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Select populations
Although HIV infection affects people from all ethnic groups,
genders, ages, and income levels, some groups have been significantly
affected by the AIDS epidemic. These groups have included
men who have sex with men, injecting drug users, people with
hemophilia, women and people of Color. The following information
details how these different populations may be uniquely affected
by the AIDS epidemic.
Men Who Have Sex With Men
Among MSM overall, there were more new HIV infections in
young black MSM (aged 13-29) than any other age/racial group
of MSM. The number of new infections among young, black gay
and bisexual men was roughly twice that of whites and of Hispanics/Latinos
(5,220 infections in blacks vs. 3,330 among whites and 2,300
among Hispanics/Latinos) (CDC, 2008e). White MSM accounted
for close to half (46%) of HIV incidence in 2006. Most new
infections among white MSM occurred in those aged 30-39 (4,670),
followed by those aged 40-49 (3,740) (CDC, 2008e). Among Hispanic/Latino
MSM, most new infections occurred in the youngest (13-29)
age group (2,300), though a substantial number of new HIV
infections were among those aged 30-39 (1,870) (CDC, 2008e).
American society still has issues with homosexuality. Grief
may not be validated when relationships are considered "unacceptable."
An example of this may be the reaction of churches to those
who are living with, or have families living with AIDS. Many
congregants report that they do not get the support they need
from their church families because of the stigma attached
to HIV, AIDS and homosexuality.
Self-esteem issues and psychological issues (including depression,
anxiety, diagnosed mental illness and risk-taking behaviors)
may also complicate the lives of these men.
Additionally, there are the issues with HIV-negative men
who have sex with men. Most of the attention, resources and
services are focused on HIV-positive gay men. As with any
behavior change people can become "tired" with safer sex messages,
and may make choices that place them at risk. Some may feel
that HIV infection is inevitable (although it is not) and
purposely engage in unprotected sex.
Men who have sex with both men and women (who do not exclusively
self-identify as "gay") face additional challenges. Most of
the HIV-prevention activities are more successful at reaching
those who identify themselves as "gay." Bisexual men face
many of the same challenges as "gay" men but may not have
the social and community resources they need.
Injecting Drug Users
American society also has issues with illegal drug use and
the way we view marginalized individuals such as those in
poverty and the homeless. People who continue to use injecting
drugs, despite warnings and information about risks, may be
viewed by some as "deserving" their infection. However, it
is important to remember that addiction is an illness and
rarely does "just say no" work to stop the addiction; indeed
it trivializes the seriousness of addiction.
Harm reduction measures like syringe exchange programs, have
been proven to reduce the transmission of blood-borne pathogens
like HIV, HBV, and HCV. These programs are controversial because
some people believe that providing clean needles and a place
to exchange used needles constitutes "approval" of injection
drug use.
In addition to poverty, self-esteem issues and psychological
issues, including depression, anxiety, diagnosed mental illness
and risk-taking behaviors, may also complicate the lives of
injection drug users. The desire to stop using illegal drugs
and the ability to do so may be very far apart. The reality
about inpatient treatment facilities is there are very few
spaces available for the demand. Many substance abusers are
placed on "waiting lists" when they want treatment, and by
the time there is a place for them, the individual may be
lost to follow-up.
People with Hemophilia
Hemophiliacs lack the ability to produce certain blood clotting
factors. Before the advent of antihemophilic factor concentrates
(products like "factor VIII" and "factor IX," which are clotting
material pooled out of donated blood plasma), hemophiliacs
could bleed to death. These concentrates allowed hemophiliacs
to receive injections of the clotting factors that they lacked,
which in turn allowed them to lead relatively normal lives.
Unfortunately, because the raw materials for these concentrates
came from donated blood, many hemophiliacs were infected with
HIV prior to the advent of blood testing.
During the 1980's, prior to routine testing of the blood
supply, 90% of severe hemophiliacs contracted HIV and/or HCV
through use of these products. There is anger within this
community because there is evidence to show that the companies
manufacturing the concentrates knew their products might be
contaminated, but continued to distribute them anyway.
While some people considered hemophiliacs to be "innocent
victims" of HIV, there had been significant discrimination
against them. The Ryan White Care Act, funding HIV services,
and the Ricky Ray Act, which provides compensation to hemophiliacs
infected with HIV, were both named after HIV-positive hemophiliacs
who suffered significant discrimination (arson, refusal of
admittance to grade school, etc.) in their hometowns.
Women With HIV
According to the CDC, in 2005, HIV/AIDS was diagnosed for
an estimated 9,708 women in the US. This number is a decrease
from the 11,941 females in 2001. Women accounted for 26% of
the estimated 37,163 diagnoses for adults and adolescents
in 2005.
Women with AIDS made up an increasing part of the epidemic.
Worldwide, at the end of 2005, according to the World Health
Organization (WHO), 17.5 million women worldwide were infected
with HIV (NIAD, 2006). In 1992, women accounted for an estimated
14% of adults and adolescents living with AIDS in the 50 states
and the District of Columbia. By the end of 2005, this proportion
had grown to 23% (CDC, 2008c).
Of the 126,964 women living with HIV/AIDS in 2005, 64% were
black, 19% were white, 15% were Hispanic, 1% were Asian or
Pacific Islander, and less than 1% were American Indian or
Alaska Native (CDC, 2008c).
