HIV and AIDS disparities among young African-Americans

Sex and AIDS in Young Adults

Attitudes and Beliefs of Young African-Americans

Distrust and Conspiracy

Educational Concerns

Late Testing

Young Adults: Sex and AIDS -- a Literature Review

According to the Center for Disease Control and Prevention, acquired immunodeficiency syndrome (AIDS) is the leading cause of death among young African-Americans (Hossain, 2003). While African-Americans make up only about 13% of the United States' population, they make up 57% of all new Human immunodeficiency virus (HIV) cases. These statistics suggest that HIV and AIDS are affecting Black America in disproportionate numbers. If education is key to success, African-Americans are respectively defeated on the issue of HIV. Researchers believe that a lack of knowledge is responsible for the crisis. For African-American young adults, lack of education is only the root of the problem, as a lack of knowledge is largely responsible for the rate at which the virus is spread. Since many infected African-Americans do not know that they are infected, they continue to put others at risk. Thus, the problem continues.

More African-Americans are infected with HIV or already dead from AIDS than any other single racial or ethnic group in the United States -- a crisis one black AIDS activist labels "a state of emergency" for the African-American community (Andriote, 2005). More than 40% of Americans who have been diagnosed with HIV since 1981 have been African-American.

This literature reviews aims to examine the factors that cause high infection and mortality rates among African-Americans (Andriote, 2005). Experts believe that a broad range of factors -- including socioeconomic factors, poor health care, late HIV testing, high rates of sexually transmitted infections, and limited knowledge of treatment and prevention options -- are contributory to the HIV / AIDS crisis among blacks.

Distrust and Conspiracy

2005 study suggests that many African-Americans are distrustful of the government's role in the origin and treatment of HIV / AIDS - and that African-American men who hold these beliefs also have more negative attitudes toward condoms and are more likely to resist using them (Floyd, 2005). The study, which was funded by the National Institutes of Child Health and Human Development, is considered the first study to examine a broad range of HIV / AIDS conspiracy beliefs and their relationship with the usage of condoms.

These 'conspiracy theories' have been out there for a while and are part of a larger distrust of government, as well as of medical and public health institutions, by many African-Americans," said Sheryl Thorburn, an associate professor of public health at Oregon State University (Floyd, 2005). "But this is one of the first studies to show that these beliefs about HIV / AIDS may be affecting behavior."

The study consisted of a national telephone survey with 500 randomly selected African-Americans, between the ages 15-44 (Floyd, 2005). Participants were asked a series of questions about HIV / AIDS beliefs, attitudes toward condoms, and condom use.

More than half stated that they believe that there is a cure for AIDS, but that it is being withheld by the government from poor people (Floyd, 2005). Only 37% believed that the government was telling the truth about AIDS. Other findings include:

43.6% of African-Americans surveyed believe that people who take new medicines for HIV are human guinea pigs for the government;

26.6% said AIDS was produced in a government laboratory;

48.2% believed that HIV is a man-made virus;

15.2% said AIDS is a form of genocide against blacks.

The study revealed that conspiracy beliefs were associated with negative attitudes toward condom usage. The researchers did not find similar results for women in the survey.

According to researchers, HIV and AIDS conspiracy beliefs are rooted in well-documented racial discrimination and disparities in health care, in addition to historical examples of unethical research, including the Tuskegee Syphilis Study in the mid-20th century (Floyd, 2005).

In the Tuskegee study, which took place from 1932-72, the U.S. Public Health Service studied the effects of untreated syphilis in 400 low-income African-American males from rural Alabama. The men believed that they were being treated for "bad blood" and were denied treatment for the disease. Distrust of the government's role in HIV may translate into distrust of public health prevention messages about HIV and condoms, researchers wrote.

Educational Concerns

Eissen et al. (2205) recently conducted six focus groups with thirty young African-American men to determine their perceptions of AIDS as a threat to the African-American community, characteristics of past situations that have placed African-Americans at risk for HIV infection, and their personal high risk behaviors.

The results revealed that young African-American men perceive HIV and AIDS as a threat to their community and they have placed themselves at risk of HIV infection based on unsafe sexual behavior, substance abuse, and lack of education about the issue (Essien, 2005).

They describe lack of money to purchase condoms as a barrier to safe sex practice. They believe that HIV educational programs should address these risk factors. They further believe that programs should be held in African-American communities and should include condoms to encourage reduction of risk behaviors.

In addition, respondents stated that many young African-American men are having sex without condoms when having sex with women often when they are under the influence of alcohol or drugs (Essien, 2005). According to the men, substance abuse is a crucial part of the problem of HIV in the African-American community.

It is difficult to ignore the fact that as the HIV / AIDS epidemic continues to spread, it is particularly predominant in poor, urban communities of color (Messina, 1994). African-Americans experience higher rates of unemployment, poor housing, poor health, early death and inadequate medical insurance than other populations. It is argued that the greatest problems facing many African-American communities are economic.

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

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.

Religious Issues

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.

Late Testing

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.

Floyd, Mark. (January 26, 2005). Beliefs may hinder HIV prevention among African-Americans. Journal of Acquired Immune Deficiency Syndromes.

Hossain, Mian. (November 17, 2003). HIV / AIDS Knowledge, Beliefs and Attitudes Among Students Attending Historical Black College and Universities. APHA.

Locke, Don. (1992). Increasing Multicultural Understanding: A Comprehensive Model. Newbury Park, CA: Sage Publications.

Messina, SA. (1994). A Youth Leader's Guide to Building Cultural Competence. Washington, DC: Advocates for Youth.

Rush, Cecilia. (July, 1989). AIDS and Traditional Health Beliefs and Practices of Black Women. Nursing Research.

Villarosa, Linda. (August, 2004). Patients With HIV Seen as Separated by a Racial Divide. New York Times.