HIV/AIDS Affect on the African American Community
Nicole Donald
Capella University

HIV/AIDS Affect on the African American Community HIV/AIDS is prevalent in the African American community. African Americans are among the highest risk group for contracting HIV/AIDS. HIV/AIDS has been an issue in the African-American community for a number of years. This learner will provide a general overview on the ethnic population under study but will have a particular focus on black heterosexual men for the purpose contributing to the much lacking knowledge base on this particular population subset.
Problem Statement The topic of HIV/AIDS is relevant to mental health counseling because this disease can have a devastating effect on the psyche of any human being suffering with this illness. Many minority teens and adults have a passive attitude when it comes to HIV/AIDS, and when confronted with the issue, they need to have access to the proper channels for information and support. Over 33 million people worldwide are living with HIV infection, and approximately 56,000 new HIV infections are reported every year in the United States alone (Kamen, et al., 2012). Black heterosexual men (BHM) are seldom mentioned in HIV prevention research, policy, and interventions, despite evidence that heterosexual contact is becoming the leading exposure category for BHM (Bowleg & Raj, 2012). It is important to identify the risk factors and treatments available for African Americans with HIV/AIDS.
HIV Prevention Research Black heterosexual men (BHM) are not usually discussed in HIV prevention research, policy, and interventions, despite the fact that heterosexual contact is the leading exposure category for BHM. This is the main reason for the study. The effect of HIV/AIDS on BHM include the "down low" myth, BHM's lives in terms of poverty, unemployment, and incarceration, and a growing empirical base linking these factors to increased HIV risk, underscore the need to prioritize HIV risk and prevention initiatives for BHM (Bowleg & Raj, 2012). HIV risk for BHM and four community-based approaches to address HIV risk and prevention for BHM include: (1) men's health programs; (2) workforce and post-incarceration release programs; (3) linkages to women's prevention programs; and (4) faith-based initiatives. With this study’s particular interest in the BHM subset, the findings raised in this study will largely inform variable identification and framework analysis of my own in my bid to further research on the BHM subset (Bowleg & Raj, 2012).
Intersectionality
This micro study looks at research implications on the study of the HIV-BHM subset. This qualitative phase of the HIV prevention study focused on Black heterosexual men, used intersectionality as a theoretical framework to explore: (1) How a sample of Black heterosexual men describe and experience the multiple intersections of race, gender, and SES; and (2) How these descriptions reflected interlocking systems of social inequality for Black men at the social-structural level (Bowleg, et al., 2013). Participants were 30 predominantly low-income self-identified Black heterosexual men between the ages of 18 and 44. Analysis highlighted four themes that demonstrate how participants' individual-level experiences as Black men reflect macro social-structural inequality: (1) racial discrimination and micro aggressions; (2) unemployment; (3) incarceration; and (4) police surveillance and harassment. The authors discuss the study's findings within the context of social-structural factors that disproportionately and adversely impact Black men. Implications of the inter-sectionality perspective for HIV prevention research and interventions for the BHM subset is of relevance to my study as it provides an additional depth of knowledge essential in understanding the challenges of study of the subset (Bowleg, et al., 2013).
Sexuality and Prevention among Adolescents There have been few studies on sexuality, relationships, and HIV prevention issues among HIV+ adolescents and fewer still that have dealt with youth living with HIV/AIDS since birth. In this qualitative study, the authors conducted individual, semi-structured, taped interviews on these topics with 29 youth prenatally infected with HIV. The 15 girls and 14 boys, 10-18 years of age, have been followed at the Centre Maternel et Infantile sur le SIDA (CMIS), Centre Hospitalier Universitaire Sainte-Justine in Montreal (Fernet, et al., 2007). Content analysis of the interview transcripts revealed two dimensions related to HIV prevention. From a rational perspective, the youth were generally knowledgeable about modes of HIV transmission and modes of prevention, including consistent condom use. From an affective perspective, they were clear about their responsibility to protect their current or future partners but fearful that efforts to do so might disclose their HIV status with subsequent threat of rejection, stigmatization and compromised relationships. The concealment strategies they adopted to address the tensions inherent in this situation are discussed in terms of their own psychosexual development and of interventions by parents, caregivers and professionals to foster healthy and satisfying sexuality for HIV+ youth and their partners. The relevance of this study is that with its focus on the adolescents living with HIV/AIDS since birth, it adds a dimension for consideration in the study of the subset and of the population in general (Fernet, et al., 2007).
