Acquired immunodeficiency syndrome and black Americans: special psychosocial issues

Approximately 25 percent of persons diagnosed with acquired immunodeficiency syndrome (AIDS) have been black. This paper examines three areas of concern when focusing on AIDS in the black population: differences from whites in patterns of transmission of the infection, cultural factors that may affect health education efforts, and ethnically relevant issues in the provision of medical care to black persons with AIDS. Recognition of these differences is important in developing appropriate AIDS-related services for the black population. First, the epidemiologic pattern of infection in the black population differs from whites. Although they represent only 12 percent of the American population, blacks make up nearly one-quarter of reported AIDS cases. Currently, it is estimated that between 1 and 1.4 percent of the black population may be infected with the human T-lymphotropic virus/lymphadenopathy-associated virus (HTLV-III/LAV), a rate estimated to be three times that of whites. In addition, epidemiologic patterns of viral transmission in the black community suggest a greater incursion into the heterosexual population. Second, educational interventions designed to slow the rate of infection need to be sensitive to cultural and behavioral differences between blacks and whites who are at increased risk for acquiring or transmitting an HTLV-III/LAV infection. These include possible differences in perceptions of being at risk and actual risk behaviors. Third, in caring for black AIDS patients there are psychological, sociocultural, and medical care issues that are relevant. Research findings specific to health care for blacks are reviewed with particular reference to concerns that might arise in the treatment of black persons with AIDS. Recommendations for research and health education efforts in the black community are presented.