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The Complex Knot—Being HIV-Positive, African American, With a Mental Disorder

The HIV epidemic, socioeconomic and cultural factors, and mental disorders have become wrapped into a complex knot for African American individuals and the communities in which they live and work. Many aspects of African American communities have combined to make its members more vulnerable to HIV infection. Since the first cases of HIV infection among African Americans were identified in the early 1980s—primarily in men who have sex with men (MSM) and IDUs—African American communities bore an increasingly disproportionate burden of the epidemic among US racial and ethnic groups.

African Americans’ Vulnerability to the HIV Epidemic

African Americans’ vulnerability to HIV infection—and to mental disorders—arose from a complex set of historical, socioeconomic, and cultural factors: [CDC Heightened response, 2012]

  • Racism and discrimination
  • Poverty
  • Incarceration
  • Denial, particularly regarding MSM and drug use
  • Stigma surrounding HIV-positive status
  • Homophobia
  • Limited access to healthcare

The high incarceration rates among African American men present a further risk for HIV transmission, with HIV incidences among incarcerated persons being 3 times that of the general population. [HIV in prisons] Practices such as tattooing, unsafe sexual activity, and injection drug use among some prisoners all add to the vulnerability of this population, as well as that of their partners after they are released from incarceration.

Hard to Reach Populations

Lack of trust in government institutions, arising from a history of discrimination, makes public health agencies’ efforts to reach out to African Americans more difficult. Combined with misperceptions about gay people, this lack of trust can discourage MSM from becoming accessible to public health messages targeted at them. [CDC Highlights, 2011] Likewise, some people may avoid HIV testing or treatment due to the stigma associated with an HIV diagnosis, fearing rejection by family members, friends, and coworkers.

Because of HIV’s early association with white gay men, today some African Americans may mistakenly believe that HIV is less of a concern for their community. This belief can be reinforced by cultural taboos about openly discussing sexuality, sex outside marriage, drug use, and other private issues. The resulting relatively high proportion of HIV-positive African Americans who are not aware of their status contributes significantly to ongoing risky behaviors and the fact that 44% of new HIV infections are identified in African American communities. [CDC HIV Incidence, Marks 2006]

Another factor contributing to the ongoing HIV epidemic among African Americans is the relatively higher rates of gonorrhea, chlamydia, and syphilis vs other racial groups. [CDC 2010 STI] The presence of certain STDs can increase the probability of HIV transmission.

All of these individual and social circumstances combine to present major challenges to addressing the HIV epidemic among African Americans.

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Howard University College of Medicine AIDS Education and Training Center - National Multicultural Center