Introduction
The prevalence rates of HIV/AIDS vary from on ethnic group to another in the United States. The epidemiology of this global menace has evolved with time since it started by affecting the white people and is now affecting the black people. Epidemiological data indicates that in the modern society, black people have high prevalence rates of HIV/AIDS.
One of the many ethnic groups experiencing worst cases of this disease is the African Americans because they have high prevalence rates when compared to other ethnic groups. For example, this disease is more prevalent among African Americans than among Asian Americans and Hispanic Americans.
Stone, Ojikutu, Rawlings, and Smith (2009) record that within a period of 20 years, viz.1985 – 2005, the rate of infection of HIV/AIDS doubled from 25 per cent to 50 per cent among African Americans.
This change means that more African Americans are contracting the disease, living with it, or are under treatment than ever before. Additionally, statistics indicate that HIV/AIDS infections have gender orientation, as rates of infections are higher among women than among men (National Alliance of State & Territorial AIDS Directors, 2008).
Overall, a number of reasons might explain this scenario; for instance, drug abuse, sexual behaviors, and socioeconomic factors. The American government has come up with a number of programs to combat this problem. Therefore, this paper explores the potential causes of the disparity in HIV/AIDS and examines the efficacy of the programs that have been established to help in combating this menace.
Overview of HIV/AIDS in the US
Beyond 1980s, the white people had a higher number of people living with HIV/AIDS when compared to the blacks. Drug abusers and homosexuals defined the group of people among the whites who had a high prevalence of the disease. However, as cases of HIV/AIDS infections increased among the Americans, Africans Americans started to experience higher rates of infections than other ethnicities.
Between 1985 and 2005, the infection rates doubled among African Americans from about 25 per cent to approximately 50 per cent (Stone, Ojikutu, Rawlings, & Smith, 2009). In 1985, the population of African Americans formed about 12 per cent and during 2005, their population comprised 13 per cent.
The increase in population by 1 per cent does not justify the doubling of the disease cases. The increase was quite shocking because infection rates among other ethnic groups remained considerably low. Currently, the cases of infections among African Americans are still increasing exponentially. The disproportionate impact of the disease on the Americans indicates that many factors, which mediate infection, exist among varied ethnicities and communities.
In the United States, the population of people living with the disease has been increasing exponential in the last three decades. The people at risk of getting HIV/AIDS infections belong to the ages of 13 and 34 years because they are sexually active. Stone, Ojikutu, Rawlings, and Smith (2009) indicate, “At the end of 2008, 322, 796 persons were living with AIDS, nearly twice the number of those at the end of 1994” (p. 2).
The exponential increase of the people living with the disease occurs due to change of lifestyles in the society coupled with other factors related to sexual behaviors. The government thus supported the introduction of treatment regimes and increased the number of prevention strategies.
Although the treatment regimes and prevention strategies enabled stemming of HIV/AIDS amongst the whites, cases of the infections continued to increase among African Americans. As the cases of the disease continued to increase unabated among African Americans, the government and health care system had to revise their preventive strategies to help in combating the epidemic. From 1980s, it gradually became evident that African Americans had numerous predisposing factors that cause high rates of infections.
Surveillance studies indicate that HIV/AIDS infections have both geographical and gender orientations. Stone, Ojikutu, Rawlings, and Smith (2009) note that surveillance data provided an interesting epidemiological aspect of HIV/AIDS epidemic, viz. “It was concentrated in specific geographical areas: the Northeast, the South, the Mid-Atlantic and the West coast” (p.3).
The geographical aspect of the disease distribution indicates that there are social, economic, and cultural factors that contribute to the dominance of the disease in one region than other regions.
Moreover, the occurrence of HIV/AIDS among African Americans has gender orientation. African American women have higher cases of infections than their men counterparts do. “African American women comprise only 12 per cent of the female population in the United States, yet they accounted for 64 per cent of women living with HIV/AIDS at the end of 2006” (National Alliance of State & Territorial AIDS Directors, 2008, p. 1).
This observation means that gender-based factors predispose African American women to the disease. In this view, the presence of many predisposing factors to the disease is responsible for the disproportionate distribution of HIV/AIDS cases amongst American ethnic groups.
Potential Causes
Drug Abuse
The prevalence of HIV/AIDS infections among African Americans is higher when compared to the general population of the United States because they form a significant population of drug abusers. Given that African Americans have low socioeconomic status, they tend to abuse drugs as a way of dealing with stress and other life challenges.
Laurencin, Christensen, and Taylor (2008) posit, “Illicit drug use is an important primary risk factor for HIV/AIDS infection among African Americans, which is also noted as the second leading cause of HIV infection for both black men and black women” (p.38). Drug abuse predisposes African Americans to the disease because they share needles that they use when injecting drugs into their bodies.
Since drugs that people abuse are illegal, they abuse them in secret places where they cannot access extra needles in the event that they attempt to avoid sharing. Lack of extra needles and the addictive nature of the drugs compel the drugs users to share needles, thus predisposing them to the disease. Hence, if one of the drug users has HIV/AIDS, the entire group of drug users would contract it.
