African-American Women in New York State

African-American Women in New York State

"About 30% of Hispanic and 20% of African-Americans lack a usual source of health care compared with less than 16% of European-Americans" (Agency for Healthcare Research and Quality, 2003). "Racial and ethnic disparities in health care, whether in insurance coverage, access, or quality of care, are one of many factors producing inequalities in health status in the United States" (Lillie-Blanton & Lewis, 2005, p. 1). "No universally accepted definition of health disparities or health inequities currently exists; to some, disparities are simply differences in health processes or outcomes between population groups" (Meyers, 2007, p. 1).

"Clearly understanding ethnical and racial health disparities demands a careful examination of all groups in all societies in which such disparities exist" (Dressler, Oths & Gravlee, 2005, p. 233). Eliminating disparities in health and healthcare was a priority identified in the U.S. Department of Health and Human Services Healthy People 2010 initiative (Kilbourne, Switzer, Hyman, Crowley-Matoka & Fine, 2006).

In this research report the author has described the current health situation and issues facing African-American Women in the New York city. After describing the current health status i.e population, birth rate, health status, infant mortality rate, the author focussed on the major issue i.e HIV Aids. The main focus of the research report is racial and ethnical disadvantages, as well as discrimination in regards to being HIV positive attempting to receive primary care treatment. It is challenging and to eradicate these disparities for government and institutions partially because their causes are tangled with a controversial history of race relations in United States. However, it is important to assure better fairness and liability in the healthcare system to a rising regional base, including those who purchase, pay and health plan and for those too who provide health care. (Lillie-Blanton & Lewis, 2005). As currently much research has been conducted on healthcare disparities and information is available on healthcare disparities, the focal point of research has been changed from assessing and exploring disparities toward exploring the roots and causes of these health disparities as well as developing interventions to improve them. James, Thomas and Lillie-Blanton (2007), state that facts and figures are still incomplete for certain racial and ethnic subgroups, and for those who self recognize with more than one racial group. "Information that documents health care disparities is important to understanding where progress has been made and the challenges that remain" (James, Thomas & Lillie-Blanton, 2007).

Current Health Status: African-American Women in New York

Dressler, Oths, and Gravlee (2005) state that based on present investigation comparatively little development was made toward the objective to eliminate racial and ethnic inequalities among the health status pointers throughout the last 10 years. Progress toward the goal of eliminating health disparities will require more concerted efforts during the next 10 years. For HIV prevention to be successful in communities of color, such as Pacific Islanders, Hispanics and/or American Indians, research must specifically target the African-American communities.

In the New York Metro African-American population is the leading than any other city in the United States which is almost 3.5 million. This is approximately 9% of the whole Black population of the United States. While there are 2.4 million African-Americans in the New York City . African-American women form 52%.(CDC Health, United States report, 2007)

Health Statistics show that 18% of African-American Women in New York City currently smoke, 79% are overweight in the age group of 20 years and above Life Expectency has increased as of 1900 which was averaged 33 .5 and now its 76.5. 41% have hypertension problem in African-American in New York State

Overall infant mortality rate in the United States (the number of deaths among infants aged

Racial/ethnic differences in infant mortality rates might imitate, partially, distinctions in motherly socio demographic and behavioural risk factors. For instance, infant mortality rates are higher than the U.S. average among infants born to mothers who are "teenagers, unmarried, smokers, have lower educational levels, had a fourth or higher order birth, or did not obtain adequate prenatal care" (Matthews TJ, MacDorman MF, 2010).

"Medical care makes a limited contribution to population differences in health but may have a greater impact on the health status of vulnerable populations, such as African-American women with HIV / AIDS" (Williams, 2002, p. S43). Kilbourne et al. (2006) defines health disparities as "observed clinically and statistically differences in health outcomes or healthcare use between socially distinct vulnerable and less vulnerable populations that are not explained by the effects of selection bias" (p. 2114). Observed differences in health22outcomes or health status represent inequalities or measured gaps between groups (Kilbourne et al., 2006). "These disparities in health outcomes or health status may because or exacerbated by patient, provider or system level factors that result in differential treatment" (Kilbourne et al., 2006, p. 2114). "A large body of evidence documents pervasive racial and ethnic health disparities in diagnosis and treatment of minority persons once they enter the U.S. health care system" (Williams, 2002, p. S43).The health disparities are present within various facets ranging from technology to basic forms of diagnostic and treatment interventions, which includes healthcare coverage (e.g., Medicare and Veteran Affairs health system), disease progression (e.g., HIV / AIDS progression stages) and medical facility (e.g., primary care facilities; Williams, 2002).

