African-American Women Living With AIDS

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

RACE and GENDER IMPLICATIONS

The work of Andrews and Buchanan entitled: "HIV / AIDS in African-American Women: Implications for Feminist Therapists" relates that the percentage of women with HIV / AIDS has continued to increase, reflecting an ongoing shift in those populations most affected by the epidemic. The HIV / AIDS epidemic has increase most dramatically among women of color. In 2003 African-American and Hispanic women accounted for over 80% of the 11,211 newly reported HIV / AIDS cases among women, though together they represented less than one-fourth of all American women." (Andrews and Buchanan, nd) Since HIV / AIDS disproportionately impact African-American women it is critically important that the factors that make this community "particularly vulnerable to the spread of HIV" (Andrews and Buchanan, nd) are addressed. Andrews and Buchanan state that in particular are: "...contextual factors, such as environmental stress, relationship history, and victimization experience..." (Andrews and Buchanan, nd) Issues such as poverty and disparate educational and economic opportunities also lead to increased rates of unemployment, incarceration and substances abuse, most specifically intravenous drug use which fuels the epidemic in Africa American communities and presents barriers to healthcare. (Andrews and Buchanan, nd; paraphrased)

Andrews and Buchanan report that the factors associated with transmission of the HIV disease include: "...inconsistent use of condoms, multiple sex partners, and other behaviors..." (Andrews and Buchanan, nd) Another factor that affects a young woman's vulnerability to HIV infection is "when her sexual autonomy is comprised. Gendered power relations decrease women's sexual autonomy and therefore increase their risk to HIV infection. According to the dominant female gender roles, particularly in adolescent heterosexual relationships, young women are not supposed to desire sex or to be sexually assertive, and are therefore expected to resist young men's sexual advances." (Andrews and Buchanan, nd) Therefore a young woman who is independent and empowered who "seeks sexual pleasure and sexual safety on her own terms is not a 'normal' feminine woman but often seen as sexually and socially deviant." (Andrews and Buchanan, nd) Negotiating safer sex is a challenge for many women due to "socio-cultural norms that have traditionally fostered female sexual passivity, innocence or ignorance." (Andrews and Buchanan, nd)

Andrews and Buchanan state that African-American women "of all ages are bombarded with 'defeminizing and demonizing' media images of Black women. African-American women are commonly depicted in one of four roles: the asexual and subservient 'caretaker' or 'mammy', the emasculating and assertive 'matriarch', the economically dependent 'welfare mother', of the hypersexualized 'whore' or 'jezebel'." (Andrews and Buchanan, nd) it is related that this type of socialization "can permeate the consciousness and cause some African-American women to internalize these oppressive stereotypes that devalue their bodies." (Andrews and Buchanan, nd) Added to this cultural norms related to power in intimate relationships also tend to shape the sexual behaviors of African-American women with the example given being that "...a woman may feel she has limited options to negotiate or assert protective health measures as a result of unequal distribution of power in male-female relationships." (Andrews and Buchanan, nd) HIV and the associated stigma along with the likelihood of death resulting from the disease "may cause an HIV-infected person and his/her family to experience a wide range of emotional reactions that may require therapeutic intervention. Women are at risk of internalizing this stigma which can lead to deleterious psychological effects." (Andrews and Buchanan, nd) Emotions that HIV-infected women may experience include "shock, disbelief, guilt, anger, sadness, and suicide ideation..." (Andrews and Buchanan, nd)

Many times women learn of their HIV-positive status "following pregnancy and/or childbirth and their functioning as a material caregiver may become complicated and/or compromised due to feelings of blame, guilt, anger and shame." (Andrews and Buchanan, nd) Other factors that may exacerbate the woman's psychological reaction to being diagnosed with HIV are lack of knowledge concerning available resources, underemployment, and a fear of stigmatization. (Andrews and Buchanan, nd; paraphrased) the African-American community and families are such that due to the "role flexibility and strong kinship alliances of African-American families, relatives expect and accept reliance on one another in times of need and often live in close proximity to one another. Extended family serves critical support roles in caring for children within the family." (Andrews and Buchanan, nd)