High-risk heterosexual contact was the source of 80% of these
newly diagnosed infections (CDC, 2008c). An estimated 1 in
5 new HIV diagnoses for women are related to injection drug
use (CDC, 2008c).
Worldwide, more than 90 percent of all adolescent and adult
HIV infections have resulted from heterosexual intercourse.
Women are particularly vulnerable to heterosexual transmission
of HIV due to substantial mucosal exposure to seminal fluids.
This biological fact amplifies the risk of HIV transmission
when coupled with the high prevalence of non-consensual sex,
sex without condom use due to some women's inability to negotiate
safer sex practices with their partners, and the unknown and/or
high-risk behaviors of their partners (CDC, 2008c).
The rates of HIV diagnosis and the risk factors for HIV infection
differ for women of various races or ethnicities-a situation
that must be considered when creating prevention programs.
For example, even though the annual estimated rate of HIV
diagnosis for black women decreased significantly-from 82.7
per 100,000 population in 2001 to 60.2 per 100,000 population
in 2005-it remained 20 times the rate for white women. Overall,
the rates of HIV diagnosis are much higher for black and Hispanic
women than for white, Asian and Pacific Islander, or American
Indian and Alaska Native women. The rates for black women
are higher than the rates for all men except for black men
(CDC, 2008c).
Women suffer from the same complications of AIDS that afflict
men but also suffer gender-specific manifestations of HIV
disease, such as recurrent vaginal yeast infections, severe
pelvic inflammatory disease (PID), and an increased risk of
precancerous changes in the cervix including probable increased
rates of cervical cancer. Women also exhibit different characteristics
from men for many of the same complications of antiretroviral
therapy, such as metabolic abnormalities (NIAD, 2006).
Frequently, women with HIV infection have great difficulty
accessing healthcare. According to a recent CDC study of more
than19,500 patients with HIV in 10 US cities, women were slightly
less likely than men to receive prescriptions for the most
effective treatments for HIV infection (CDC, 2008c).
Women may postpone taking medication, or going to their own
medical appointments because of the heavy burden of caring
for children and other family members who may also be HIV-infected.
They often lack social support and face other challenges that
may interfere with their ability to adhere to treatment regimens
(NIAID, 2006). Women (and also men) may fear disclosing their
HIV status to others, out of fear of losing their jobs, housing,
or other forms of discrimination. Single parents with HIV
may feel particularly fearful because of their lack of support.
Many women have problems with lack of transportation, lack
of health insurance, limited education and low income. They
may have child-care problems that prevent them from going
to medical appointments.
Many women who have HIV infection do not consider this to
be their "worst problem". Their symptoms may be mild and manageable
for many years. Meanwhile, they may have more pressing concerns,
such as their income, housing, access to medical care, possible
abusive relationships, and concerns about their children.
People of Color
Populations of minority races/ethnicities are disproportionately
affected by the HIV epidemic (CDC, 2008c). African Americans
make up 12% of the total U.S. population, yet represented
46% of new HIV infections in the United States in 2006 (CDC,
2008e). Of the 1.1 million persons living with HIV infection
in the US, the majority were nonwhite (65.4%), and nearly
half (48.1%) were men who have sex with men (MSM). The HIV
prevalence rates for blacks (1,715.1 per 100,000) and Hispanics
(585.3 per 100,000) were, respectively, 7.6 and 2.6 times
the rate for whites (224.3 per 100,000) (CDC, 2008d).
African Americans and Hispanics specifically
have disproportionately higher rates of AIDS cases in the
US despite the fact that there are no biological reasons for
the disparities. African American and Hispanic women make
up less than 25% of the total US population, but account for
77% of all reported AIDS cases in women. African Americans
make up about 12% of the population, but account for 37% of
all AIDS cases in the US. Hispanics made up 13% of the population
but accounted for 20% of reported AIDS cases.
There is not one single reason that stands out
as to why the disparities exist. One factor is health disparities,
which are linked to socioeconomic conditions. Another factor
is distrust of the healthcare system. Both legacies of the
past and current issues of race mean that many people of color
do not trust "the system" for a variety of reasons. Thus,
even when income is not a barrier, access to early intervention
and treatment may be limited. And HIV may be only one of a
list of problems, which also include adequate housing, food,
employment, etc.
Another factor may be the diversities within
these populations. Diversity is evident in immigrant status,
religion, languages, geographic locations and, again, socioeconomic
conditions. Getting information out in appropriate ways to
these diverse populations is challenging.
There is a significant amount of denial about
HIV risk, which continues to exist in these communities. As
with other groups, there may also be fear and stigmatization
of those who have HIV. Prevention messages must be tailored
and presented in a culturally and linguistically appropriate
manner. The messages must be carried thorough channels that
are appropriate for the individual community. These channels
a\may include religious institutions or through respected
elders in the community. Ironically, it may be these institutions
or elders who, in the past, have contributed to the misinformation
and stigma associated with HIV. Many HIV prevention programs
are recognizing the importance of working with diverse communities.
Input from these communities must be included in planning,
delivering, and evaluating HIV prevention activities.
For blacks in the United States, health disparities
can mean earlier deaths, decreased quality of life, loss of
economic opportunities, and perceptions of injustice. For
society, these disparities translate into less than optimal
productivity, higher health-care costs, and social inequity.
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