African Americans and Voluntary HIV Counseling and Testing

African Americans are the single most affected group by HIV/AIDS. In fact they have been disproportionately affected since the beginning of the epidemic.¹ In 2003, African Americans represented 13% of the population; however, they were 40% of the total AIDS cases and half of all newly diagnosed HIV/AIDS cases. The numbers of women and youth with AIDS in this group have been on the rise. African American women accounted for 67% of new AIDS cases among all women in 2003, and African American teens ages 13-19 were 65% of all cases among teens in 2002.^1,2

Factors to Consider When Promoting and Providing HIV Prevention and Treatment

Socioeconomic Factors

There are a number of relevant structural factors associated with social access and equality. For instance, studies have found a direct correlation between higher AIDS incidence and lower income and nearly one in four African Americans lives in poverty.³ Limited and late access to quality health care are also related. African Americans with HIV/AIDS are more likely to be publicly insured or uninsured than are Caucasians, with 59% relying on Medicaid and 22% being uninsured.¹ A study of HIV-positive people found that 56% of late testers (those diagnosed with AIDS within one year of their HIV diagnosis) were African American. Survival rates are also low for this group, with only 60% living nine years after an AIDS diagnosis.³

Denial and Stigma

Segments of the African American community have yet to successfully address relevant social issues, such as sexual orientation, HIV-related stigma and silence around sexual and drug use behaviors. For example, studies show that a significant number of African American men who have sex with men identify not as gay or bisexual but as heterosexual. 3 Some individuals don't test or return for their results for fear that a positive result will damage their self-image and their family and social relationships.⁴

Distrust and Fatalism

Historical and current discrimination towards African Americans in the health care arena is relevant to HIV prevention. Many have a general distrust of the medical and scientific establishments and some believe HIV to be government-made. A recent study found that among African American men, those who hold stronger conspiracy beliefs, regardless of other factors, are less likely to use condoms consistently.⁵

Immigration Issues

The growing community of African and Caribbean immigrants requires greater understanding of cultural and immigration issues. According to studies, immigrants face poverty, racism, stigma, extended separation from family and low self-esteem, which in turn can result in stress, depression and anxiety.⁶ This can increase immigrants' risk behaviors and prevent them from seeking services.

Suggestions for Effective Services and Campaign Messages

• This is a culturally diverse population, and prevention efforts must be tailored to reach each specific target group as there is no single approach that will effectively reach all groups.

• Some men who have sex with men may identify as heterosexual or bisexual or may not disclose this behavior at all. Make sure your services and messages are inclusive of various sexual identities.

• Include HIV-positive African Americans in the design and implementation of services and campaigns, as visibility can help reduce the stigma of HIV. Develop support networks for HIV-positive individuals.

• Address relevant social issues such as HIV-related stigma, homophobia and disclosure issues.

• Actively address feelings of distrust. Highlight the importance of prevention and care, regardless of the origin of the epidemic. Community forums and focus groups may be an effective way to accomplish this.

• Pay special attention to providing appropriate services to immigrants from Africa and the Caribbean. Encourage anonymous rather than confidential testing to avoid any negative consequences to their immigration status. HIV-positive immigrants should always consult with an immigration attorney.

• As you design and implement services, collaborate with trusted agencies, schools, businesses, churches, etc.

• HIV testing and counseling programs should develop protocols to provide medical, mental and social service referrals specific to the populations they serve, so as to create a continuum of care.

• Provide staff training as needed.

References

1. The Henry J. Kaiser Family Foundation, African Americans and HIV/AIDS, February 2005.

2. CDC, HIV/AIDS Surveillance Report, Vol. 15, December 2004.

3. CDC, Fact Sheet: HIV/AIDS Among African Americans, February 2005.

4. CDC, Best Practices in Prevention Services for Persons Living with HIV, December 2004.

5. JAIDS, Are HIV/AIDS Conspiracy Beliefs a Barrier to HIV Prevention Among African Americans? 38(2):213-218, Feb. 1, 2005.

6. UNIDOS Network, AIDS and Migrants: Solutions and Recommendations, June 2004.