Understanding the Impact of HIV/AIDS in the Black and African American Community
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The Black and African American community is disproportionately affected by HIV/AIDS. In 2018, Black and African American people made up 13% of the U.S. population, but accounted for 42% (16,002) of the 37,968 new HIV diagnoses in the United States, according to the Centers for Disease Control and Prevention.
Systemic barriers to prevention and care, in addition to the stigma surrounding HIV/AIDS in the Black and African American community, help contribute to the growing number of cases.
Fortunately, diversity within nursing and culturally competent care can help reduce health disparities, whether among Black and African Americans or other groups, such as Native Americans or Indigenous people.
This guide describes the impact of HIV/AIDS among the Black and African American population and what you need to know as a nurse to administer proper care.
The History and Stigma of HIV/AIDS in the Black and African American Community
Dr. Alicia Morehead-Gee, medical director of HIV prevention at AltaMed Health Services, points out the role that stigma plays.
"HIV-related stigma includes the perception of the condition as a 'shameful' disease, a 'gay' disease, and/or a 'death sentence,'" she says, "although these are all misleading and inaccurate statements. Anti-LGBTQIA+ stigma still permeates through HIV-related stigma in our country."
When a health condition is a stigma, people often avoid finding out if they have that condition or not. They may avoid testing and ignore symptoms.
Even if they are diagnosed, they may refuse to take medications for HIV, fearing that someone may find out.
"Due to [the stigma], individuals may avoid getting tested for HIV or taking HIV prevention or treatment medications," says Morehead-Gee. "Their avoidance may stem from a fear of being stigmatized by others for their sexual orientation or HIV status."
"It is important to talk about the issues surrounding stigma so that we can effectively prevent and treat HIV."
Discrimination and the Barriers to Proper Care and Prevention
Stigma isn't the only barrier Black and African Americans experience in preventing, diagnosing, or treating HIV/AIDS. Long-standing health inequities, disparities, and discrimination have an impact on attitudes and beliefs toward HIV/AIDS in the Black and African American community.
A 2016 survey of Black American adults found that almost a third (31%) think that HIV/AIDS was created deliberately; 40% think that a cure is being withheld; and one in three (33%) think that antiretroviral treatment is poison.
Morehead-Gee notes, "Lack of healthcare access leads to less opportunities for HIV testing, in addition to less awareness and access to HIV prevention and treatment medications. This has greatly influenced the HIV disparities affecting African Americans."
Black and African American patients have better outcomes when treated by Black and African American doctors. However, only 5.4% of doctors are Black. Cultural competence and more representation in healthcare can have a positive impact on patient care.
Addressing the Challenges Caused by HIV/AIDS in the Black and African American Community
Those working in healthcare can address stigmas, discrimination, and lack of access to care through various efforts. Partnerships with community organizations, volunteer work, fundraising, and the willingness to understand discrimination and how to dismantle it can help.
Addressing these challenges also calls for individual efforts, such as:
Understanding unconscious bias and its impact
Advocating for Black and African American patients and community needs
Establishing respectful and open communication with patients that sets the ground for trust
Understanding the roots of stigma and addressing them with sensitivity (This may mean being aware of how trauma can affect interactions and encouraging the patient to inform you about their situation, needs, and history. Avoid presenting facts that may be received as lecturing or judgment which in turn may reinforce stigma and affect a patient's trust in you.)
Efforts to Reduce Stigma
Healthcare or public health systems have created campaigns to educate Black and African American communities about HIV and how it can be prevented or treated. These campaigns include billboards, printed public service announcements, or social media.
Community outreach within churches, barbershops, beauty salons, or other places that have been thought of as safe spaces for Black and African Americans can help reduce stigma. These trusted community locations for Black and African Americans can be a promising source for trusted education about HIV, blood pressure, and other health issues.
"More outreach in these settings, as well as schools and other community events, can be done to decrease HIV stigma and increase knowledge on HIV prevention and treatment," says Morehead-Gee.
