HIV health crisis and African Americans: a cultural perspective.

Abstract: While incidence of new HIV infections have decreased in the overall population, the numbers continue to rise in African-Americans creating a serious health emergency. Studies seem to imply that part of the rise is due to HIV beliefs and high risk behaviors among African Americans. Due to certain societal factors, African Americans appear to be at greater risk for contracting the virus. This article will examine these critical social factors and their impact on this current state of emergency in the African American community using Leininger's theory of Culture Care and Universality. Implications for health providers are also addressed. Key words: HIV, African Americans, Cultural Beliefs, Fatalism Human Immunodeficiency Virus (HIV), the virus that causes AIDS, has created a health crisis for African-Americans. Baker (1999) reports that the Congressional Black Caucus (CBC) declared HIV as a public health emergency in the African-American community. According to the US Census Bureau (1999), AfricanAmericans make up 12.7 percent of the total population (6% male and 6.7% female), but they make up a significantly higher percentage of new HIV infections and diagnosed AIDS cases. To date, African-Americans are a staggering 54% of all diagnosed AIDS cases (Centers for Disease Control and Prevention [CDC], 1999a). Approximately 40% of all new HIV infections are among AfricanAmericans (CDC, 1999a). Between the ages of 25-44, AIDS is the number one killer of African-Americans (CDC, 1999a). For pediatric cases, 63% of all cases are among African-Americans. Although race/ethnicity have not been identified risk factors for HIV/AIDS, African-Americans are disproportionately affected by HIV and associated complications. Studies seem to imply that African Americans are less likely to participate in clinical trials, less compliant with treatment regimen, and more likely to engage in high risk behavior (Peterson, Coats, Catania, Middleton, Hillard, & Hearst, 1992; El-Bassel & White, 1998; CDC, 1999a). These behaviors have significant implications for African Americans including the development of resistant HIV. The development of a resistant strain could potentially render this epidemic untreatable in African Americans. Although studies have demonstrated risky behavior in African Americans, few have attempted to understand underlying factors. The authors of this article will attempt to examine some potential factors contributing to the HIV crisis in the African American community. An understanding of the social structural factors imposed upon African- Americans and how these factors influence beliefs, perceptions, and behavior might answer this question. Using a solid cultural theoretical framework that examines societal influence on the development of cultural norms is the first step to understanding the epidemic in African Americans. Additionally, understanding these influences can better assist with the development of effective primary and secondary prevention interventions by focusing on these societal factors. Early in the epidemic, behavioral modifications focusing on critical societal factors have demonstrated effective in the perceived at risk group (gay white men). Current reports show a decrease in new infections among gay white men (CDC, 1999a). CULTURE AND HIV: A THEORETICAL PERSPECTIVE Illness has been defined as a relationship between culture and biology (Airhihenbuwa, 1995; Morris, 1998). Based on this definition, how individuals perceive health and illness will ultimately affect health behavior. In order to understand illness, an understanding of cultural and biological factors are needed. Culture is learned and shared beliefs, values, and lifeways of a designated group that is transmitted from generation to generation (Leininger, 1995). Therefore, essential social factors known to effect cultural beliefs, perceptions, and behavior must be analyzed. Leininger's Culture Care Diversity and Universality (Leininger, 1988, 1991a, 1991b,1995, 1998) provides a good framework for understanding critical social factors and their impact on health beliefs and practices. …