2. Triple Whammy—HIV, Mental Disorders, African Americans
Barriers to Obtaining Appropriate Diagnosis and Care
Several personal and familial factors often present barriers to African Americans’ obtaining diagnosis and treatment for both HIV disease and mental disorders. As Modules 2 and 3 in the present curriculum discussed, these can include:
- Cultural reluctance to acknowledge the existence of these concerns
- Lack of accurate understanding of symptoms that require professional attention
- Preference for reliance on family and
religious institutions when support is needed - Stigmas attached to behaviors associated with HIV and mental disorders
The discussion of the barriers to accessing healthcare services in the following paragraphs is not meant to be comprehensive but only to suggest the complexity of factors through which African Americans must navigate to seek care for either HIV disease or mental health issues. The references cited throughout this curriculum provide much more thorough discussion of these issues.
Cultural Barriers
The Supplement to the Surgeon General’s report on mental health cites 2 examples of the barriers to appropriate care that can arise from personal and familial factors among African Americans: [Surgeon General Supplement, 2001]
- One study found that the proportion of African Americans who feared mental health treatment was 2.5 times greater than the proportion of whites with the same fear.
- Another study of parents of children who met the criteria for attention deficit/hyperactivity disorder (ADHD) reported that African American parents were less likely than white parents to use specific medical terms in describing their child’s difficulties and more likely to expect a shorter treatment course.
Structural Barriers
A host of studies has examined the structural barriers that limit African Americans’ access to appropriate diagnosis and care for HIV infection and mental disorders. Frequently, these barriers are provider-related and include:
- Lack of awareness of African American cultural idioms for expressing emotional distress. For example, somatization—the manifestation of mental health issues as physical symptoms—occurs at a rate of 15% among African Americans vs 9% among whites.[NAMI African American]
- Limited number of African American providers of mental healthcare services—particularly important for individuals who prefer a provider from their own community
- Availability of transportation, whether private or public, to reach facilities providing either specialized HIV or mental health services
Financial Barriers
Financial issues represent another strand in the thread of the complex knot faced by African Americans living with HIV disease and mental disorder. Healthcare services for both management of either HIV disease or mental disorders can be costly and typically are ongoing expenses.
Approximately twice as many African American families as white families have incomes below the federally defined poverty line. [Census Income] Inadequate or no health insurance coverage acts as another finance-related barrier to HIV and mental healthcare services. The percentage of African Americans who are uninsured is approximately 1.5 times that of whites. [Surgeon General Supplement, 2001]