Minority women face many challenges when it comes to medical care, such as access to medical services and insurance coverage. Williams (2002) stated minority women are less likely to be insured and are more likely to have public health coverage, which is limited in medical treatment and services

Evidence from Literature

The widening gap in health disparities is receiving increased national attention; vast literature exists documenting the substantial racial, ethnic and socioeconomic differences in health status, treatment, access to services, and health outcomes (DeLoach,2003). HIV health disparities still continue to plague the African-American female community. The research study was an attempt to understand the essence of the lived experience of African-American women with HIV / AIDS that will help to bridge the gap on racial and ethnic health disparities in medical/primary care settings among this vulnerable community. The reasons are complex and include poverty, discrimination, inadequate access to healthcare, distrust of medical services and physicians, and high risk behaviours. Stigmas and discrimination are factors that remain heavily within urban communities in regards to HIV / AIDS issues.

There are also gaps in patient-provider communication and trust within the primary care setting. Armstrong, Ravenell, McMurphy, and Putt (2007) stated that "adding to concerns about the overall decline in trust is the recognition that distrust maybe particularly prevalent among racial and ethnic minority groups" (p. 1283). Potvin, Gendron, Bilodeau, and Chabot (2005) argue that the first challenge of overcoming health disparities in the primary care setting is to formulate a program theory that takes25into account the social determinants of health and the mobilization of diverse factors for social change.

The report can help local community and state health organizations establish more effective treatment and prevention programs geared toward African-American women, especially young African-American HIV / AIDS infected females. In many communities, there is lack of information and consideration about the outbreak feeds stigma and bias against people living with HIV / AIDS. Effective and efficient health communication efforts regarding treatment and prevention programs are the key components to decreasing HIV / AIDS within minority communities.

Health Status of African-American Women

Copeland (2005) found that despite outstanding improvements in the general health at national level through the past twenty years, undeniable facts show that the nation's racial and ethnic minority Americans are suffering rising inequalities in the occurrence, pervasiveness, mortality, and burden of diseases and bad health effects compared with European-Americans. In a recent analysis of racial and ethnic disparities, Williams (2002) found:

"Differences in access to and use of health services between 1977 and 1996 concluded that the gap between African-Americans and European-Americans has not narrowed over time. The study also found that even if income and health insurance coverage were equalized, racial and ethnic differences in outpatient care would not be eliminated due to one half to three quarters of these disparities are not accounted for by the previous stated factors." (p. S43)

A research study by Levine, Briggs, Kilbourne, King, Fry-Johnson, Baltrus, Husaini, and Rust (2007) revealed that in the "United States, African-Americans have a disproportionate share of mortality from HIV compared with European-Americans; African-Americans comprised less than 15% of the U.S. population but accounted for 39.7% of all cases (368,169 of 928,188) reported through 2003" (p. 1884).Through statistical research, Buchanan and Hatcher (2007) reported "during 2005, about1.1 million Americans were living with HIV; about half of the new HIV or AIDS diagnoses occurred among African-American individuals during 2004, whereas 18%occurred among Hispanic individuals and 30% among European-American individuals."(p. 2013)

Out of the women living in the United States, two out of three women living with HIV / AIDS during 2004 were African-American, with another 15% being Hispanic (Buchanan & Hatcher, 2007). "For African-American women, the result has been devastating, according to the founding president and CEO of the National Black Leadership Commission on AIDS" (Fears, 2005, p. A01). In 2003, the rate of new AIDS cases for African-American women was 20 times that of European-American women and five times greater than the infection rate for Latinos (CDC, 2007b). "African-American and Hispanic women accounted for 77% of all new AIDS infections in 1994; nine years later, the rate was 85%, according to the agency" (Fears, 2005, p. A01). According to Sutton. (2009):

"The highest rates of new infections occurred among African-American men and women, which are 115.7 and 55.7 per100000 population, respectively compared with men and women from all other racial/ethnic groups. Furthermore, the estimated lifetime risk of being diagnosed with HIV was higher for African-Americans than for European-Americans: 1 in 30 African-American females in the United States will be diagnosed with HIV, compared to 1 in 588 European-American females." (p. S351)

Barriers in Healthcare

The barriers in health and healthcare settings vary among the African-American women population. The most stated problem found when conducting this literature review was access to healthcare programs and treatment facilities. Research studies done by the U.S. Department of Health and Human Services (2010) found that most women who are HIV positive live in poverty and were already poor when they learned their serostatus; the socioeconomic status of women negatively influences access to health care.del Rio (2003) stated that

"Challenges to improving access to care and keeping patients in care have been documented in a variety of studies. The difficulty of keeping patients in care, for example, is illustrated by a 1994 study showing that 27% of HIV infected patients delayed seeking medical care for more than 1 year and 12% for more than 2 years after initially testing as sero-positive. In addition, many patients in care are not on antiretroviral therapy, with 1 study indicating that women and injection drug users are less likely than other patients to be prescribed antiretroviral treatment; once prescribed antiretroviral treatment, most patients at urban clinics do not have the desired virologic response, with missed clinic appointments being the most important risk factor for virologic failure." (p. 142)

