For the many African-Americans who struggle with poverty, concerns about HIV and AIDS often fall to the bottom of their lists of concerns (Messina, 1994). When feeding their families, paying the rent or taking a sick child to the emergency room are everyday problems, concern about a disease that might be fatal in a decade is unlikely to be a priority.
In African-American communities, childbearing is extremely important. Various researchers have suggested that for African-Americans "who live in poverty, having children is often the only way they have to prove that they are socially productive and to demonstrate their manhood or womanhood (de la Vega, 1990). HIV / AIDS prevention messages that encourage condom use are in direct conflict with this cultural values, as condoms prevent pregnancy.
Denial of the threat of HIV / AIDS is common in African-American communities. Most people assume that they are safe from infection, even when they participate in risky sexual behavior (Messina, 1994). Denial of danger is a common human trait. Many people still believe that HIV / AIDS is a disease that is only a threat to homosexuals and African-American young adults are no different. Therefore, creating HIV / AIDS prevention messages and programs that personalize the risk for this population is important.
Religion plays an important role in the lives of many people, including African-American young adults (Messina, 1994). African-American churches are often much more than just religious institutions, serving as centers for the development of leadership, education and the teaching of the values and traditions of the African-American community. Starting with slavery, when religion offered slaves the promise of eventual freedom and comfort during captivity, religion has helped African-Americans cope with their social and economic isolation (Locke, 1992).
There are several ways in which religious beliefs affect HIV / AIDS prevention education (Messina, 1994). It is important to note that in most religions, homosexuality is perceived as immoral, unnatural, sinful and evil. The amount of guilt and shame that many religions install in lesbian, gay and bisexual people is large. Religious intolerance is part of what makes it difficult for many homosexual people to be honest about their sexual orientation, which results in less open and honest communication with sexual partners.
In addition, the belief that AIDS is punishment from God for immoral behavior is common in African-American communities (Messina, 1994). In a small study of young African-American women from an urban area (Rush, 1989), two-thirds believed that AIDS is a fulfillment of prophesies regarding plagues from the Book of Revelations. Finally, the Catholic ban on any contraceptive use, even among married couples, makes it difficult to convince religious blacks to use condoms.
Risk Factors and Obstacles to Prevention
While HIV most commonly infects African-Americans through sex and drug-using behaviors, the proportions of African-Americans infected with HIV from specific risk behaviors vary from other populations (Andriote, 2005). Additional socioeconomic and cultural factors -- including inadequate access to health care, denial about HIV, and conspiracy theories about the virus -- also make African-Americans vulnerable to infection.
Not knowing one is infected with HIV until the virus has already affected the immune system creates missed opportunities for preventing and treating HIV infection (Andriote, 2005). Research from Centers for Disease Control (CDC) reveals that, between 2000 and 2003, 56% of late testers -- defined as those who were diagnosed with full-blown AIDS within one year after learning they were HIV-positive -- were African-Americans (CDC, 2003).
African-Americans with HIV have a greater tendency to delay being tested because of various psychological or social factors -- which means they frequently are diagnosed with full-blown AIDS soon after learning they are infected with HIV (Andriote, 2005). For this reason, African-Americans with AIDS have shorter lives than people with HIV / AIDS from other populations.
Dr. Daniel Kuritzkes, director of AIDS research at Boston's Brigham and Women's Hospital and associate professor of medicine at Harvard Medical School, describes two uneven tracks of HIV treatment and care in the United States (Andriote, 2005). In what Kuritzkes describes as an "ideal track," a person discovers the infection, seeks medical care, has regular follow-ups, and follows a HAART regimen without complications. "There is every expectation that this person will lead a normal life," Kuritzkes says Villarosa, 2004).
However, some individuals follow a different track (Andriote, 2005). These individuals "come to the hospital with full-blown AIDS as their initial diagnosis (Villarosa, 2004). They may have limited access to care because of finances or because other social or medical problems interfere. By and large, the deaths [from HIV / AIDS] are among this group, which tends to be African-Americans."
References (March 18, 1998). The Untold Story: AIDS and Black American: A Briefing on the Crisis of AIDS among African-Americans. The Kaiser Family Foundation Survey of African-Americans on HIV / AIDS.
Andriote, John-Manuel. (2005). HIV / AIDS and African-Americans: A 'State of Emergency. Population Reference Bureau.
CDC. (2003) Late vs. early testing of HIV -- 16 sites, United States, 2000-2003. Morbidity and Mortality Weekly Report: 581-86.
A de la Vega, Ernesto. (March, 1990). Considerations for Reaching the Latino Population With Sexuality and HIV / AIDS Information and Education. SIECUS Report 18 (3), p.3.
Essien et al. (2005). Strategies to prevent HIV transmission among heterosexual African-American men. BMC Public Health: 5: 3.