Understanding this epidemic

In honor of Black History Month, the Ethnicity and Health in America Series is highlighting HIV in the African-American community. Our focus on HIV among African-Americans this month coincides with a national focus on HIV among Black Americans. February 7, is National Black HIV/AIDS Awareness Day, designed to get the African American community to understand the extent to which it is infected and affected by HIV. Prevalence rates for HIV infection among African Americans have now reached epidemic proportions:

  • African-Americans make up approximately 14 percent of the population of the United States. Yet in 2009, African Americans accounted for 44 percent of the new HIV/AIDS diagnoses.1

  • African American men account for 70 percent of the new infections, so that 1 in 16 black men and 1 in 32 black women will be diagnosed at some point in their lifetime.

  • Thus, the number of African Americans living with HIV infection was found to be almost eight times higher than the rate for their Caucasian counterparts.

  • African Americans with HIV/AIDS are dying at a disproportionately high rate — nearly 10 times the rate of Whites.1

1CDC, 2011
HIV/AIDS cases in Washington, D.C.
Recently, Washington, D.C., the national headquarters for APA, has seen a drastic surge in HIV infections among African Americans in the city. In fact, a column by Courtland Milloy featured in the Washington Post on December 3, 2008, titled AIDS: DC’s Silent Stalker of Women quoted Barbara Chinn, director of Whitman Walker Clinic's Max Robinson Center in Southeast Washington as saying, “the District is the epicenter [of the HIV/AIDS infection] in this country, with infection rates in some neighborhoods east of the Anacostia River rivaling those in sub-Saharan Africa." According to DC Department of Health (2007a), the nation’s capital ranked number 1 in AIDS case rates (128.4 cases per 100,000 population compared to 14.0 per 100,000 for the entire United States). While African Americans comprised approximately 60 percent of the District’s population in 2000 (DC Department of Health, 2003), they account for approximately 80.7 percent of the reported HIV/AIDS cases in the city (DC Department of Health, 2007a).
Women and youth
Additionally, the proportion of HIV cases among youth and women in the District is rising. HIV infection rates among District young people tripled for the period 2000 to 2005 compared to the previous five years. Of the 336 newly reported HIV cases among youth from 2001 to 2006, 86 percent were black (2007b). A similar increase is noted for African American women. In DC, African American women accounted for the majority — 9 out of 10 of all reported HIV/AIDS cases among women from 2001 to 2006 (2007c) and much of the increase can be attributed to heterosexual contact. Heterosexual transmission is now the leading method of transmission in the District. Approximately, 37 percent of all newly reported HIV cases were transmitted through heterosexual contact (DC Department of Health, 2007a), and this figure increases to 46 percent among women (DC Department of Health, 2007c).
Socioeconomic status and discrimination

Examining the social determinants of health such as poverty, education, poor access to health care, social justice and unemployment are essential in understanding this disparity (World Health Organization [WHO], 2008). For instance, discrimination and stigmatization are influential from diagnosis to treatment:

  • It can deter people from getting tested, disclosing their status and pursuing appropriate treatment and care (Aggleton, Wood, Malcolm, & Parker, 2005).

  • It also makes it difficult for those who are attempting to cope with and fight HIV. The fear of contagion and negative assumptions about those who have contracted the virus can prevent one’s social network from providing necessary support and reassurance (Ogden & Nyblade, 2005).

  • It can also influence the person’s interactions with the wider community, causing poor outcomes in education, health care and employment. As reported by Ogden & Nyblade (2005), this alone can lead to psychological damage, inhibiting an individual’s desire to seek HIV testing and limiting the success of HIV treatment.

In general, individuals diagnosed with HIV/AIDS are often marginalized if/when their diagnosis is disclosed, which can exacerbate the stigmatization experienced by African Americans with HIV, who were already oppressed and discriminated against because of their race. Due to pre-existing stereotypes associated with African Americans along with the higher incidence of HIV among this population, negative assumptions frequently arise regarding African American’s sexuality and behaviors, reinforcing pre-existing social inequalities (Parker, Aggleton, Attawell, Pulerwitz & Brown, 2002) and negatively influencing an African American’s help seeking behavior and ultimate response to HIV treatment. 

HIV/AIDS advocacy

The US HIV/AIDS strategy

Many efforts have been established to support the fight against AIDS. In 2010, The U.S. HIV/AIDS strategy was established, making it the first federal plan to address HIV in the United States. The primary goals of the strategy are to

  1. Reduce the number of people who become infected with HIV, 

  2. Increase access to care and optimize health outcomes for people living with HIV, and 

  3. Reduce HIV related health disparities.

Conferences

The International AIDS Conference

An effort such as the International AIDS Conference is an opportunity to brainstorm and bring such resolutions and strategies into fruition. This conference serves as a site for policy makers, researchers, service providers and others infected or affected by HIV to convene in order to share innovative ideas and possible solutions to the pandemic. It has been almost 20 years since this conference has been held in the United States. However, on July 22, 2012, through July 27, 2012, the conference will return to the U.S. and will be hosted in Washington D.C., a fitting location as it is one of the cities in this country hardest hit by the virus. The conference will review new scientific research and will address the major issues facing the global response to HIV.

