HIV/AIDS disparities among African-American women in the United States

African-American Women Living With AIDS

The year 1981 marked many historic events in the world but none as tragic as the discovery of 'Acquired Immunodeficiency Syndrome (AIDS). AIDS was first recognized as a disease when clinics in the larger cities in the United States such as New York, Los Angeles and San Francisco first saw young men who were homosexuals with Pnemocystis carinii pneumonia and Kaposi's sarcoma which was quite unusual for young adults who were not know to be immunosuppressed. The first report appeared in June 1981. This disease was first believed to be a homosexually transmitted disease but soon it was recognized that this disease was being transmitted among drug users as well. It wasn't long however, until it was understood that this disease was spreading among heterosexuals as well.

Prior to the identification of HIV as the virus that caused AIDS, those who tracked the epidemics course were dependent upon AIDS being reported when diagnosed to the public health departments, which became a requirements by all fifty U.S. states from the beginning of the epidemic however many states failed to report until the 1990s when the new multidrug regime of antiretroviral therapy became available. It is related that by the fall of 1982 100 cases had been reported which increased to 1,000 in February 1983, with another 1.000 reported 6 months later, and another 1,000 before the end of 1983 being reported. In 1988, 100,000 cases reported with another 100,00 being reported in 1990 and by October 1995 more than 500,000 cases of AIDS were reported in the United States.

The work of Lorraine Cole entitled: "From Cries and Whispers to Answers: Curbing the Spread of HIV / AIDS among Black Women" states that in the United States that "Black women between the ages of 25 and 44 are 13 times more likely to die of the disease than their counterparts." (2005) in fact, according to Cole, HIV / AIDS is "among the top 4 causes of death for African-American women aged 20-54. In addition, more than half of the new cases of HIV infection in women over 50 are African-American. Black women are the fastest growing population of new cases, accounting for two-third (67%) of new AIDS cases among women." (Cole, 2005)

The work entitled: "AIDS Pandemic: African-American Women Can't Sleep on This" published in the Black Women's Health Imperative states that "Black women comprise nearly two-thirds of all women who are HIV positive according to the Centers for Disease Control." (Morris, 2004) While the African-American population comprises only 12% of the population in the United States: "more than half of the 40,000 new HIV infections diagnosed each year are African-Americans..." (Morris, 2004) in a 2007 article entitled: "HIV / AIDS and the Young African-American Woman" published by Advocates for Youth it is stated that African-Americans "now represent 36% of all reported AIDS cases and 43% of new AIDS cases..." (Advocate for Youth, 2007)

Of all AIDS cases reported among women, sixty percent of these cases are African-American women. Geraldine Brown reports in the work entitled: "HIV / AIDS among African-Americans and U.S. Women: Minority and Young Women" that a recent study by CDC of Job Corp entrants: "...ages 16 to 21, showed that, compared to their white counterparts, African-American women were seven times more likely to be infected with HIV." (Brown, 2004) Brown reports further that "in addition to experiencing historically higher rates of HIV infection, African-Americans continue to face challenges in accessing health care, prevention services and treatment." (2003) Health care providers generally focus on the physical manifestations related to AIDS and fail to address the emotional and psychological needs of the African-American woman with aids. It is critical that these needs be addressed as well as the physical problems of living with AIDS.

AFRICAN-AMERICAN WOMEN LIVING WITH AIDS

PART TWO

INFORMATION

Poverty and homelessness are often experienced by those who test HIV-positive. "For many women who are living on the street or in transient residences, are feeling overwhelmed by the needs of their children, or are battered within their relationships, illicit drugs may seem to be the best antidote." (a Clinical Guide to Care of Women with HIV / AIDS, 2005) the work of Gore-Felton and Dimarco entitled: "Brief Summary of Behavioral and Social Science Research Related to Women, Violence, Trauma and HIV / AIDS" states that many times "violence perpetrated against women is linked to risks for sexually transmitted infections, including HIV infection. Studies conducted in the U.S.A. shown that women in violent and abusive relationships are less likely to use condoms, more likely to incur abuse as a result of requesting condoms and more likely to contract sexually transmitted infections (STIs) than who have not been in violent relationships." (Gore-Felton and DiMarco, 2007)

