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Fact Sheet: HIV/AIDS Among Various Groups

December 1, 1998

The HIV/AIDS pandemic has become a public health threat in communities throughout the United States. While the discovery of antiretroviral combination drug therapies, or "drug cocktails," directly resulted in the first overall decrease in both AIDS cases and AIDS-related deaths in the United States, the overall rate of HIV transmission has not mirrored this trend.

Since the beginning of the HIV/AIDS pandemic, there have been specific communities and population groups throughout the United States that have been and continue to be disproportionately infected with and affected by HIV, who account for the large majority of U.S. AIDS cases and who are more likely to die from an AIDS-related illness.

Racial and ethnic minority groups, particularly African Americans and Latinos, women, and men who have sex with men (MSM) represent the population groups in the United States that are at the highest risk of becoming infected with HIV. This remains true despite the fact that more is known now about HIV prevention than in past years and antiretroviral drugs, which significantly increase the time lapse between HIV infection and AIDS development, have been discovered. So why does the paradox exist?

Social barriers play integral roles in challenging the messages behind HIV/AIDS awareness and education efforts. This is particularly true in African-American and Latino communities where many still equate HIV/AIDS with homosexuality or drug use. As long as HIV/AIDS prevention and education initiatives lack community support, including that from the faith and political communities, this epidemic will continue to disproportionately affect African Americans and Latinos.

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Many racial/ethnic minorities, especially African-American and Latina women, and MSM are put at even greater risk of becoming infected with HIV due to:
  • disparities in access to quality health care services between socioeconomic classes;

  • the nexus between TB and HIV, and STDs and HIV;

  • a lack of success in effectively addressing substance abuse issues in the United States; and/or

  • a lack of prevention and awareness pro-grams and messages appropriately structured to impact the behaviors of and educate individuals in high-risk groups.


African Americans

In the United States, African Americans display a wealth of socioeconomic, cultural, ethnic and religious backgrounds. However, despite the limiting definition of this diverse group, African Americans have been, and continue to be, infected and affected by HIV more than any other population group in the United States. African-American women especially have been infected by HIV, demonstrating the highest increase in heterosexual transmission of all cases of HIV among women. AIDS-related illnesses are the leading causes of death among African-Americans between the ages of 25 and 44.

  • Based on recent data from the Centers for Disease Control and Prevention (CDC), reports of HIV transmission in 30 states indicate that African Americans 13 years of age or older represented 50% of all new HIV infections among males last year and a shocking 69% of new HIV infections among women.

  • An estimated 38% of African-American men with AIDS were infected through MSM transmission and 35% reported injection drug use transmission. A significant portion of AIDS cases among African-American women (15%) were caused by unsafe heterosexual sex with an infected male injection drug user.

  • African-American children under the age of 13 constitute 58% of all reported AIDS cases among children in the United States.


Latinos

Like African Americans, Latinos represent a variety of cultural, socioeconomic and ethnic backgrounds. For many Latina women, cultural influences and traditions hinder their ability to protect themselves from HIV infection. These barriers undoubtedly play an integral role in the significant increase in the proportion of annual AIDS cases among Latina women infected heterosexually -- from 30% to 60% -- in the decade between 1986 and 1996. The actual number of AIDS cases among Latinos in the United States, when viewed in isolation, seems small and fails to accurately portray the rapidity of HIV transmission among this at-risk population group.

  • An estimated 43% of reported AIDS cases among Latino men were due to unsafe MSM behavior, and injection drug use accounts for 36% of cases.

  • In the decade between 1986 and 1996, AIDS incidence among Latino men infected heterosexually increased 11%, while incidence among those infected through injection drug use and MSM decreased by 5% and 8%, respectively.


Men Who Have Sex With Men

Men who have sex with men (MSM) continue to be more at risk of HIV infection than other population groups in the United States. This is especially true for young MSM, who are represented in nearly 75% of all reported HIV infections among young men.

Based on reports to CDC, MSM of color are infected by HIV more than men of color who are not MSM. Last year, MSM accounted for more than one quarter of all reported new HIV infections among African-American men, and more than one out of every four reported AIDS cases among MSM in the United States were in African-American men. This is startling, considering that 27% is significantly higher than the proportion of African-American men in the overall population.