Quality of Life The purpose of this study was to examine the influence of denial coping on quality of life (QOL) over time among individuals living with HIV, as denial has been understudied as a coping strategy within the literature on HIV/AIDS. In a sample of 65 adult men and women, the authors used multilevel linear modeling to test trajectories of change in physical and mental health-related QOL across baseline, 3, 6, and 12 months, including denial as a predictor and gender as a moderator (Kamen, et al., 2012). The use of denial coping was associated with lower physical and mental health-related QOL at baseline. Denial coping predicted an increase in QOL over time, though QOL remained low in those who practiced denial coping. Men's baseline mental health-related QOL was more negatively affected by denial coping than women's. Women tended to increase in QOL more slowly over time compared to men. Reliance on denial as a coping strategy is associated with poorer physical and mental health-related QOL in an HIV-positive population, though participants who engaged in denial also displayed more rapid improvement in their QOL over time. Men and women displayed different rates of improvement in QOL, indicating a need for gender-based treatment approaches. The relevance of this study is that it highlights the component of denial which in itself impacts counseling and has a wider and more profound effect on risky sexual activities that can endanger future partners (Kamen, et al., 2012).
Perceptions of Condom Use, Gender and Power, Etc. The overall goal of the research project was to develop, administer and assess a brief male-focused condom promotion program for inner-city young adult African-American males. To achieve that goal, the authors conducted a formative study consisting of both quantitative and qualitative research methods. For the qualitative component, which was guided by the relevant tenets of the social cognitive theory and the stages of change model, a series of focus group discussions was conducted among the target population based upon a thematic topic guide that covered three broad areas: young men's perceptions of condom use relative to pregnancy and HIV/sexually transmitted disease (STD) prevention, gender-based issues surrounding condom use, and potential guidelines for the development of customized condom promotion programs (Kennedy, et al., 2007). Those focus group discussions were audiotaped and the transcribed data summarized and analyzed based on those thematic topics. The findings revealed that respondents were more likely to assume that they know the risk behaviors of their sexual partners, more likely to consider pregnancy as a socially desirable outcome, more likely to control condom use within relationship dynamics and sexual contexts, and also more likely to provide suggestions on suitable components for program development. The implications and limitations of those findings from this qualitative component of the project are herein described, including potential recommendations for program development. The relevance of this study in my research is in its findings in relation to condom use as it relates to HIV prevention (Kennedy, et al., 2007).
Macro-level Approaches to HIV Prevention The HIV epidemic continues to disproportionately affect ethnic minority youth. These disconcerting health disparities indicate that although existing HIV preventive strategies for ethnic minority youth have been efficacious, they have not significantly reduced the impact of the epidemic in this population. Macro-level interventions, such as structural or policy interventions, have the potential to impact the HIV epidemic at a population level, and thus reduce the HIV health disparities that exist among ethnic minority youth and other segments of the U.S. population (Prado, Lightfoot, & Brown, 2013). This article calls for a paradigm shift to develop, evaluate, and disseminate interventions that target upstream/macro-level factors or that, at a minimum, integrate both a macro and individual level perspective. The article also discusses the challenges in developing and evaluating such interventions. Psychologists and other behavioral scientists can play a critical role in reducing the impact of HIV on ethnic minority youth by integrating macro-level approaches to future HIV prevention strategies (Prado, Lightfoot, & Brown, 2013).
Addressing Poverty and HIV Microenterprise programs are widely used to improve health outcomes among women internationally. However, there is little information on applicability to American women living in poverty. The authors conducted formative research to identify activities that are viable and attractive, that may produce income to address some proportion of economic need and could be incorporated in the development of a micro-enterprise HIV-prevention intervention to reduce HIV/STD transmission among unemployed or underemployed African American women at risk for HIV (Prather, et al., 2012). Methods included focus groups which were convened with young African American women and community leaders in two southern states. Interviews with women participating in the focus groups were also convened. Findings suggest an intervention should incorporate activities to increase self-esteem, enhance employability and job sustainability to decrease financial dependence. This research serves as the foundation for developing a novel approach to HIV prevention in the U.S. that may directly address poverty as a social determinant of health. The relevance of this research is that findings here can be utilized to the subset of BHM and their potential partners in counseling to help reduce risky behavior and improve life outcomes (Prather, et al., 2012).
