The social context of HIV transmission in the African-American community

The concept of acquired immune deficiency syndrome (AIDS) as a behavioral problem, and the emphasis placed by researchers on race and ethnicity as "risk factors," have led to research focused on the "risk behaviors" of historically oppressed groups and a continuing social policy thrust that "blames the victim." Disproportionate numbers of AIDS cases have been reported among African Americans, and these cases are not evenly distributed throughout the nation. This geographical variation and distribution of AIDS among African Americans suggests that there are forces in society that impact African-American communities in differential ways. A review of alternate models presented in the scientific literature reveals that some attention is being given to reconceptualizing AIDS as a disease to be understood within the context of factors that affect the African-American community, rather than as a problem of personal behavior. The current status of "contextual approaches" found in the health and social science literature over a 5-year period (1987 to 1992) was assessed. Literature surveyed includes studies from the fields of social epidemiology, public health, and social science that address the issue of AIDS in the African-American community from a contextual perspective--that is, studies that seek to explain key issues within a framework that allows a "community-in-environment" analysis, as opposed to a behavioral perspective. Analysis of these contextual approaches indicates that dynamics external to individuals must be clarified to better understand the disparate pattern of AIDS among African Americans and whites.