Black Women and HIV: A Thriving Epidemic. Monica A. Hobbs M.A. University of Miami February 2010

Transcription

1 Black Women and HIV: A Thriving Epidemic Monica A. Hobbs M.A. University of Miami February 2010

2 Presentation Overview Prevalence rates of HIV Racial, ethnic and gender differences in HIV prevalence Factors that contribute to surveillance data differences Physical and Psychological effects of HIV Current physical and psychological treatments Implications for current research

3 HIV Prevalence Worldwide estimates of HIV prevalence range from 33.2 million to 40 million (Zarocostas, 2007) Women, oppressed ethnic minorities, and impoverished groups are currently suffering the greatest impact of HIV worldwide (Whetten, Reif, Whetten, & Murphy-McMillan, 2008)

4 Prevalence in the US Difficult to capture accurately due to lack of reporting and nondiagnosis status of individuals who have not initiated testing (CDC, 2009) Approximately 1.1 million adults are currently living with HIV in the United States (Long, Brandeau, & Owens, 2009; CDC, 2009)

5 Prevalence in the US Women represent the fastest growing portion of HIV infected individuals in the US (Edwards, 2006) An estimated 278,400 (CDC, 2009) to 300,000 women (over the age of 13) are living with HIV in the United States (Long et al., 2009)

6 Geographic and Regional Differences

7 Geographic and Regional Differences

8 Racial and Ethnic Disparities Black women represent 66% of all of the newly diagnosed HIV cases among women (Gilbert & Goddard, 2007; King et al., 2008; Rose et al., 2008)

9 Ethnicity and Regional Data Combined

10 Florida Prevalence In Florida, the number of people living with HIV and AIDS is one of the highest in the country (CDC, 2009) State-specific surveillance data indicate that rates of HIV infection are higher in Florida than the national average with approximately 83,041 people currently living with HIV in the state of Florida (CDC, 2009)

11 Black Women in Miami- Dade County The high prevalence trends continue within Miami-Dade county where Black women account for 75% of the HIV/AIDS cases in the county (Miami-Dade County Health Department, 2009)

12 Contextual Factors Low SES Interpersonal Factors High Prevalence Cultural Norms Oppression, racism & discrimination

13 Low SES Low-income and poverty have been widely identified as risk factors for HIV transmission among Black women and restricts where Black women reside which limits access to quality medical care and services (Gentry, 2005)

14 Sexual Partners High-risk sexual partners Black women are more likely to be involved with men who have sex with men (MSWM) and to men who have sex with women (MSW) unprotected and/or have multiple partners (Lauby, 2008; Aidala, 2006)

15 Questions What is the most common mode of HIV Transmission among Black women? Are Black women engaging in risky sexual practices more than their White counterparts?

16 Gender and Power in relationships Male control over sexual practices (Sherman, 2000) Lack of condom use within female perceived monogamous relationships (Wagstaff, 1995)

17 Physical Effects of HIV Pain and Discomfort Opportunistic Infections Neurological Effects

18 Pain and Discomfort

19 Opportunistic Infections The immune system is damaged extensively (Portilla, 2007) Increases in opportunistic infections are common and for women with HIV there is an increase in gynecological infections (Portilla, 2007) Opportunistic infections affect the brain, eyes, mouth and throat, lungs, GI, skin and genitalia (AEGIS, 2001)

20 Neurological Effects Neurological difficulties increase Headaches Memory loss Impairments in short term memory and loss of balance (Tambussi, 2000)

21 Psychological Effects Anxiety Depression Substance Abuse Quality of Life

22 Depression Depression Most common comorbid mental disorder among HIV+ individuals (Whetten, 2008) Black women with HIV experience higher levels of depression than their non- Black counterparts (Moneyham, 2000)

23 Depression Depression Significant levels of depressive symptomatology among women have been linked to increased risk for suicide, increases in general distress, and are associate with a negative impact on family environment (Jones, 2001)

24 Anxiety Stigma-related PTSD is more common among Black women with HIV in addition to PTSD based upon experiences of discrimination (Bird, 2004) For Black women Fear, guilt, shame and stigma contribute to anxiety (Miles, 2003)

25 Substance Abuse Individuals with co-occurring HIV and substance abuse face increased difficulty with maintaining supportive social and familial networks and have decreased levels of involvement in medical treatment programs (Walkup, 2008) HIV+ Black women suffer disproportionally from comorbid substance abuse (Amaro, 2001)

26 HIV Treatments HIV Treatments Medical Treatment Highly Active Antiretroviral treatment (HAART) is most common Psychological Treatment Group psychotherapy has been found to be highly effective in the reduction of depressive symptoms (Ashton, 2005)

