AIDS in Minority Communities

by Food and Drug Administration (FDA)

Although the spread of HIV seems to be relentless worldwide, and the virus that causes AIDS now affects men, women and children of every age and ethnic group, concern has been expressed that in this country, certain groups may not be receiving adequate health care due to cultural barriers.

Figures released from the national Centers for Disease Control and Prevention in Atlanta show that as of Dec. 31, 1994, there have been a total of 441,528 reported cases of AIDS in the United States since the epidemic began, and about 1 million people are infected with the virus. Although the number of new cases reported in 1994 (80,691) shows a decline from 1993 (106,618), when CDC expanded the AIDS surveillance case definition to include conditions — that is, opportunistic infections — that happen earlier in the disease, they are higher than in 1992 (47,572).

Now, rapid increases in HIV infection are showing up among minorities, specifically in the African American and the Hispanic communities. As CDC's HIV/AIDS Surveillance Report of December 1994 states, "Among reported cases, 1994 was the first year when blacks and Hispanics together accounted for the majority (53 percent) of all cases reported among men."

Data from the Centers for Disease Control and Prevention indicate that in 1990, European Americans accounted for about 52 percent of AIDS cases while African Americans made up about 30 percent and Hispanics about 17 percent. By 1994, the proportion of African American and European American cases had become nearly equal: Europeans Americans made up about 41 percent of AIDS cases and African Americans about 39 percent. The Hispanic proportion rose to about 19 percent. (The chart on the right can be selected as a 128K JPEG file.)

Infection rates are growing among the two other minority communities as well — the Asian American/Pacific Islander and the Native American (American Indian/Alaska Native) communities. According to CDC, of the total reported new cases (including men, women and children) of AIDS in 1994, 33,193 were among European Americans (not Hispanic); 31,487 among African Americans; 15,066 among Hispanics; 577 among Asian Americans/Pacific Islanders; and 227 among American Indian/Alaska Natives.

Minority groups, or "communities of color," have been, for reporting purposes, classified into these four categories by the National Commission on AIDS. According to the 1992 study, "The Challenge of HIV/AIDS in Communities of Color" by the now disbanded commission, members of each community share some physical characteristics or ancestry. In addition, the study says, they also share the unfortunate position of being society's underdogs, facing, historically, "broad, sustained" racial discrimination. Other experts point out that those who live in poverty of any ethnic background, including European American, face the same kinds of problems accessing health care as do those classified as racial or ethnic minorities.

HIV's Spread Among Minorities

Even from the beginning of the epidemic, minorities were affected by the virus, says the commission's study. In fact, says Helen Fox, senior policy analyst, National Minority AIDS Council, Washington, D.C., there has always been a higher incidence of HIV infection in communities of color than early statistics indicated, because people used to assume that AIDS was a gay white man's disease only and did not look for it elsewhere. "There was no understanding of the disease or of the relationship of injecting drugs and the transmission of the virus," she says.

"Race and ethnicity are not risk factors," says Paul Denning, M.D., epidemiologist in CDC's AIDS Surveillance Branch. "But they are markers for other factors that put people at increased risk, like lack of health insurance and limited access to care."

Indeed, say Brenda Lee and Lyvon Covington, public health specialists in the Food and Drug Administration's Office of AIDS and Special Health Issues, a number of common factors, many economic ones, affecting many minority groups contribute to the increase in AIDS: lack of medical insurance, which results in a lack of access to health care; a higher incidence of diseases or maladies in general; fear of medical care, particularly among illegal aliens; limited or no means of transportation to get to a health clinic; and for some, particularly in rural areas, too few doctors. And even when doctors are available, having Medicaid does not ensure adequate care, says Denning. "You may have Medicaid," he says, "but many practitioners won't accept it."

Without routine medical care or testing, many people never suspect they are infected with the virus, says Fox. "There is such a long incubation period, and so many people feel pretty good," she says. "It is not until they come down with some kind of infection or [for women] a yeast infection that doesn't go away that they suspect something. Also people may be sick, but without access to health care, they won't do anything about it until they are very ill. Taking care of kids, housing and work — these basic needs are more important than worrying about HIV."

In addition, for many women, condom use can be a major domestic issue. Hispanic women, for example, often lack empowerment in sexual relationships, says Ledia Martinez, Hispanic HIV/AIDS coordinator, Office of HIV/AIDS Education, American Red Cross. "Women may not be able to speak with their partners about condom use. ... Such conversations are often interpreted as a sign that the female thinks the male is unfaithful. So even if you are unsure of your man, but he is putting food on the table, you risk losing him by pushing the condom-use issue. You put that aside because it is more important that the kids have a roof and that you are alive on a day-to-day basis." Besides, she notes, most Hispanics are Roman Catholics, and the position of the Catholic church, which opposes the use of condoms and other forms of contraception, is another barrier against condom use.

And, Denning points out, many minorities live in the inner city or urban areas, the foci of the epidemic. "Because the virus is very prevalent in these communities, the chances or odds that a person's sexual partner may be infected with HIV are increased," he says. "Also, one must consider the fact that injection drug use and other substance abuse, which are concentrated in disadvantaged, urban areas, have played a major role in the spread of HIV. Injection drug use serves as a direct mode of HIV transmission, while other substance abuse, like crack cocaine use, may contribute to high-risk sexual behavior."

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