The Phenomenon of the Growing Epidemic of HIV/AIDS Among

African American Females

Kimberly MurrayFebruary 22, 2007

Physician Assistant Masters ProjectAdvisor: Prof. David Fahringer, MSPH, PA-C

Introduction

• HIV/AIDS epidemic– Affects all people regardless of age, religion, sexual

orientation, socioeconomic status, race/ethnicity– Originally believed to be a virus of “gay white men”– African Americans, particularly African American females,

are the fastest ethnic population for HIV diagnoses– Why are African American women, in particular,

contracting and being diagnosed at higher rates than any other ethnic group?

• How can Physician Assistants (PAs) take an active role in the HIV/AIDS epidemic?

HIV/AIDS• HIV (Human Immunodeficiency Virus)

– Targets cells of the immune system, mainly CD4+ T-cells • Without these cells, patients are unable to fight off infections• Patients who are sick are mostly ill due to other illnesses and not the HIV virus itself

– Frequent monitoring of CD4+ T cells is required• Once the T-cell count is consistently below the 200 cells/μl level (along with S/Sx)

the patient is said to have AIDS

• AIDS (Acquired Immune Deficiency Syndrome)– The most severe manifestation of HIV– Further weakening of the immune system causing more illnesses

• Symptoms of AIDS is primarily the result of not having an healthy immune system

– With antiretroviral therapy, survival time is 5+ years– Without therapy, survival time is <1 year

• NO CURE!!

Epidemiology

• At the end of 2003, ~1,039,000-1,185,000 were living with HIV/AIDS in the U. S. (~24-27% were unaware and undiagnosed with the virus) (CDC, 2006)

• 40.3 million people live with HIV/AIDS worldwide (Harrington & Spach, 2006)

• Of the ~300,000,000 people in the United States, African Americans only make up ~12% (U. S. Census Bureau)

• African Americans make up about half of HIV diagnoses in the U. S.

• ~69% of the HIV diagnoses among African Americans are women

Race/ethnicity of persons (including children) living with HIV/AIDS, 2004

Source: CDC, 2006

Reasons for the Epidemic Among the African American Female Population (Review of Literature)

• Incarceration of African American Men– Black men are twice as likely to be imprisoned over Hispanics; five times more likely than white men – MSM and IV drug use– HIV + men return to society, engage in sexual acts, transmit the virus (Goosby, 2004)

• African American Culture– Taboo to be a gay black male; therefore, homosexual men lead heterosexual lifestyles but continue to

have sexual encounters with other males (“Down-Low”)– Promiscuity is accepted and encouraged among the black males

• Black males are more likely to engage in risky sexual behaviors (i.e. multiple sex partners, have their first sexual encounter at an early age), which increases the chances of contracting and/or transmitting HIV at phenomenal rates (Clarke-Tasker et al., 2005)

• Lack of perception of risk (i.e. due to being in a monogamous relationship)– HIV transmission is becoming more popular amongst heterosexual acts (Simmons et al., 2005)

• Substance Abuse

Reasons for the Epidemic Among the African American Female Population (Review of Literature)

• Adolescent and adult women who were diagnosed with HIV from 1999 to 2004 were investigated in seven areas of the U. S.– At the end of the study, HIV diagnoses over the 5 year span remained

consistently higher for Hispanic woman but especially higher among African American women; the rates for Hispanic women and black women were 5 and 21 times, respectively, the rate for white women.

– Minority women with HIV in the southern area of the U. S. had higher rates than any other area, possibly due to women having heterosexual contact with men on the “down-low” (McDavid et. al., 2004)

What can PAs do if…?

• Encourage the use of contraceptives (i.e. male condom, female condom)– Do not only inform the patient but demonstrate its application in order for proper

protection– African American women were unaware of the female condom and its added protection

during sexual intercourse; therefore they relied on the male condom as their means of protection (Brown & Wimberly, 2005)

• Encourage patients to become interested in knowing their HIV status by being tested at least once and more frequently if involved in risky behaviors

– “Only ~27% of African American patients were tested for HIV because of their own curiosity…talking with your patients is a must to decrease detection of unknown HIV infections and to reduce AIDS” (Simmons et al., 2005)

• Do not be judgmental of patients because of their lifestyle– It is our job to put the patient’s medical needs first

THE PATIENT IS NOT HIV POSITIVE

What can PAs do if…?