Gore-Felton and DiMarco state that there is a growing body of evidence "that adults and adolescents who were sexually abused as children are more likely to engage in high risk activities that could increase their exposure to HIV." (2007) Furthermore, "mood disorders that result from abuse such as chronic depression and behaviors that include self-destructive tendencies, revictimization, and drug/alcohol abuse can increase one's vulnerability to HIV infections." (2007) Being diagnosed with a life-threatening illness "has been categorized as a traumatic stressor in the Diagnostic Statistical Manual 4th Edition (APA, 1994) Moreover, a growing body of research suggests that traumatic stress responses and even full-blown PTSD syndromes can ensue from the traumatic experience of being diagnosed with a life-threatening illness." (Gore-Felton and DiMarco, 2007) the problem with stress in those with HIV is connected to the response of stress upon the immune systems because "cumulative stress can disrupt this complex interactive system."(Gore-Felton and DiMarco, 2007) This may contribute to progression of the HIV disease. "Clinical evidence suggests that stressful live events predict more rapid HIV disease progression." (Gore-Felton and DiMarco, 2007)

In the course of the study is has been comprehended that "women experience HIV infection within the context of their various relationships." (a Guide to Clinical Care of Women with HIV / AIDS, 2005) Over 25% of HIV infected women have children, are three times as likely to have children as men, and are more than three times likely to live with their children. (Ibid; 2005 paraphrased) it is related that it has been characterized by clinical psychologists as to the "fundamental differences in the way women and men think about themselves with significant implications for practice. (Ibid, 2005; paraphrased) Women who have children in their household are more likely to delay medical care for themselves than are women without children or men. The following chart lists a demographic comparison of HIV-positive women and men.

HIV-Positive Women and Men

Women

Men

Level of Significance

African-American

Unemployed

Incomes

Without medical insurance

35-year-old

Source: A Guide to Clinical Care of Women with HIV / AIDS, 2005

The work entitled: " a Guide to Clinical Care of Women with HIV / AIDS" states that the emotional adjustment after finding out that one is HIV-positive "...including coping as an individual on a daily basis with the demands of having HIV and becoming an HIV patient, commonly follows by a natural course of progression through stages. For every 'shock' - a new diagnosis, a new symptom, the need to take more pills, more intrusions on daily routines - there is often the 'aftershock' of anger and avoidance, fear and denial." (2005) Furthermore this emotional adjustment "may vary by culture, race, and ethnicity, by level of social support and caretaking responsibilities, and by age and severity of physical and psychiatric symptoms..." (a Guide to Clinical Care of Women with HIV / AIDS, 2005) Appendix a provides the table showing the various milestones which are discussed in the Clinical Guide. The first stage is that of HIV Prevention in which the health care provider must be able to discuss high-risk behaviors with ease with the patient as well as discuss prevention measures. At this point the patient should be educated about HIV including the disease, transmission and negotiating safe behaviors. Empathy must be shown for the patient's denial, lack of interest, and high-risk behaviors. (Ibid)

The work of Archie-Booker, Cervero, and Langone entitled: "The Politics of Planning Culturally Relevant AIDS Prevention Education for African-American Women" reports a study conducted for the purposes of determining: (1) the extent to which the programs of a community-based AIDS education provider were culturally relevant for African-American women; and (2) What organizational and social factors in the program planning process influence whether these programs are culturally relevant. The study was of a qualitative nature, which studies an AIDS community services agency through conduction of interviews with staff and board members. Further participants-observations of three programs were utilized in order to analyze the programs and finally an analysis of the agency's documents was conducted. Findings of the study state that: "...except for a one-hour segment of one program, the overall AIDS education efforts were not culturally relevant for African-American women." (Archie-Booker, Cervero, and Langone, 1999)

There were three stated factors that accounted for the lack of cultural relevancy which included: (1) the organizational image and financing were directed toward the interests of its white gay male leadership, (2) the internal interpretation of the agency's educational mission did not include a focus on African-American women, and (3) the organizational structure did not support substantive representation of the interests of African-American women in regard to programmatic decisions. (Archie-Booker, Cervero, and Langone, 1999) This study concludes that: "...power relations manifested themselves concretely through these factors in the social and organizational context, which by defining African-American learners as generic entities, produced undifferentiated educational programs." (Archie-Booker, Cervero, and Langone, 1999)

The work of Gilbert and Wright reports a study conducted through collecting a series of articles in which African-American women were interviewed concerning living with AIDS. They write in their book entitled: "African-American Women and HIV / AIDS: Critical Responses" that: "From the beginning of the AIDS epidemic, the concept of culture has been used to interpret, define and further distance the 'other' or members of groups deemed socially deviant." (2002) They state additionally that African-American women "have long suffered from being defined by mainstream dominant society's cultural characteristics of popular images of them, examining their behavior and creating policies that affected their well-being. Reconstructing realities for HIV-positive African-American women also requires that we hear from them directly, and that we understand the meaning that they attach to this disease." (Gilbert and Wright, 2002)

