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HIV Care and Culture: Making the Connection

The U.S. population was once viewed as a melting pot in which different cultures blended to form a more homogenous national identity. Today, describing our collective national identity as a quilt might be a better metaphor. Although there is a sense of an American identity, different segments of our society are increasingly recognized for the unique strengths they contribute to the whole. The diversity of American cultural perspectives adds richness to our daily experience. In almost every arena, culture influences our behavior and the choices we make.

Public health experts now recognize that cultural groups face disparities in availability of health care and access to health education. As a result, health care providers have become increasingly aware of the need to consider culture in the context of their work with patients and their families. Thus, cultural competence has become an important area of skill building for health care providers, and some believe it is an ethical imperative. 12

It is important to note here that racial and ethnic minority youth often face limitations in their access to adequate health care. The guidelines and recommendations listed in this section are intended to enhance and support cultural competence among providers serving HIV-infected youth.

"Minority" patients are a growing share of the population of people living with HIV.
  • Among adolescents 13 to 19 years of age, the proportion of AIDS cases is: 3
    • 70% African American
    • 15% White, not Hispanic
    • 13% Hispanic
    • <2% Asian American/Pacific Islander (AA/PI) and American Indian/Alaska Native (AI/AN)
    • Over 60% of cases among males involved male-to-male sexual contact as the likely transmission category in this age cohort, increasing to over 70% percent for young adults between ages 20 and 24.

Although more recent national data provide only limited adolescent-specific transmission information, we do know that transmission among adult populations varies significantly on the basis of race and ethnicity. Providers must take the time to educate themselves about the HIV/AIDS epidemic in their local community, and to understand the impact of the epidemic on their client population in the context of demographic variations in transmission, as well as substance abuse trends and other locally available information.

The pervasive myth of HIV in the United States as a White, homosexual disease continues to put minority populations at risk.
  • During 2001-2004, in nearly every demographic and transmission category, the largest percentages of HIV/AIDS cases diagnosed were among Blacks/African Americans. Disparities were observed in all demographic and transmission categories; however, the disparity was especially pronounced among Black/African American women, children, and persons with high-risk heterosexual contact.4 Blacks/African Americans continue to represent the greater proportion of youth living with HIV. However, rates of HIV infection are growing among other minority groups. In fact, increases in the annual percent change of HIV diagnosis rates from 2001 to 2004 were greatest among AA/PI women (14.3%) and men (8.1%)."

References

  1. Ridley CR. Imperatives for ethnic and cultural relevance in psychology training programs. Prof Psychol Res Pr. 1985;16(5):611-622.
  2. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Smedley BD, Stith AY, Nelson AR, eds. Washington: National Academies Press; 2003.
  3. Centers for Disease Control and Prevention. HIV/AIDS Surveillance in Adolescents and Young Adults (through 2004).
  4. Centers for Disease Control and Prevention. Racial/ethnic disparities in diagnoses of HIV/AIDS--33 states, 2001-2004. MMWR Morb Mortal Wkly Rep. 2006 Feb 10;55(5):121-5.