Sexual Health Behaviors of Low-Income African American Adolescents Although many factors contribute to racial disparities in human immunodeficiency virus (HIV)/AIDS among young African Americans, knowledge is a particularly modifiable factor. However, little information has been published about the current HIV knowledge of African American teens or to what extent knowledge independently contributes to their sexual behavior and health. This study aimed to describe the level of knowledge among this at-risk population and determine whether knowledge contributes to variance in sexual behavior and health beyond that of sociodemographic and psychological factors. African American adolescents (n = 1658) were recruited in 2 northeastern and 2 southeastern US cities (74% eligible for free or reduced-price school lunch). Analyses utilized data gathered from adolescents using an audio computer-assisted self-interview program. On average, participants answered only 50% of HIV knowledge items correctly and were least accurate concerning effective condom use and HIV testing (Swenson, et al., 2010). Controlling tor associated sociodemographic and psychological factors, greater knowledge was associated with sexual experience and, among experienced adolescents, with sexually transmitted infection/HIV testing and--unexpectedly--less condom use. HIV knowledge, which is modifiable, is limited among at-risk African American adolescents and is an important contributor to sexual behavior and health. Findings indicate a need for more comprehensive HIV/AIDS education, particularly with regard to condom use and the benefits of routine sexually transmitted infection/HIV testing. Although knowledge might not be sufficiently protective in and of itself, having accurate information about HIV may benefit sexual health by impacting health-promoting attitudes necessary for successful engagement in health care-seeking behavior. This study’s relevance in my own is that it incorporates the importance of making information available to the youth which includes a subset of BHM (Swenson, et al., 2010). Health Concerns In this study, qualitative and quantitative data collection methods were used to identify the health concerns of African American residents in an urban community and analyzed the extent to which there were consistencies across methods in the concerns identified. The authors completed 9 focus groups with 51 residents, 27 key informant interviews, and 201 community health surveys with a random sample of community residents to identify the health issues participants considered of greatest importance. They then compared the issues identified through these methods (Weathers, et al., 2011). Focus group participants and key informants gave priority to cancer and cardiovascular diseases, but most respondents in the community health survey indicated that sexually transmitted diseases, substance abuse, and obesity were conditions in need of intervention. How respondents ranked their concerns varied in the qualitative versus the quantitative methods. Using qualitative and quantitative approaches simultaneously is useful in determining community health concerns. Although quantitative approaches yield concrete evidence of community needs, qualitative approaches provide a context for how these issues can be addressed. Since I intend to utilize mixed-methods in my study, this research will inform how I will utilize the approach in the manner by which I engage with the subset the ethnic group in general (Weathers, et al., 2011). Intersection of Gender and Ethnicity This study articulates a contextualized understanding of gender and ethnicity as interacting social determinants of HIV risk and acquisition, with special focus on African Americans and Hispanics/Latinos—2 ethnic groups currently at most risk for HIV/AIDS acquisition in the United States. First, sex and gender are defined. Second, a conceptual model of gender, ethnicity, and HIV risk and resilience is presented. Third, a historical backdrop of gender and ethnic disparities is provided, with attention to key moments in history when notions of the intersections between gender, ethnicity, and HIV have taken important shifts (Wyatt, et al., 2013). Finally, new frontiers in psychology are presented, with recommendations as to how psychology as a discipline can better incorporate considerations of gender and ethnicity as not only HIV risk factors but also as potential avenues of resilience in ethnic families and communities. Throughout the study, the authors promulgate the notion of a syndemic intersectional approach, which provides a critical framework for understanding and building the conditions that create and sustain overall community health by locating gendered lived experiences and expectations within the layered conceptual model ranging from the biological self to broader societal structures that define and constrain personal decisions, behaviors, actions, resources, and consequences. For ethnic individuals and populations, health disparities, stress and depression, substance abuse, and violence and trauma are of considerable concern, especially with regard to HIV risk, infection, and treatment. The conceptual model poses new frontiers for psychology in HIV policy, research, interventions, and training. This study is of relevance to mine since I frame my own research within a particular ethnic subset (Wyatt, et al., 2013).