DeLoach (2003) used the phenomenological approach to conduct a qualitative research study of ethnic and racism of African-American women with HIV access to28healthcare treatment. DeLoach also used interviewing, observation and content analysis for the data collection and data analysis portion of the study. The study revealed that African-American women described salient experiences of being discriminated against on the basis of their HIV status when attempting to receive medical treatment (DeLoach,2003). Malebranche (2005) study found that

"African-Americans with HIV / AIDS are often diagnosed at more advanced stages of HIV, and utilize fewer outpatients and more inpatient care than their European-American counterparts, even when controlling for socioeconomic status and insurance. The lack utilizing primary care services is to be expected, as an emphasis on emergency medical treatment utilization instead of primary care services has long been a staple of healthcare access patterns in the African-American community. At first glance, it appears that the high rates of poverty, lack of insurance, poor access and inadequate transportation as the main culprits of this public health dilemma. Moreover, policy barriers such as Medicaid requirements for legal immigration status and residency and limits on Medicaid eligibility based on disability requirements also represent larger structural forces at work." (p. 3)

del Rio (2003) suggested that the in general prevention message for HIV infected patients is apparent and that is HIV infected individuals should practice safe sex and should adopt other risk prevention methods to save themselves and others from new infections, and they must stick to antiretroviral therapy both to benefit themselves and to prevent development of resistant virus that can be transmitted to others. HIV care settings provide a good location for risk assessment and prevention counselling, along with any additional work that is needed to develop the best strategies for delivering risk reduction counselling in healthcare environment. However, according to del Rio (2003):

"A number of basic recommendations can be made: (a) training in risk reduction counselling should be made more available to physicians and other health care workers, (b) more time should be allocated in the typical office/clinic visit to discuss prevention measures with patients, and (c) use of referrals and other strategies for providing prevention counselling to patients should be optimized in clinical practice." (p.143)

Stigma and Discrimination

It is an gradually more approved veracity today that all over the world individual who are most intensely affected by the HIV epidemic are also the most sternly deprived, whether on the basis of race, economic status, age, sexual orientation or gender. Bharat (2002) noted that

"As in the case of most other stigmatized health conditions such as tuberculosis, cholera and plague, fundamental structural inequalities, social prejudices and social exclusion explain why women, children, sexual minorities and people of color are disproportionately impacted by AIDS and the accompanying stigma and discrimination. The stigmatization of the African-American identity in relation to diseases in the early twentieth century shows a remarkable continuity today in the context of HIV / AIDS at the turn of the century." (p. 1)

Bharat (2002) also describe that stigma related to AIDS and discrimination is multifaceted social practice. They are neither exclusive and nor arbitrarily patterned. They generally are constructed upon and strengthen pre-existing doubts, chauvinisms and social disparities pertaining to poverty, gender, race, sex and sexuality, and so on. In this way, racist behaviors and racial inequity associated to HIV / AIDS status are only playing into, and reinforcing, previously active racial stereotypes and disparities about people of color in general. "There is a four part process of stigmatization on the part of a society: first, by identifying and defining the disease; second by assigning responsibility for its appearance to some person, group or thing; third, by determining whether those affected by the disease are to be viewed as innocent or guilty; and fourth, by assigning responsibility for identifying a cure or solution to another segment of society." (pp. 4-5)

The focus of this research report was African-American women, in New York. The United States carry on experiencing sturdy augments in the estimated numbers of persons living with HIV / AIDS and comparatively stable on the whole trends in HIV diagnoses. Lyles, Kay, Crepaz, Herbst, et al. (2007) revealed via research study that given the challenges of further reducing HIV infection rates and developing an effective vaccine, it is critical to focus on behavioural prevention efforts that are based on the best available scientific evidence. In a recent case study done by Miller et al. (2007)at the New York Medical College showed that in a situation of high backdrop HIV occurrence and low levels of HIV status revelation, sero-discordant mixing patterns probable make easy the transtmission.

For African-American women this disparity is amplified, as they account for 72% of all new female HIV / AIDS cases nationally and experience rates at 25 times greater than European-American women (Davis, Sloan, MacMaster & Kilbourne, 2007). An additional case study done by Collins, Whiters, and Braithwaite (2007) at the University of Georgia using a peer-led community treatment and prevention program illustrated that prevention models using peer educators still prove to be effectual intervention approaches, ceaselessly encouraging healthy attitudes, practices and lifestyles, leading to a decrease in HIV and other sexually transmitted infections.