AFRICAN-AMERICAN WOMEN LIVING WITH AIDS

PART THREE

CONCLUSION

The HIV / AIDS epidemic has disproportionately affected African-American females and as identified in this study there are many causes for this. In 1981, when the HIV / AIDS disease was first recognized it was believed that it was carried by young homosexual men therefore these were the individuals targeted for early prevention of HIV / AIDS. It wasn't until sometime in the late 1980s that the number of cases reached 100,000 but this number climbed over fives time to approximately 500,000 in 1995. The work of Cole (2005) has informed this study that today, African-American women between the ages of 5 and 44 are 13 times more likely to die from HIV / AIDS and that this disease is among the top four causes of death in the African-American group of women between the ages of 24 and 54. Even worse, over one-half of all new cases of HIV infection reported in women over the age of 50 are African-American women. African-American women are being diagnosed with HIV infection faster than any other demographic group and now represent 36% of the total of AIDS cases and 43% of all new AIDS cases being reported in the present. This work has reviewed the 'Clinical Guide to Care of Women with HIV / AIDS which has informed this study that many women infected with the HIV virus are homeless living in the street or other temporary residences and many of them are overwhelmed with the responsibility of children and taking illicit drugs to deaden the psychological pain associated with poverty, sickness and dying. Other African-American women with HIV / AIDS are living in abusive and often violent relationships trapped by economic need and others are living in relationships characterized by infidelity on the part of their partner who has brought them the death warrant from sex on the side or perhaps from some prison upon their return to society. These women are afraid to stand up for themselves because to do so requires stepping out of the possible acceptable roles that society has assigned to them to choose from in the manner their life should be lived. To require condoms during sex means within the African-American culture that these women are fast, loose, or as stated in the work of Andrews and Buchanan this woman, taking direction and responsibility for her own health and welfare is labeled to be, a 'jezebel'. (nd) Gilbert and Wright have noted that substance abuse and racism are situated next to one another with racism being an underlying problem to substance abuse. Furthermore, structural barriers or 'impediments' have been acknowledged within the context of the African-American "historical oppression." Structural barriers have been identified in this study as being of the type of: 'social, political, and economic forces' that are established within society and that the reality of the African-American paradigm is defined by these structural barriers and their lives are inherently restricted by these barriers in their options for the means to survive. This work has noted the statement of Gilbert and Wright that the choices in lifestyle of the young African-American women are very much dependent upon the "extent to which individuals have access and personal agency" to obtain necessary and critical resources to include food and shelter as well as housing and education. Mental and physical care and assistance with legal issues are other necessities that often the African-American population meets barriers in attempting to assess. These barriers and restrictions bar the African-American individual and result in these individuals being in 'high risk situations' that if it were not for poverty that they would not be placed in.

In order that the lives of young African-American women be characterized by information and knowledge, health and welfare for their future, it is necessary that practitioners reach outside of their own known reality and enter the reality in which these young women reside within. In order that these young women be armed with information to assist themselves it is necessary that today's practitioner learn to speak the language, if you will, of these young African-American women. If true change is to occur within this group of individuals, and true change would be defined as a transformative change then there must be a method identified that is sure to gain the attention of this group of women and then too this method must be inclusive of something fundamental that will keep the attention of this group and become just as woven into the fabric of their lives as are the elements of poverty, violence, abuse, and the other factors that comprise these individuals daily life. This certainly must begin with a community-based effort and be one that has strategies to inform the African-American man that it has been declared to be intelligent and right that the young African-American woman respect herself enough to require the use of condoms for her own self-protection and not for the purpose of questioning the authority of masculinity of the male. This change must be one that is a societal change that is wrought through collaboration with African-American women and not through merely tacking posters in community centers and handing out flyers around the community. This effort will require meeting with key persons in the community who will be able to open otherwise closed doors which cannot be breached by outsiders who are those feared because of their power over the lives of these young women. In order to make psychological changes in the young African-American female individual it will be necessary to move toward, into and within the totality of the young African-American community strategically maneuvering the change that is so desperately needed by these individuals. Finally, for those who already are infected with AIDS/HIV disease it is critically important that practitioners help this population understand that much progress has been made in the field of research of HIV / AIDS and that instead of concentrating on dying, that these already infected individuals be armed with the information and access to care that sets them on the track to learning now to 'live' with this disease, and this will indeed, require reaching these individuals on a psychological level in order to combat the depression and defeat that is faced when one is informed that they have been infected with the HIV / AIDS disease.