Ethical and Multicultural Considerations Licensed Mental Health Counselors have to deal with people of various cultures. The counselors have to be prepared and understand the cultural background of the clients. HIV/AIDS is both a contagious and life threatening disease. The AMCD Multicultural Counseling Competencies addresses multicultural issues by initially addressing the counselor The AMCD states that culturally skilled counselors believe that cultural self-awareness and sensitivity to one’s own cultural heritage is essential. Culturally skilled counselors are aware of how their own cultural background and experiences have influenced attitudes, values, and biases about psychological processes. Culturally skilled counselors are able to recognize the limits of their multicultural competency and expertise. Lastly, culturally skilled counselors recognize their sources of discomfort with differences that exist between themselves and clients in terms of race, ethnicity and culture (Arredondo, et. al., 1996). The ACA Code of Ethics addresses these issues by informing counselors of their ethical obligations to clients. According to ACA Code of Ethics (2005), Section E addresses Multicultural Issues/Diversity in Assessment. Section E.8. addresses the Multicultural Issues/Diversity in Assessment by stating that counselors use with caution assessment techniques that were normed on populations other than that of the client. Counselors recognize the effects of age, color, culture, disability, ethnic group, gender, race, language, preference, religion, spirituality, sexual orientation, and socioeconomic status on test administration and interpretation, and place test results in proper perspective with other relevant factors. (ACA, 2005). Since it is known that HIV/AIDS is a both a contagious and life-threatening disease, Section B.2 of the ACA Code of Ethics addresses this issue. Section B.2.b. addresses contagious/life-threatening diseases by stating that when clients disclose that they have a disease commonly known to be both communicable and life-threatening, counselors may be justified in disclosing information to identifiable third parties, if they are known to be at demonstrable and high risk of contracting the disease. Prior to making a disclosure, counselors confirm that there is such a diagnosis and assess the intent of clients to inform the third parties about their disease or to engage in any behaviors that may be harmful to an identifiable third party (ACA, 2005).
Clinical Implications Research supports using therapeutic exercise as an adjunct therapy in the treatment of symptoms of HIV infection. In patients without acute infections or severe wasting, exercise therapy should begin as soon as possible after the diagnosis of HIV infection in an attempt to delay the onset of symptoms, decrease the severity of those symptoms already present, and potentially delay disease progression. Exercise therapy may also decrease the ultimate cost of treating HIV-infected patients by prolonging the asymptomatic period of the disease, thereby decreasing medication use and health care utilization rates, although further research is needed to clarify the effects of exercise in these areas. When implementing therapeutic exercise programs for HIV-infected patients, programs should be individualized on the basis of functional capacity and individual symptomology of each client. Clients present with varying types and intensities of symptoms so that no one exercise program can adequately deal with the special needs of all HIV-infected patients. Ainsworth and associates (2000) prepared a compendium of physical activities and their associated metabolic equivalent (MET) levels.
Strategies to Improve Research Methodologies Some useful strategies to improve research methodologies when it comes to HIV/AIDS would be gathering more information concerning the topic that would enable a more stable conclusion. The study groups should involve more participants in order to gain a broader prospective of the issue at hand. Having accurate results is another useful strategy. Guessing or believing is unacceptable in any research. The researcher needs to have accurate and adequate data in order to provide an accurate analysis. The samples used in research should include larger samples, more diverse samples, different methods of gathering information, and providing broader analyses of the studies.
Recommend New or Improved Strategies
According to Houser (2009), some new and improved strategies for incorporating research into clinical practice are using practical support, providing researcher reflections, discussing limitations of the study and suggestions for future studies, and devising programs that would benefit the study group in a positive manner. As with all research, the final analysis needs to be accurate, adequate, and able to be proven. Conclusion The HIV/AIDS research provides valuable information to assist in determining the why HIV/AIDS is running rampant in the African-American community; specifically among Black, heterosexual men. For the most part, health disparities, stress, depression, substance abuse, violence, and trauma are considerable concerns when it comes to HIV risk, infection, and treatment. Most of the research provides studies conducted to determine how to change the statistics. The best way to reduce the numbers is by becoming knowledgeable and using protection to prevent exposure to HIV/AIDS.

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