The Impact of HIV/AIDS on African American Communities

1995 marked a turning point in the history of the HIV/AIDS epidemic. For the first time, African Americans equaled whites in the proportion of reported AIDS cases.¹ According to the Centers for Disease Control and Prevention (CDC), African Americans currently represent more than half of all HIV/AIDS² cases and HIV/AIDS² is now the leading cause of death for African American women age 25-34.³ The rate at which African Americans are diagnosed with HIV and AIDS reveals an alarming trend: African American women in the U.S. are diagnosed with HIV/AIDS² at a rate nineteen times that of white women and African American men are diagnosed at a rate seven times higher than that of white men.³ Moreover, specific African American populations, including men who have sex with men (MSM), African American women and the incarcerated, are impacted even greater by HIV and AIDS. What began in the early 1980s as an epidemic primarily viewed as affecting gay, white men, has become an epidemic that progressively and aggressively impacts African American communities.

A 2004 survey of Americans on HIV/AIDS conducted by the Kaiser Family Foundation revealed that African Americans were the only racial/ethnic group to name HIV/AIDS as the number-one domestic health problem.⁴

Additional findings revealed that 43 percent of the African Americans surveyed were personally "very concerned" about becoming infected with HIV, as compared to only 10 percent of whites. Unfortunately, this concern has not always translated into early HIV testing for African Americans. CDC data suggest that African Americans tend to be diagnosed with HIV infection much later and often at a more advanced stage of their illnesses.⁵ This explains, in part, why African Americans die from AIDS-related complications sooner than any other racial/ethnic group in the U.S.

Additionally, African Americans and other minorities are more likely to be uninsured and, therefore, less likely to receive timely preventive care.⁶ However, lack of health insurance is only part of the problem. According to the Institute of Medicine (IOM), several reports indicate that African Americans and other racial/ethnic minorities may receive lower-quality healthcare and treatment, regardless of their insurance status. The impact of inadequate access to quality care and treatment for African Americans, as it relates to diabetes, heart disease and other chronic illnesses is clear. HIV/AIDS must not be relegated to the litany of other health disparities that disproportionately impacts African American communities and continues to jeopardize the health and longevity of millions of African Americans.

In addition to these challenges, stigma, and distrust of the medical establishment continue to impact the HIV/AIDS epidemic in African American communities. Beliefs about public health systems, fueled in part by historical events such as the Tuskegee Syphilis Study, impact the health-seeking behavior of many African Americans and pose barriers to the HIV/AIDS prevention, research, and treatment efforts of many government-sponsored programs. A study published in the Journal of Acquired Immune Deficiency Syndromes (JAIDS) reports that a significant number of African Americans harbor HIV/AIDS conspiracy beliefs. The study further suggests that stronger conspiracy beliefs are associated with more negative attitudes toward condom use and more inconsistent condom use among African American men.⁷

Reflecting on the earlier days of the epidemic, noted psychiatrist Alvin Poussaint, M.D., in a 1990 New York Times article on African Americans and AIDS conspiracy theories, describes such beliefs surrounding AIDS and drugs as a "measure of frustration and neglect" felt by the African American community.⁸ The article further highlights the fear of many public health workers that conspiracy theories could erode the credibility of many AIDS programs. Conspiracy theories surrounding the origin of HIV/AIDS and a widespread belief in the government's promotion of drug use and other health risk behaviors, pose substantial barriers to HIV prevention efforts, as well as African American participation in HIV/AIDS related medical research and HIV vaccine trials. NASTAD's monograph, HIV/AIDS: African American Perspectives and Recommendations for State and Local AIDS Directors and Health Departments, advises that "To fight AIDS effectively, it is imperative to acknowledge events (past and present) that underlie attitudes of mistrust."⁹

"HIV/AIDS is a serious health crisis in the African American community and without swift, decisive, and continuous action, the greater the risk that HIV/AIDS will simply join the long list of health conditions that prematurely ends the lives of African Americans. Public health continues to be the most consistent source of services for our most vulnerable citizens, and state and local health departments play a unique and vital role in HIV-related prevention, care, and treatment. However public health cannot be expected to reverse this alarming trend alone. It requires that we each take ownership over this issue. The impact of HIV/AIDS on African Americans demands not only a 'call to action' but also a 'commitment to action.' Challenge yourself to ask 'what can I do?' and then do it." Loretta Davis-Satterla Director, Division of Health, Wellness and Disease Control, Michigan Department of Community Health