As trusted professionals, nurses can provide formal and informal education about HIV/AIDS, and nurses can advocate for LGBTQ+ equality to help put an end to stigma. Nurses can also model respect for people who identify as LGBTQ+ or who have HIV or AIDS.
Eliminating Barriers to Healthcare and Prevention
Education alone isn't enough to address HIV/AIDS disparities among Black and African Americans. Morehead-Gee points out, "More can be done to increase healthcare access in African American communities by opening more primary care and specialty care clinics to provide these services."
In addition to making it easier to access healthcare, providers can promote annual health examinations that include routine HIV/AIDS testing. They can make it easier to schedule and access these exams too.
Nurses might also advocate for public policy measures to increase access to healthcare and reduce patient out-of-pocket costs.
Providers can also increase trust in healthcare by demonstrating respect and commitment to reducing healthcare disparities. They can work to increase their staff and volunteer diversity, establish collaborations with trusted organizations, and educate legislators, funders, and the public on the lack of access within their communities and what to do about it.
What Nurses Can Do to Mitigate Healthcare, Education, and Prevention Challenges
Nurses can encourage patients to have annual examinations and identify barriers, such as lack of transportation or the need to offer care outside normal working hours. They can encourage their organizations to address these barriers.
Other measures nurses can take include mentoring Black and African American nurses and encouraging Black and African Americans to become nurses.
Morehead-Gee's advice to nurses:
[We must] recognize the impact of historical oppression and inequity on the current HIV landscape. The current HIV disparities are not due to a difference in behaviors or practices among African Americans; they are a result of longstanding discriminatory practices against African Americans in education, employment, housing, and healthcare access. Thus, we have a lot of work to do to combat these inequities, in addition to the stigma affecting individuals' thoughts regarding HIV.
We must work to provide a welcoming, inclusive space for people to learn about HIV, get tested, and get the correct prevention or treatment medications. With these efforts, we can address the disparities and end the HIV epidemic.
Caring for Patients Impacted by HIV/AIDS: FAQ
How does HIV affect patient care?
If HIV progresses to AIDS, it increases a patient's vulnerability to other infections. Nurses must treat these patients with the same precautions they take with other immunocompromised patients. They should maintain hygiene and keep vaccinations and boosters up to date.
HIV patients, like others with serious chronic conditions, may need additional support for mental and emotional well-being.
What kind of medical care is needed for HIV?
Patients with HIV receive antiretroviral treatments that reduce the number of viruses in their blood.
Especially if treated early, patients with HIV can lead lives similar to what they may have imagined before they tested positive, which is why HIV diagnosis and treatment are critical. Early diagnosis and treatment can also reduce the chances of HIV being transmitted to others.
What are HIV patients at risk for?
HIV patients are at risk of developing AIDS. This compromises their immune systems, making them more vulnerable to illness. Some of the most common infections among those with HIV are pneumonia, certain types of cancers, hepatitis, shingles, and fungal infections like thrush.
What precautions should a nursing assistant take when caring for a resident with HIV/AIDS?
Nursing assistants caring for a resident with HIV/AIDS should take the same precautions that they do against any other blood-borne pathogen. They should use gloves when encountering blood, either directly or in feces or vomit.
Nurses should also take all possible precautions to avoid exposing a resident to other infections by washing their hands regularly and thoroughly, getting vaccinations and boosters, and using a mask when appropriate.
Resources for Nurses and Healthcare Providers
There are many resources for nurses who want to address HIV/AIDS stigma in the Black and African American community and reduce barriers to prevention and treatment.
Resources for African Americans Impacted by HIV/AIDS
If you or somebody you care for has HIV/AIDS, or you want to educate yourself more, these are some valuable resources.
Meet Our Contributor
Dr. Alicia Morehead-Gee
Dr. Alicia Morehead-Gee is a general internal medicine physician and health leader committed to improving health outcomes among underserved populations across Los Angeles and Orange counties.
As medical director of HIV Prevention at AltaMed Health Services, one of the nation's largest federally qualified health centers, she is leading an initiative to teach primary care providers, pharmacists, and healthcare staff about HIV prevention.
Page last reviewed February 6, 2022
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