The work of McGoldrick, Giordano and Pearce (1996) state that: "It is not uncommon for a child to be informally adopted and reared by extended family members who have resources not available to the child's parents or who reside in a more 'wholesome' environment." (as cited in Andrews and Buchanan, nd) the work of Gilbert and Wright share another dimension of what the African-American woman faces in the statement "next to racism, substance abuse is the primary health and social problem of the African-American community and cites Watts and Wright 1983, which incidentally is a statement made as pointed out by Gilbert and Wright "before the onslaught of the crack epidemic and obviously before the full impact of AIDS hit home in the African-American community." (Gilbert and Wright, 2002) Gilbert and Wright state that it is not that substance abuse and racism are situated necessarily "next" to one another it is that racism is an underlying cause of substance abuse and "other negative social and psychological outcomes experienced disproportionately by African-Americans." (Gilbert and Wright, 2002)

In order that the "individual behavior and the psychological processes of African-Americans within the context of their historical oppression, we must first as the right questions in our research. Within the Afrocentric paradigm it is related by Gilbert and Wright that the work of Asante 1980 held that actual treatment would be inclusive of elements that would assist these individuals in combating oppressive structural conditions while simultaneously developing and maintaining "a core set of values that are congruent with health cultural identity, and participate in specific culturally congruent rituals. Of these structural "impediments" Gilbert and Wright state that it is these "social, political, and economic forces" in our society that establish and define the reality of certain populations and restrict the options that people can choose as a means of survival. (Gilbert and Wright, 2002; paraphrased)

Lifestyle choices can be said to be dependent on the extent to which individuals have access and personal agency to obtain crucial societal resources such as food, shelter, education, housing and appropriate mental and physical health care - all of which are limited by poverty and social equality, which in turn, impact the effectiveness of AIDS prevention messages." (Gilbert and Wright, 2002) it is just as sure that structural barriers place people in "high risk situation" as stated in the work of Zwi and Cabral (1992) and noted in the work of Gilbert and Wright "where sociocultural forces act in ways to increase individual or group vulnerability to HIV-infection." (Gilbert and Wright, 2002) it is agreed among researchers of HIV / AIDS and policy makers alike that "early prevention strategies have failed to influence African-American communities for two major reasons." (Gilbert and Wright, 2002) the first of these is that prevention messages were not designed for targeting in a culturally specific manner that will reach the African-American community. Furthermore, initial early prevention methods targeted "primarily...White, gay males." (Gilbert and Wright, 2002) the secondary reason is that for African-Americans, HIV / AIDS is woven within the selfsame fabric in the lives of the ethnic minority as are the elements of "poverty, chemical dependency, lack of accessible and affordable health care, mistrust of medical and other institutions, isolation, institutionalized racism and internalized oppression" (Gilbert and Wright, 2002) that comprise the daily lives of these individuals and the families and communities to which they belong.

As stated by Gilbert and Wright the vulnerability to HIV-infection of the African-American woman "includes the entire spectrum of issues that impact their lives and place them in 'high risk situations.'" (Gilbert and Wright, 2002) Poverty assists in creating an environment of risk and the statistics state that "nearly every black American adult in this country will at some point experience a year below the poverty line.." (Gilbert and Wright, 2002) Furthermore the African-American populations in the United States are concentrated in poor urban areas "as a result of residential discrimination footed in the legacies of slavery, segregation, and individual and institutionalized discrimination." (Gilbert and Wright, 2002) Furthermore these communities are characterized by decay from within both literally and figuratively due to structural barriers placed by society, economics, and unequal access to fundamental and elemental needs. This has only worsenened in the past decade and a half. Legal Services Corporations all across the United States have been cut back to skeleton staff who are very limited in the assistance that can be offered to the urban poor minority individual, which has severely limited and served as an additional structural barrier for the African-American woman. It is the all too unfortunate fact that many of today's young African America women never had a glimmer of a chance to remove themselves from the fateful role they are fulfilling in today's world due to the violence and male-dominated society in which they were born with only a very few roles available to them from which to choose.

AFRICAN-AMERICAN WOMEN LIVING WITH AIDS

PART FOUR

CONCLUSION