  • According to a study conducted by CDC in 6 urban counties, young African-American MSM between 15 and 22 years of age were more than three times as likely to be infected with HIV than young white MSM in the same age group.

In 1997, MSM transmission accounted for 35% and 42% of new HIV infections reported among Latino and Asian American/Pacific Island men, respectively. Of HIV infections in Native American men reported in 1997, 47% of them were caused by MSM transmission.

According to CDC, young, sexually active gay and bisexual men are likely to be influenced by a number of factors that increase their risk of becoming infected with HIV. Homophobia plays a major role in depleting the self-esteem of many young, gay MSM, leading to a lack of self-protection.

In some high-risk situations, young MSM are also less likely to engage in safe sex with other men, despite the increase in HIV prevention messages that have been aimed at this group. According to a recent study by CDC, nearly two thirds of the gay men polled admitted to having unprotected anal sex within the past 18 months. Additionally, 56% of gay men aged 25 years or younger reported having unprotected receptive anal intercourse in the previous 18 months, compared to 46% of older men. Men who meet their sexual partners in a bar are more likely to engage in unsafe sex, the CDC study indicates.


Asian Americans / Pacific Islanders

According to CDC, Asian Americans/Pacific Islanders comprise less than 1% of all reported HIV infections in the United States. However, 25% of all reported Asian American/Pacific Island women infected with HIV are between 20 and 24 years old. Last year, more than 40% of Asian American/Pacific Island men infected with HIV were infected through unsafe MSM contact.

Asian Americans/Pacific Islanders experience a number of cultural barriers that not only hinder the effectiveness of HIV/AIDS awareness and prevention messages but also make it difficult to monitor the spread of HIV and the number of AIDS cases in these communities.

U.S. public health officials also are confronted with complex language barriers. Asian Americans/Pacific Islanders comprise several sub-populations and speak hundreds of different languages and dialects. These language barriers make HIV/AIDS prevention initiatives and awareness campaigns extremely challenging. They also significantly limit the quantitative data available about the numbers of people in these population groups infected with and affected by HIV.


Native Americans

The men, women and children who fall under the classification group "Native American" represent hundreds of tribal nations. Today's system of classification fails to accurately identify the myriad of ethnicities embraced by Native Americans, and thus undercounts and under-represents large numbers of people in this population group. As a result, the HIV transmission rates and numbers of AIDS cases within Native American population groups is thought to be grossly underestimated.

While language barriers do not challenge HIV/AIDS awareness and prevention efforts in Native American communities, cultural and ethnic barriers do. However, community-based prevention and awareness initiatives that address these barriers have been successful in informing people of different tribal nations about the HIV/AIDS pandemic.

Of the reported HIV infections among Native American adolescent and adult males, nearly half (48%) were transmitted through unsafe MSM contact, and 15% of HIV infections were reported to be transmitted through injection drug use. CDC also indicates that of the Native American adolescent and adult females reported with HIV infections last year, a shocking 43% were infected through injection drug use, and unsafe heterosexual contact accounted for nearly one quarter of the HIV infections among this group.


Women

Women in the United States are increasingly affected by HIV. The number of women infected with HIV via heterosexual contact increases each year, and AIDS-related deaths are the third leading cause of death in women in this country.

Women of color especially are affected by HIV. In 1997, African-American and Latina women collectively accounted for four out of five female AIDS cases reported in the United States. Recent literature from CDC suggests that women who have developed AIDS by the age of 30 most likely were infected with HIV during their teenage years or early twenties. AIDS rates for African-American and Latina women are 18 and 8 times higher, respectively, than for white women. There is little information about HIV/AIDS among Asian American/Pacific Island women and Native American women. HIV surveillance programs need to be established for these communities.

While all women are biologically more susceptible to HIV infection, many women in the United States also suffer from a number of economic, cultural and social influences that make it difficult for them to protect themselves from it. This is particularly true for women of color who are disproportionately influenced by economic and cultural standards and for women who are sexually exploited or abused.

The disparities in HIV infection rates among population groups in the United States introduce a number of challenges that increasingly are being acknowledged in community-based efforts to inform people about HIV. However, other gaps need to be addressed, such as access to effective drug treatments as well as prevention and educational initiatives.


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This article was provided by American Association for World Health. It is a part of the publication Be a Force for Change.
 
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