Moreover, drug abuse predisposes African Americans to unprotected sexual intercourse because drugs influence one’s rational judgment. Usually, sober individuals are unlikely to participate in unprotected sexual activities because they still have the rational capacity of protecting themselves during sexual intercourse.
In contrast, drug users are unable to protect themselves either during consented sexual intercourse or from rape. When a drug user is under intoxication, the chance that he/she can consent to perform sexual intercourse with protection is minimal. Hence, most sexual intercourse activities that occur among intoxicated drug users are unprotected.
McCree, Jones, and O’Leary (2010) assert that drug abuse is responsible for high cases of HIV/AIDS among drug users because they are vulnerable to sexual abuses. Drugs users are vulnerable to abuses such as rape, sodomy, and gang rape because they do not have the capacity to protect themselves from such abuses. Eventually, victims contract the disease and continue to transmit to other people whom they abuse drugs together.
Drug abuse also influences adherence to antiretroviral medication and other related medications. When infected people abuse drugs, they forget to take their medication, thus increasing viral load in their bodies.
Increased viral load increases the chances of HIV/AIDS transmission during unprotected sexual intercourse. “A study of female cocaine users, predominantly African American women, showed that substance users were less likely than nonusers to take their antiretroviral therapies exactly as prescribed” (Laurencin, Christensen, & Taylor, 2008, p. 38).
Thus, drug abuse among African Americans contributes to poor adherence to prescribed medication and increases transmission of HIV/AIDS within population. Additionally, some illegal drugs impede efficacy of antiretroviral drugs for the normal dose of medication does not have the intended impact on the viral load. Reduced efficacy of the antiretroviral drugs implies that the medication does not help in management of the disease. Therefore, among drug abusers, antiretroviral drugs are not significantly helpful.
Sexual Behaviors
The nature and type of sexual behaviors that Africa Americans practice put them at risk of contracting HIV/AIDS. Significant cases of infections occur through heterosexual contacts. African Americans nurture the social behavior of trusting each other while mistrusting other ethnic groups.
The National Alliance of State and Territorial AIDS Directors (2008) posit, “African American women are less likely than other women to date men outside their racial/ethnic group” (p.1). Essentially, African American women tend to have sexual intercourse with African American men, thus restricting transmission of HIV/AIDS within their ethnic circle. Hence, heterosexual contact within the community explains why African Americans have a high prevalence of the disease when compared to other ethnic groups.
Lower marriage rates among African Americans contribute to the increase in the cases of HIV/AIDS transmission. Owing to low rates of marriage, African Americans prefer having multiple sexual partners. Given that most young people are single, they indulge in heterosexual intercourse with many partners, thus increasing the rate of transmission of HIV/AIDS. Moreover, sex-ratio imbalance has given men the advantage of having many sexual partners because women seem to be desperate in competing for the few available men.
“The sex-ratio imbalance in African American communities can give rise to women’s difficulties in discussing and negotiating condom use with male sexual partners” (National Alliance of State & Territorial AIDS Directors, 2008, p. 4). Thus, African American women succumb to demands of their partners, hence increasing their vulnerability to the disease. Ultimately, since men have multiple sexual partners, they increase the rate of transmission of HIV/AIDS among African Americans.
Homosexual behaviors among African American men also contribute to the disproportionate occurrence of the disease. Among African American men, male-to-male sexual contact is responsible for the occurrence of high incidences of HIV/AIDS. Studies have shown that homosexuals have increased in the past decade due to recognition of their rights in the society. Hence, homosexuals have contributed to the increase in the prevalent rates of the disease among African Americans.
According to Laurencin, Christensen, and Taylor (2008), survey conducted across the United States indicated that clubs, cafes, bars, parks, gyms, gay pride events, and social organizations are places where homosexuals interact and propagate their sexual activities. Since most African American men are dominant in such places, they are vulnerable to HIV/AIDs because they interact with people from various backgrounds.
Sexually transmitted diseases predispose people to HIV/AIDS. The disproportionate occurrence of the disease among African Americans is due to the high incidences of sexually transmitted diseases. In 2005, “African Americans were 18 times as likely as whites to have gonorrhea and approximately five times as likely to have syphilis” (Laurencin, Christensen, & Taylor, 2008, p. 38).
Gonorrhea cases formed about 58 per cent of the total cases while cases of syphilis comprised 41 per cent. Sexually transmitted diseases such as gonorrhea cause inflammation on genital areas and increases susceptibility to the disease.
Susceptibility to HIV/AIDS increases because white blood cells concentrate on an inflamed genital tract thus causing the viral load to increase (Friedman, Cooper, & Osborne, 2009). Syphilis is an ulcerative sexually transmitted disease, which enhances entry of viruses through mucosal ulcerations. Therefore, high prevalence of sexually transmitted diseases among African Americans has contributed to the disproportionate occurrence of the disease.
Socio-economic status
Socio-economic status is a factor that determines the susceptibility of people to HIV/AIDS. The low socio-economic status amongst African Americans has contributed to high incidences of the disease. Women under low socioeconomic status are prone to sexual abuse because they are unable to defend themselves.
