Why do HIV/AIDS rates remain stubbornly high in some populations -- and what can be done to help?
Robert Fullilove regularly makes a long commute from his job as associate dean for community and minority affairs at Columbia University to a prison in upstate New York, where he teaches college courses to inmates. When released, many of the men make the same journey as Fullilove, returning to their old New York neighborhoods, often serving as a link in the spread of HIV/AIDS among both this male population and, increasingly, the women in their communities back home.
“The traffic back-and-forth from prisons to communities is why New York City is the epicenter of HIV/AIDS,” Fullilove says. “When the ratio of women to men exceeds 2-to-1, you see a change in relations over things like the use of a condom.”
African Americans and Latinos have higher rates of HIV/AIDS than the general populations, and those disparities also extend to specific populations like prison inmates, the homeless and men who have sex with men. For example, black women contract AIDS at a rate 15 times higher than white women, and African Americans comprise about two-thirds of the new HIV infections among women and 73 percent among teenagers.
On November 16, SSA’s STI/HIV Intervention Network (SHINE) held a symposium, “Social and Structural Determinants of HIV Infections Among Minority Populations,” to examine why these disparities exist and what can be done to change these trajectories.
“In order to reduce the disproportionate rates of HIV infections among communities of color, it is critical to understand how social and structural factors drive the various epidemics among subpopulations,” says SSA Associate Professor Dexter Voisin, the principal investigator of the SHINE network and the conference conveyor. Voisin founded SHINE, along with co-principal investigator Alida Bouris, an assistant professor at SSA. “For too long we have taken an individual approach to HIV prevention and intervention, and eradicating new infections calls for bold structural initiatives.”
Like Fullilove, many of the speakers at the interdisciplinary conference talked about the circumstances that lead to the spread of HIV/AIDS among minority groups. Matthew Epperson, assistant professor at SSA, noted that common risk factors for African-American women with criminal justice involvement include fear of intimate partner violence, drug use and financial dependency. “They have a fear of demonstrating a lack of trust in their sexual partners," he said, and "carrying condoms is perceived as not 'lady-like.'"
Although HIV/AIDS is no longer stereotyped as a “gay” disease, men who have sex with other men remain the population most at-risk to contract the disease. This is especially true for black men, who comprise about as many new infections as white men despite being only 12 percent of the overall population, said Stuart Michaels, senior research scientist at NORC at the University of Chicago. The “good news,” he added, is that survey data show people find it easier to talk about sex and sexual identity now than in the past,making frank conversations about HIV/AIDS more likely.
The conference included ideas for how to change the dire statistics, as well. To combat both recidivism and the spread of HIV/AIDS, Fullilove, who delivered the keynote speech, recommended reorienting parole officers to act as case workers, enlisting black churches to provide HIV-related counseling, and enlisting returning prisoners to warn teens about the consequences of acting “like a knucklehead.”
Geri Donenberg, a psychiatry professor at the University of Illinois at Chicago, talked about how UIC’s Informed Motivated Aware and Responsive About AIDS (IMARA) program has brought together African-American teen girls and their mothers for prevention-oriented services grounded in ethnic and gender pride.
And Kischa Hampton, director of preventative and behavioral health for Access Community Health Network, presented information about Sisters Informing Sisters on Topics About AIDS (SISTA), an intervention that provides empowerment-oriented group sessions to “women from high-risk communities who are trying to make a change in their lives.” Over the last six years, ACCESS has enrolled more than 750 participants in the program.
As many as 60 percent of people with HIV report some level of homelessness, said Dave Thomas, the supportive housing programs manager at the AIDS Foundation of Chicago. Death rates from HIV for those experiencing homelessness are five to seven times higher than the general population of those who have the disease, he added, while self-reports show that medication adherence for those experiencing homelessness is significantly lower. For this population, providing safe, affordable housing opens up the possibility of in-home case management. Interventions like these hold out the hope that one day, no group will be more likely than any other to be stricken with HIV/AIDS. — Ed Finkel