AIDS in Minority Communities : Barriers to Treatment

by Food and Drug Administration (FDA)

(Page 2 of 3)

Some experts point to the "at-risk" factor as another reason why HIV has spread rampantly, a factor that knows no community boundaries. "I think the primary reason why people don't use protective measures — from abstinence to condoms — is that they don't see themselves at risk," says Owen McMaster, Ph.D., pharmacology toxicology reviewer, Center for Drug Evaluation and Research, FDA. "They think they know their sexual partner, or believe that this happens only to gay men who are not in a mutually monogamous relationship, or they think that there is no way that this beautiful, healthy-looking man or woman could have HIV."

Even understanding risk factors does not prevent risky behavior among some minorities, points out Rafael Chang, prevention education director, The Living Well Project, San Francisco. In a recent study of 260 gay Asian Pacific Islander men, he says, the researchers found that many people do understand the risk. "But they are not incorporating a sense of worthiness and self esteem," he says, since they feel they do not meet the American standard of beauty. As a result, he says, these men take great risks by not practicing safer sex if their partner does meet that standard of beauty.

Barriers to Treatment

For minorities, discrimination, poverty, and inadequate health care and education are barriers to meaningful prevention messages and to treatment. And often, so are traditional beliefs.

Homophobia and the belief that AIDS is a gay, white man's disease have helped both to spread and to hide the disease. First, many minorities believe that the epidemic can't affect them or those in other communities of color, says Cherylene Showell, executive director of IMPACT (Intergroup Minority Project, AIDS Consortium and Trust) of D.C. in Washington, so they ignore its threat. Second, when HIV strikes and is associated with homosexuality, people deny its presence. This is true in some African American communities, she says, where families often hide and treat infected relatives as long as possible so outsiders cannot suspect the presence of homosexuality.

And it is true in many Asian American communities, adds Fox, where AIDS still often remains undiscussed and hidden and where many recent immigrants believe that homosexuality brings shame on the family. Among other immigrant populations, when men have sex with men, they do not consider themselves gay, she says — and if the men become infected, it's a real stigma.

"In most public health practices, once you know that there is something dangerous, you let the community know," says Showell. "And they can take whatever measures they need to protect themselves. But with HIV, people don't treat it like the flu, because it is tied to all these 'isms' [prejudices]." Instead, HIV becomes invisible with devastating results: no awareness of HIV, increased infection rates, limited medical treatment, and the spread of the epidemic. "It's really rather simple," she says. "I have seen this played out over and over again."

Other traditions provide roadblocks to medical care, too. In the Hispanic population, for example, the community's language isolation and culture may be part of the problem, according to Martinez. "Many Hispanics live in their own communities and remain connected to each other, but isolated from the mainstream," she says. "Even at school, there might be an HIV curriculum, but it is not taught in Spanish, so Hispanic children who speak only Spanish often never receive any HIV-prevention messages."

Add to that the Hispanic view of life, their fatalism, she says. "It is very common among Hispanics to feel that people are born with their own cross to bear, and for some, having AIDS, or a son or sister with AIDS, is the cross."

Among African Americans, the epidemic has provided a greater sense of discrimination. "There is a denial [among African Americans] about the origins of the disease," says Darlene Washington, African American HIV/AIDS coordinator, Office of HIV/AIDS Education, the American Red Cross. "The disease was associated with Africa, and immediately, people said, `I won't believe this. They are always blaming us for bad things. Why is Africa a deep, dark place of teeming germs?'"

But there is another level of denial, says Washington. The social, sexual and drug implications of HIV at first caused some African American faith communities to shy away from the issue, and as a result its members shied away, too. However, says McMaster, many African American congregations now do have HIV programs and are involved in HIV ministries.

In addition, Washington and others believe that for African Americans, the notorious 1970s Tuskeegee study, in which black men infected with syphilis were studied but not treated, stirred a fear of mainstream medicine. McMaster says this history seems to lead some African Americans to believe that AIDS was created by scientists to get rid of black people. "They think, 'If you made the disease to make me sick, why should I trust you to cure me?'" he says. This distrust keeps people from getting early treatment, from participating in clinical trials, and from using experimental drugs.

Finally, some minorities still prefer traditional medicines — such as herbs, massage, vitamins, and acupuncture — over Western medicines due to uncertainty about side effects of some drugs, says Chang. "In the Asian population, for example," he says, "there is a high rate of allergic reactions to sulfa drugs. ... So if you have a community with a high incidence of moderate-to-severe reactions, word gets out quickly, and there is an unwillingness to participate in Western interventions."

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