Therefore, they become subjects of sexual abuse, thus predisposed to HIV/AIDS. Friedman, Cooper, and Osborne (2009, p.1003) argue, “Infections are not simple product of behavior alone”, but a complex of social and economic factors that affect the lives of African Americans. Hence, differences in socio-economic status between the whites and blacks have contributed to the high incidences of the disease among African Americans.
Additionally, low socio-economic status determines access to healthcare, and thus relates to the incidences of HIV/AIDS cases among the African Americans. “Limited access to high-quality healthcare, housing, and HIV/AIDS prevention and education programs both directly and indirectly increase the risk factors for HIV infection” (Laurencin, Christensen, & Taylor, 2008, p. 38).
In the year 2000, approximately 25 per cent of African Americans lived in poverty, which means that they could not access essential healthcare services. Historically, African Americans faced social and economic marginalization, which increased their vulnerability to drug abuse, homelessness, incarceration, and risky sexual behaviors. Hence, poverty and social alienation prevent African Americans from accessing critical healthcare services, which translates to increased HIV/AIDS prevalence.
Government Programs
Community mobilization to increase awareness about HIV/AIDS is one of the strategies that the United States has applied in reversing trends of the epidemic among African Americans. Issues to deal with increased awareness of the disease and its associated risk factors such as drugs and sexual behaviors have significantly reduced the rate of infections among African Americans and the general population. Mobilization of communities to enhance awareness of the disease has changed perceptions and norms about the disease.
Through awareness, stigma has reduced, people have diagnosed HIV/AIDS early, patients have adhered to treatment plans, and the entire population has transformed their lifestyles for healthy behaviors (Stone, Ojikutu, Rawlings, & Smith, 2009). Hence, community mobilization has made tremendous reductions in the rate of HIV/AIDS infection among African Americans for they have avoided drug abuse and risky sexual behaviors.
Adherence to medication is a major problem that influences management of HIV/AIDS. The government employs an educational program where healthcare providers offer patients with essential information to enhance adherence to antiretroviral drugs.
The United Nations Educational, Scientific, and Cultural Organization (2007) indicate, “Preparing patients through treatment education and providing ongoing need-based education help persons with HIV to manage their treatment and HIV-related diseases” (p.1). Treatment education enables patients to manage their condition by adhering to medication and improving their CD4 counts.
Treatment education at the community level aims at encouraging people to check their HIV status and take the appropriate healthcare measures. Eventually, the community becomes responsive to the needs of patients and thus reduces the stigma associated with the disease. Hence, treatment education is an effective program that is helpful in promoting adherence to medication.
Enhancement of socio-economic status of the African Americans is a strategy that the government has employed in combating the high incidences of HIV/AIDS. Enhancement of socio-economic status of African Americans enables them to access healthcare services they could not afford before.
The government has made significant progress in enhancing accessibility of healthcare services. It has collaborated with various stakeholders such as Medicaid and Medicare in providing affordable healthcare to the poor people, who are mainly African Americans.
The government has also used comprehensive approach in empowering African Americans to reverse trends of HIV/AIDS infections. “One strategy to create such a vast change involves merging HIV/AIDS prevention with efforts against racism, homophobia, joblessness, sexual violence, homelessness, substance abuse, mental illness, and poverty” (Laurencin, Christensen, & Taylor, 2008, p.41). Hence, comprehensive approach is appropriate in combating HIV/AIDS among African Americans.
Conclusion
The disproportionate occurrence of HIV/AIDS among African Americans indicates social, economic, and health disparities that exist in the United States. Though African Americans represent about 13 per cent of the population, they have about 50 per cent cases of HIV/AIDS.
The major causes for the disproportionate occurrence of the disease among African Americans include drug abuse, sexual behaviors, and low socio-economic status. Hence, the government has set up programs such as community mobilization, treatment education, and enhancement of socio-economic status via comprehensive approach to combat HIV/AIDS among African Americans.
References
Friedman, S., Cooper, H., & Osborne, A. (2009). Interventions strategies for HIV/AIDS Prevention among African Americans: Structural and social contexts of HIV risk among African Americans. American Journal of Public Health, 99(6), 1002-1008.
Laurencin, C., Christensen, D., & Taylor, E. (2008). HIV/AIDS and the African-American Community: A state of Emergency. Journal of the National Medical Association, 100(1), 35-43.
McCree, D., Jones, K., & O’Leary, A. (2010). African Americans and HIV/AIDS: Understanding and addressing the epidemic. New York, NY: Springer.
National Alliance of State & Territorial AIDS Directors. (2008). The landscape of HIV/AIDS among African American: Women in the United States. Web.
Stone, V., Ojikutu, B., Rawlings, M., & Smith, K. (2009). HIV/AIDS in U.S. communities Of color. New York, NY: Springer.
United Nations Educational, Scientific, and Cultural Organization. (2007). Current Research and good practice in HIV and AIDS treatment education. Retrieved from https://unesdoc.unesco.org/ark:/48223/pf0000149722