HIV/AIDS and African Americans

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?

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.

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