27 Current Research Outcomes Medication Adherence Spiritual Well-Being Social Support Network Trust in Physician

28 Implications for Research? Community Family Medical Research, Practice & Policy

29 THANK YOU If you would like additional information please contact m.hobbs@umiami.edu

30 References Aidala, A. A., Lee, G., Howard, J. M., Caban, M., Abramson, D., & Messeri, P. (2006). HIV-positive men sexually active with women: Sexual behaviors and sexual risks. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 83(4), Aids Education Global Information System. (2001). Opportunistic infections. Retrieved October 22, 2009, from Amaro, H., Raj, A., Vega, R. R., Mangione, T. W., & Perez, L. N. (2001). Racial/ethnic disparities in the HIV and substance abuse epidemics: Communities responding to the need. Public Health Reports (Washington, D.C.: 1974), 116(5), Ashton, E., Vosvick, M., Chesney, M., Gore-Felton, C., Koopman, C., O'Shea, K., Maldonado, J., Bachmann, M. H., Israelski, D., Flamm, J., & Spiegel, D. (2005). Social support and maladaptive coping as predictors of the change in physical health symptoms among persons living with HIV/AIDS. AIDS Patient Care and STDs, 19(9), doi: /apc Bird, S. T., Bogart, L. M., & Delahanty, D. L. (2004). Health-related correlates of perceived discrimination in HIV care. AIDS Patient Care and STDs, 18(1), doi: / Centers for Disease Control and Prevention. (2009a). HIV/AIDS surveillance in women. Retrieved October 16, 2009, from Centers for Disease Control and Prevention. (2009b). HIV/AIDS surveillance supplemental report Retrieved October 16, 2009, from Edwards, L. V. (2006). Perceived social support and HIV/AIDS medication adherence among African American women. Qualitative Health Research, 16(5), Gentry, Q. M., Elifson, K., & Sterk, C. (2005). Aiming for more relevant HIV risk reduction: A black feminist perspective for enhancing HIV intervention for low-income African American women. AIDS Education and Prevention, 17(3), doi: /aeap Gilbert, D. J., & Goddard, L. (2007). HIV prevention targeting African American women: Theory, objectives, and outcomes from an African-centered behavior change perspective. Family & Community Health, 30(1), S109-SS111. Jones, D. J., Beach, S. R., & Forehand, R. (2001a). Disease status in African American single mothers with HIV: The role of depressive symptoms. Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association, 20(6), Jones, D. J., Beach, S. R., & Forehand, R. (2001b). HIV infection and depressive symptoms: An investigation of African American single mothers. AIDS Care, 13(3),

31 References King, W., Nu Man, J., Fuller, T. R., Brown, M., Smith, S., Howell, A. V., Little, S., Patrick, P., & Glover, L. (2008). The diffusion of a community-level HIV intervention for women: Lessons learned and best practices. Journal of Women's Health, 17(7), doi: /jwh Lauby, J. L., Millett, G. A., LaPollo, A. B., Bond, L., Murrill, C. S., & Marks, G. (2008). Sexual risk behaviors of HIV-positive, HIV-negative, and serostatus-unknown black men who have sex with men and women. Archives of Sexual Behavior, 37(5), doi: /s Long, C. A., Vance, D. E., & Antia, L. A. (2009). A descriptive study of empowerment and sexual decision making in HIV-positive African-American women. Psychological Reports, 104(2), Long, E. F., Brandeau, M. L., & Owens, D. K. (2009). Potential population health outcomes and expenditures of HIV vaccination strategies in the united states. Vaccine, 27(39), Miami-Dade County Health Department. (2009). HIV/AIDS surveillance. Retrieved October/17, 2009, from Miles, M. S., Holditch-Davis, D., Eron, J., Black, B. P., Pedersen, C., & Harris, D. A. (2003). An HIV self-care symptom management intervention for African American mothers. Nursing Research, 52(6), doi: / Moneyham, L., Sowell, R., Seals, B., & Demi, A. (2000). Depressive symptoms among African American women with HIV disease. Scholarly Inquiry for Nursing Practice, 14(1), 9. Portillo, C. J., Holzemer, W. L., & Chou, F. (2007). HIV symptoms. Annual Review of Nursing Research, 25, Rose, M. A., Sharpe, T. T., Raliegh, K., Reid, L., Foley, M., & Cleveland, J. (2008). An HIV/AIDS crisis among African American women: A summary for prevention and care in the 21st century. Journal of Women's Health, 17(3), doi: /jwh

32 References Sherman, S. G., Gielen, A. C., & McDonnell, K. A. (2000). Power and attitudes in relationships (PAIR) among a sample of low-income, African-American women: Implications for HIV/AIDS prevention. Sex Roles, 42(3), doi: /a: Tambussi, G., Gori, A., Capiluppi, B., Balotta, C., Papagno, L., Morandini, B., Di Pietro, M., Ciuffreda, D., Saracco, A., & Lazzarin, A. (2000). Neurological symptoms during primary human immunodeficiency virus (HIV) infection correlate with high levels of HIV RNA in cerebrospinal fluid. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 30(6), Wagstaff, D. A., Kelly, J. A., Perry, M. J., Sikkema, K. J., Solomon, L. J., Heckman, T. G., & Anderson, E. S. (1995). Multiple partners, risky partners and HIV risk among low-income urban women. Family Planning Perspectives, 27(6), Walkup, J., Blank, M. B., Gonzalez, J. S., Safren, S., Schwartz, R., Brown, L., Wilson, I., Knowlton, A., Lombard, F., Grossman, C., Lyda, K., & Schumacher, J. E. (2008). The impact of mental health and substance abuse factors on HIV prevention and treatment. Journal of Acquired Immune Deficiency Syndromes (1999), 47 Suppl 1, S15-9. Whetten, K., Reif, S., Whetten, R., & Murphy-McMillan, L. (2008). Trauma, mental health, distrust, and stigma among HIV positive persons: Implications for effective care. Psychosomatic Medicine, 70(5), doi: /psy.0b013e dc Zarocostas, J. (2007). WHO and UN slash their estimates of global HIV prevalence. BMJ (Clinical Research Ed.), 335(7629),