The HIV/AIDS Science-Practice Partnership Conference

Currently, members of The Ad Hoc Committee on Psychology and AIDS (COPA) participate in HIV/AIDS advocacy, and have been instrumental in developing the HIV/AIDS Science-Practice Partnership Conference, which will be hosted at Howard University on April 20, 2012 for approximately 300 local HIV/AIDS researchers, front-line providers and policymakers.

APA Initiatives

APA also has initiatives dedicated to a wide range of AIDS/HIV topics. For example, within the Public Interests Directorate is the Office on AIDS, which provides information, training and technical assistance on a wide range of HIV/AIDS-related topics and administers several federally funded HIV related projects:

BSSV HOPE COPA
The Behavioral and Social Science Volunteer Program is a national HIV prevention technical assistance program directed by the Office on AIDS and funded by the CDC. BSSV has established a national network of behavioral and social science volunteers (BSSVs) to assist with HIV prevention efforts in their communities. The HIV Office of Psychology Education Program endeavors to enhance psychologists' ability to competently and compassionately respond to people infected and/or affected by HIV. HOPE is funded by the Center for Mental Health Services (CMHS) of the Substance Abuse and Mental Health Services Administration (SAMHSA). The Committee on Psychology and AIDS is an APA member-driven governance body guiding APA's organizational response to the HIV/AIDS epidemic in key ways:
  • Provides administrative staff support to the Committee on Psychology and AIDS
  • Developed the HIV/AIDS Science-Practice Partnership Conference
  • Former Chair of COPA, Dr. Lisa Bowleg, helped found the Psychology and AIDS Exchange newsletter

 

Summary

HIV continues to be a national and international public health concern. In fact, specific organizations have been created to address this topic and active research is continuing around the country in search of treatment and prevention options for those living with HIV/AIDS. It is important to note that psychologists have played a major role in finding scientific solutions to this major health concern. This month, OEMA joins these national and international efforts to raise awareness concerning HIV and particularly HIV in the African American community. On the following pages you will find OEMA sponsored activities that focus on HIV among Black Americans as well as additional resources that cover this topic, including a list of African American psychologists whose scientific work have contributed to our understanding of HIV and its prevention. We hope our effort to shine a light on this issue will encourage others, including psychologists, to join in the fight against the spread of HIV. Everyone can and should be a part of the solution.

Tiffany G. Townsend, PhD, Senior Director
Office of Ethnic Minority Affairs

Farzana Saleem, BA, Special Projects Manager
Office of Ethnic Minority Affairs

Scyatta A. Wallace, PhD, Associate Professor of Psychology
St. Johns University
Former Chair, APA Committee on Psychology and AIDS

References

Aggleton, P., Wood, K., Malcolm, A., & Parker, R., (2005). UNAIDS Case studies of successful
programmes. HIV- Related Stigma, Discrimination and Human Rights Violations. (PDF, 1MB) Retrieved on January 5, 2012.

Centers for Disease Control and Prevention. (2011). CDC Fact Sheet: HIV and AIDS among
African Americans.
 (PDF, 260KB) Retrieved on January 23, 2012.

DC Department of Health (2007a). District of Columbia HIV/AIDS Epidemiology Annual
Report, 2007.
Retrieved on November 20, 2008.

DC Department of Health (2007b). Fact Sheet, Snapshot of HIV/AIDS among Women in
the District of Columbia, Revised November 2007.
(PDF, 248KB) Retrieved on November 2008.

DC Department of Health (2007c). Fact Sheet, Snapshot of HIV/AIDS in Ward Five and
Seven.
Retrieved on November 20, 2008.

DC Department of Health (2003). District of Columbia State Health Profile. Washington DC:
State Center for Health Statistics Administration.

Ogden, J., & Nyblade, L. (2005). Report from the International Center for Research on Women
[ICRW]. Common at its Core: HIV Related Stigma Across Contexts. (PDF, 433.49) Retrieved on January 5, 2012.

Parker, R., Aggleton, P., Attawell, K., Pulerwitz, J., & Brown, L. (2002). HIV/AIDS-related Stigma and Discrimination: A Conceptual Framework and an Agenda for Action. (PDF, 507.37KB) Retrieved on December 10, 2011.

World Health Organization [WHO], (2008), Social determinants of health: Key concepts. 

Events

In honor of Black History Month, OEMA sponsored two panel discussions to focus on HIV/AIDS in the African-American community during 2012. The sessions included screenings of the short film HIV: D.C. and the ABC Primetime Documentary, AIDS in Black America, and were followed by a discussion with an expert panel including researchers, service providers and community members who worked with HIV affected communities in Washington, D.C.

  • In collaboration with the APA Diversity Committtee present: HIV/AIDS in the African American Community: A Panel Discussion Brown Bag
    Monday, February 27, 2012
    12 p.m. — 1:30 p.m.
    APA 9th Floor Conference Room

  • HIV/AIDS in the African American Community: A Panel Discussion in Collaboration with the Healthy Families/Thriving Communities Collaborative Council
    Wednesday, February 29, 2012
    1 p.m. — 3 p.m.
    Marshall Heights Community Development Building
    3939 Benning Road, NE
    Washington, D.C. 20019