the disease is transferred and what percentages correlate to a particular transmission activity. The data also provides specifics on the exact proportion of male to male, and heterosexual accounts.
Provide an overview of population and disease and identify how characteristics of these selections influence population vulnerability.
This aspect was covered in detail above.
Identify primary, secondary, and tertiary prevention to address the disease
Currently, many forms of prevention on all levels are available to the homeless population. The first of which are shelters designed specifically to help abate the prevalence of HIV. Many of these shelters focus on intervention by providing facilities to better educate the homeless. These shelters provide access to primary care, substance abuse treatment, both of which contribute heavily to the spread of HIV. In New York City, the location with the most HIV cases, preventative measures are being used to address the female homeless population. Here condoms, gels, and other contraceptives are given to these individuals to help protect and empower them.
Personally, I believe these prevention measures are futile and do not address the bigger issue of homelessness. I believe the issue of homelessness must first be addressed. As a result HIV would diminish as a by-product of addressing the bigger issue of homelessness. I believe it to be both impractical and somewhat absurd to simply give out protective items and hope that the homeless use them. For one, even if they do use them, the effectiveness is not 100%. It is quite possible for a homeless person to use a condom and still contract HIV. Further, there is no guarantee the items will even be used. Second, it is unrealistic to believe that these shelters can provide a realistic means of defense against the transfer of HIV. It is the nature of homeless individuals to be nomadic in their movements. I concede that many congregate around the same areas, however, there is nothing hindering homeless individuals from simply moving to another area of town. The shelters however, can not move as the homeless person can. They are not as nimble and flexible in their operations. They are defendant on the prevalence of the homeless population in the surrounding area. If the homeless population…