2. Triple Whammy—HIV, Mental Disorders, African Americans
HIV, Vulnerable Populations, and African Americans
For a concise review of the HIV epidemic among African Americans, please see the Introduction to the present curriculum, and for a more detailed discussion, please see Module 1 of the curriculum, “Promoting HIV Testing in Diverse Populations.”
Untangling the complex knot formed by being an HIV-positive African American with a mental disorder will involve dealing with an array of cultural and economic challenges. African Americans experience shortages in financial and healthcare resources that is neded to untangle the knot.
One of the most fundamental challenges is to understand which groups among the African American population are the most vulnerable both to acquiring HIV infection and to difficulties in accessing the medical and mental healthcare services needed to manage the condition. The groups include:
- Men who have sex with men (MSM)
- Injection drug users (IDUs)
- Women
- Young people
- People with mental disorders
Cultural Taboos
To meet these challenges will further require acknowledging and then dealing with a set of cultural taboos that continue to affect many African American communities. These cultural taboos interfere with communities’ ability to effectively educate and treat members of groups that are most vulnerable to HIV disease and members of their support systems (e.g., family, friends, neighbors). These cultural taboos include issues that are directly related to the groups that are most vulnerable to HIV infection:
- Homosexuality and a range of issues related to gay “lifestyles”
- Sexual concerns in general
- Injection drug use
- Mental illness
- Healthcare professionals, particular those who provide mental healthcare services
A willingness to discuss issues surrounding being gay or MSM, intravenous drug use, and living with HIV are relatively common discussions in many mainstream US communities, but in many African American neighborhoods and communities, such subjects continue to be avoided or discussed only reluctantly.
Several other urban legends or misconceptions also inhibit productive discussions about and strategies to approach the HIV epidemic in African American communities. For example, the belief that women cannot transmit HIV infection to men, when in fact, vaginal fluids and menstrual blood are potential sources of HIV infection.
- HIV treatments currently available in the United States are simple to take and effective, meaning that HIV disease is now a chronic, manageable condition that is no longer the concern that it once was. In fact, approximately 20% of HIV-infected persons are not aware of their status and therefore continue to be potential sources of ongoing HIV transmission.
- Only people who are sexually promiscuous or use intravenous drugs are at risk for becoming HIV-infected. In reality, unprotected sexual activity brings a risk of HIV infection for anyone, and the number of sexual partners that a person has is not a determining factor in an individual’s vulnerability to HIV infection. Similarly, anyone who shares drug-injection needles, or “works,” is also vulnerable to HIV transmission.
