With all of the attention recent international conferences and celebrity
endorsements are attracting to the epidemic of AIDS in Africa, there is
surprisingly little discussion around its prevalence in the United
States. What is perhaps most disturbing is its rate of occurrence among
African Americans, who are affected by the deadly virus at a ratio
highly disproportionate to their overall population. Indeed, while
African Americans account for some 12% of the population, they represent
nearly 50% of those affected by HIV and
AIDS. And African American women are nearly 20 times more likely to
acquire the deadly virus than white women.
But just what is being done to combat this alarming phenomenon? And
what caused it to occur in the first place?
HIV/AIDS
The human immunodeficiency virus (HIV) is a viral infection that affects
cells present in our blood, semen, and other bodily fluids. It is
passed primarily through vaginal or anal sex. The infection affects the
body’s immune system, destroying infection-fighting cells called T-cell
lymphocytes, leaving the person highly susceptible to illnesses that
their body would otherwise be able to fight off. This is why those who
acquire HIV often develop acquired immunodeficiency syndrome (AIDS).
Why are African Americans More Susceptible to HIV/AIDS?
Race and ethnicity are not influencing factors in the acquisition of
HIV/AIDS, and alone they do not explain why certain sub groups of the
population are so unjustifiably affected. The following barriers and
circumstances are most likely responsible for the disproportionate
presence of HIV/AIDS among African Americans:
Socioeconomic factors: Currently, some 1 in 4 African Americans
are living on or below the poverty line. This affects their ability to
acquire health insurance, with some 20% of African Americans reporting
not having any insurance at all. Among those who are insured, 59% have
public insurance such as Medicaid, which provides considerably less
comprehensive coverage than private insurance. Limited health care also
means fewer opportunies for medical providers to provide education about
HIV prevention.Risky sexual behavior and substance abuse: Compared with white
men, black men are considerably less likely to acquire HIV through unprotected sex with other men (73% for
white men compared with 49% for black men). Unprotected heterosexual
sex and needle-injecting drug use are the leading causes. Among African
American women, however, some 80% are infected through heterosexual
contact. Stigmas surrounding gay behavior among men has led many to
lead dual lifestyles, whereby their women are unaware of the unsafe
sexual practices of their male partners.Sexually Transmitted Diseases
(STDs): African Americans are about 20 times more likely to have
gonorrhea and about 5 times more
likely to have syphilis then their
white counterparts. Genital lesions caused by such STDs provide an
ideal entry point for HIV — increasing the likelihood of acquiring the
virus three to five times over.Racism in the medical establishment: Because there are fewer
African American physicians, the care of black patients resides almost
entriely in the hands of white doctors. There are clear differences in
time spent, quality of care, and number of doctor’s office visits
between blacks and whites. Whites receive more thorough diagnostic work
and better treatment and care than people of color — even when
controlling for income, education, and insurance. Research has also
concluded that doctors are less likely to take the time needed to
provide preventative education and are less aggressive when treating
minority patients.Under utilization of medical care: Because of the problems
described above, blacks tend to be less trusting of the medical
establishment and tend to under utilize medical resources compared to
whites. Blacks may be concerned that their medical information will be
not kept confidential if they visit a testing clinic. They may not feel
confident that they will get good treatment for the disease if they are
infected.Limited knowledge: According to a recent study, some 67% of
African Americans infected with HIV are unaware of their HIV status,
compared with 48% of Hispanics and 18% of whites. This may be due to
the fact that blacks are generally less aware of the availability of HIV
testing, and, as described above, are less likely to seek medical care
in general.
Among African Americans, those at greatest risk are women, who account
for about 36% of all new HIV diagnoses and about two thirds of all women
affected by the virus; youth, who represent nearly 65% of all new cases
among teens; and men who have sex with other men. In fact, recent
statistics suggest that about 33% of all black men having sex with men
are infected with HIV — a sobering statistic when compared with the 7%
of white men in the same category.
What is Being Done to Combat this Epidemic?
Although previously African American advocacy groups such as the
National Association for the Advancement of Colored People (NAACP) were
accused of sidestepping the issue, they have recently begun actively
campaigning around prevention and awareness of HIV/AIDS. They are now
encouraging black Americans to be tested and to use the political
process to pressure the government into action. The Black AIDS
Institute has developed what they call the African-American Bridging
Program, which was presented at the 2006 AIDS Conference in Toronto.
The American Red Cross has also taken a stand on the issue, offering an
instructional course entitled “The African American HIV Education and
Prevention Instructor Course”, which trains individuals one how to
provide HIV education in a culturally sensitive manner.
For its part, the Center for Disease Control (CDC) is currently funding
a variety of programs and research projects aimed at HIV/AIDS education
and prevention in high-risk neighborhoods, such as gay and African
American communities.
However, it is the disturbing silence of national and regional
politicians, as well as cultural factors, that prevent open discussion
around sexuality. This continues to present one of the greatest
challenges to overcoming this critical situation.