2. Triple Whammy—HIV, Mental Disorders, African Americans
Summary
Both personal and familial factors can be barriers to African Americans’ receiving treatment for both HIV disease and mental disorders, including:
- Cultural reluctance to acknowledge the existence of these concerns
- Lack of accurate understanding of symptoms that require professional attention
- Preference for relying on family and religious institutions for support
- Stigmas attached to behaviors associated with HIV and mental disorders
- More reluctance among African Americans vs whites about seeking mental health treatment
- Use of nonstandard terms to describe mental health problems (ie, different cultural idioms for expressing emotional distress)
- Limited number of African American providers of mental healthcare services
- Availability of transportation to reach either HIV or mental health services treatment facilities
- Greater proportion of families with incomes below the federal poverty line and with little or no health insurance coverage
Primary care practitioners need to become more skilled in identifying African American patients who are experiencing serious mental health problems so that appropriate treatment can be provided. Mental healthcare professionals should receive training regarding ethnic differences in idioms of distress and techniques for overcoming patients’ feelings of mistrust. Moreover, multicultural organizations can help facilitate communication between mental healthcare providers and patients and help design appropriate services.
Many existing treatments for HIV and mental health issues need to be expanded and more fully developed to better address African Americans’ needs. In addition, providers of mental healthcare services need to consider use of nonstandard approaches to more specifically address African Americans’ needs. For example, because of the significant place of spirituality in many African Americans’ lives, religious organizations often provide support for individuals dealing with mental health issues. For many African Americans, spiritual and psychotherapeutic perspectives can reinforce each other. In addition, innovative types of music therapy can draw on African American cultural backgrounds and promote positive feelings that can provide further therapeutic support in treating emotional problems.
