Are African-American populations at risk?
Many African-American populations are at high risk for HIV infection, not because of their race or ethnicity, but because of the risk behaviors they may engage in. As with any population, it's not who you are, but what you do that puts you at risk for HIV. African-Americans are disproportionately affected by HIV: they account for 33% of total AIDS cases in the US, while comprising only 11% of the US population. (1)
In 1994, more than half (57%) of AIDS cases among women were among African-Americans. Likewise, African-Americans accounted for over half of all AIDS cases among injection drug users (IDUs). In 1994, 62% of all children with AIDS were African-American. (1)
Who are African-Americans at risk?
While African-Americans are often viewed as one group, there is, in fact, a wide variety of populations in the US included under this heading. (2) Upper class, lower class, Christian, Muslim, inner-city, suburban, descendants of slaves and recent Caribbean immigrants all come under the African-American heading. Current epidemiological surveillance does not record these social, cultural, economic, geographic, religious, and political differences that may more accurately predict risk. (3)
Although HIV transmission in African-American communities is primarily viewed as a problem among heterosexual IDUs and their sexual partners, the proportion of AIDS cases among African-Americans attributed to male homosexual/bisexual activity (36%) is almost equal to that attributed to injection drug use (38%). (1)
Injection drug use has played a major role in HIV infection among African-Americans. African-Americans are twice as likely as whites to have used drugs intravenously, and HIV infection is higher for black IDUs than white IDUs. (4) One reason may be the "ghettoization" of blacks in inner-city areas where drug trafficking, unemployment and poverty, among other factors, have assured that blacks suffer high rates of addiction. (5) Studies of drug users that describe significant association between health and race may be better explained by these characteristics of the social environment. (6)
What puts African-Americans at risk?
Very little information exists on risk factors specific to African-Americans, especially among IDUs, because until recently there has been a lack of research in this area. Funding agencies have not targeted African-Americans as a particular area of concern for research. Few non-minority researchers have demonstrated ongoing interest in intervention work with African-Americans, and currently less than 3% of National Institute of Health research grants are awarded to African-American researchers. (2)
In a survey of African-American gay and bisexual men in the San Francisco Bay Area, more than 50% reported unprotected anal intercourse, a considerably higher percentage than among white gay men. Those men were more likely to be poor, to have been paid for sex, or to have used injection drugs; to engage in unprotected sex despite knowing risk of HIV infection; and to report less social support. Men with negative expectations and beliefs about condoms were less likely to use them. (7)
Among African-American adults living in cities with a high prevalence of AIDS cases, almost one-fifth (19%) reported having two or more sexual partners in the past year. More men (30%) than women (10%) reported multiple partners. Substantial proportions of blacks with multiple sex partners used no condoms with either their main (47%) or secondary partners (35%). (8)
What are obstacles to prevention?
Many members of the black community have held an underlying distrust of the white public health world, especially since the Tuskegee Syphilis Study. Some groups, including some African-Americans, believe that the effects of AIDS on the community are the results of deliberate efforts of the US government. Adding to this are persistent inadequacies in social benefits, health care, education and opportunities for African-Americans. Effective prevention programs must address these concerns. (9,10)
Among homosexually active African-American men, including those who self-identify as gay, fear of homophobia and strong attachment to the minority community may have been strong disincentives to respond to AIDS as a primarily gay issue. At the beginning of the epidemic, the absence of national gay leaders and large gay constituencies in the African-American population offered few opportunities to mobilize support. (11)
What's being done?
Not many prevention programs specific to African-Americans have been evaluated for effectiveness, but the number of programs is increasing and there are a few promising studies. An intervention aimed at African-American gay and bisexual men extensively pilot tested all materials including videos that depicted only black men and addressed issues related to the men's same-sex attitudes and behaviors addressed in their own words. Clients who participated in three weekly three hour group sessions greatly reduced (50%) their frequency of unprotected anal intercourse, and maintained the behavior change through an 18-month follow-up. (11)
African-American male adolescents in Philadelphia, PA took part in an intervention to increase knowledge of AIDS and sexually transmitted diseases (STDs) and weaken problematic attitudes towards risky sexual behaviors. Educational materials included a video narrated by a black woman with a multiethnic cast and "AIDS basketball" where teams earned points for correctly answering AIDS questions. Participants reported less sexual intercourse, fewer partners, and greater use of condoms after the intervention. (12)
Men and women attending an STD clinic in the South Bronx, NY had access to either a video on condom use, or both the video and an interactive group session. Patients were given coupons for free condoms at a pharmacy several blocks from the clinic. Among African-American clients, condom acquisition increased substantially after the video and group session, but not after the video alone. One reason may be that the video primarily targeted behavior change among men. Also, clients who self-identified as Caribbean had lived in the US for a shorter amount of time, and the video may have been embedded in US culture. This study showed that interactive sessions combined with videos can personalize the prevention message and enhance behavior change. (13)
What needs to be done?
Researchers and service providers need a better understanding of the role of cultural and socioeconomic factors in the transmission of HIV, as well as the effect of racial inequality on public health. In addition, public health officials should consider changing epidemiological surveillance to include other demographic information besides sex, age and ethnicity. These efforts need to influence the design of prevention messages, services and programs.
In the second decade of the AIDS epidemic, few studies of HIV prevention interventions specifically for African-Americans have been conducted or published. (14) Especially lacking are studies of African-American IDUs and gay/bisexual men. (15) A comprehensive HIV prevention strategy uses many elements to protect as many people at risk for HIV as possible. Effective and equitable HIV research, policy, program and funding efforts are urgently needed in African-American communities. (5)
References:
Prepared by Pamela DeCarlo and John Peterson, PhD
Reproduction of this text is encouraged; however, copies may not be sold. The Center for AIDS
Prevention Studies at the University of California San Franciso is the source of this
information. For additional copies of this and other HIV Prevention Fact Sheets, please call the
National AIDS Clearinghouse at 800/458-5231. Comments and questions about this Fact Sheet may
be e-mailed to prevention_factsheets@quickmail.ucsf.edu. ©1996, University of California
Return to the HIV Prevention Fact Sheet Menu
Go to the HIVpositive.us Main Menu