• Try to establish an open-communication relationship between you and your patient

– Allows the patient to adhere to suggestions, treatment, and prevention measures to reduce transmission

– Having a “patient-centered” patient-provider relationship is associated with HIV + patients agreeing to receive antiretroviral therapy and more importantly, adhering to it (Beach et al., 2006)

• Continue educating the patient about the virus

• Encourage the patient to remain aware of their status (i.e. remind them that they are able to still transmit the virus)

• Relay to the patient the importance of continuing good health habits (diet, exercise, continuing their meds) to strengthen their immune system

• Again, do not be judgmental

THE PATIENT IS HIV POSITIVE

Conclusion

• “It is not an exaggeration to say that HIV/AIDS is an epidemic in the African American community.” (Goosby, 2004)– African American females remain to be the hardest-hit racial/ethnic

group

• By incorporating the ABC’s into practice, PAs can take an active role in not only decreasing the HIV/AIDS epidemic in the black community but in all populations– Abstinence: the 100% way to not become infected with the virus

– Be faithful: no matter if it is in a homosexual or heterosexual relationship

– Condom: encourage the use, male or female or both

Questions?

References

AVERT. Avert.org-bringing you information on HIV & AIDS. 2006. Available at: http://www.avert.org. Accessed September 10, 2006.

Beach MC, Keruly J, Moore RD. Is the quality of the patient-provider relationship associated with better adherence and health outcomes for patients with HIV? J Gen Intern Med. 2006; 21: 661-665.

Brown S, Wimberly Y. Reducing HIV/AIDS transmission among African-American females: is the female condom a solution? J Natl Med Assoc. 2005; 97:1421-3.

Clarke-Tasker VA, Wutoh AK, Mohammed T. HIV risk behaviors in African American Males. ABNF J. 2005; 16:56-9.

De Cock KM, Weiss HA. The global epidemiology of HIV/AIDS. Trop Med Int Health. 2000; 5:A3-9.

Department of Human Health Services, Centers for Disease Control (CDC) and Prevention. HIV/AIDS. 2006. Available at: http://www.cdc.gov/hiv/. Accessed September 7, 2006.

Goosby E. Living with HIV/AIDS: the black person’s guide to survival. Roscoe: Hilton; 2004.

Hanson S. Is HIV control in sub-Saharan Africa losing focus?: the need for simplified, prioritized prevention strategies. Scand J Public Health. 2005; 33:233-5.

Harrington RD, Spach DH. HIV and AIDS, in ACP Medicine (Dale et al., eds.) 2006, WebMD.

References

LaVeist TA, Carroll T. Race of physician and satisfaction with care among African-American patients. J Natl Med Assoc. 2002; 94: 937-42.

McDavid K, Li J, Lee LM. Racial and ethnic disparities in HIV diagnoses for women in the United States. J Acquir Immune Defic Syndr. 2006; 42:101-7.

Oprah.com: Live Your Best Life. 2006. Available at: http://www2.oprah.com/index.jhtml. Accessed December 1, 2006.Simmons EM, Rogers ML, Frierson GM, Beckwith CG, Flanigan TP. Racial/ethnic attitudes towards HIV testing in the primary

care setting. J Natl Med Assoc. 2005; 97:46-52.

USCF Center for HIV Information, HIV Insite. 2007. Available at: http://hivinsite.ucsf.edu/. Accessed October 13, 2006.

Wikipedia: The Free Encyclopediaa. HIV. 2001. Available at: http://en.wikipedia.org/wiki/HIV#Epidemiology. Accessed November 25, 2006.

Wikipedia: The Free Encyclopediab. Down-low. 2001. Available at: http://en.wikipedia.org/wiki/Down_low. Accessed November 8, 2006.

Wikipedia: The Free Encyclopediac. Condom. 2001. Available at: http://en.wikipedia.org/wiki/Condom. Accessed December 1, 2006.