The HIV epidemic is driven by sexual contact and is heavily concentrated among certain key populations, in particular gay men and other men who have sex with men. African Americans are worse affected across all key population groups. Despite condoms being widely available, their use is falling, even among people who are at heightened risk of acquiring HIV. Increasing levels of injecting drug use, linked to an epidemic of opioid misuse, are threatening the gains made on reducing HIV among people who use drugs.
This article has been cited by other articles in PMC. The next generation of HIV prevention and risk reduction interventions must move beyond basic sex education and condom use and availability.
Successful interventions targeting African Americans must optimize strategies that integrate socio-cultural factors and address institutional and historical barriers that hinder or support HIV risk reduction behaviors.
Recommendations for paradigm shifts in using innovative theories and conceptual frameworks and for training researchers, clinicians, grant and journal reviewers, and community members are made so that culturally congruent interventions may be tested and implemented at the community level.
The CDC and researchers in the public and private domains have sought to identify factors that heighten HIV risks and promote disease infection and transmission [ 3 ]. When HIV was initially identified, prevention efforts targeted certain risk groups [ 45 ]. As the epidemic progressed in the mids, increasing numbers of infected black, non-Hispanic populations surpassed those of whites [ 16 ].
Importantly, it became more apparent that in the absence of a biomedical cure for HIV, behavior change was and still is, the most effective strategy in decreasing HIV infection, re-infection, and transmission [ 910 ]. This is especially significant given that sexual behaviors continue to be the most common mode of HIV transmission, and understanding the processes involved in sexual decision-making is necessary to ensure long-term behavior change.
While these programs Hiv aids among young african americans been evidenced-based, there continues to be barriers to implementing them in the real world, including their uptake by potential recipients who may not be motivated to participate without financial incentives.
Financial incentives are commonly used in the testing of HIV interventions, but questions of successful programs arise when incentives are not part of community services. Further, the basic premise of these interventions was that knowledge influences behaviors and that by providing HIV education and access to condoms, HIV infection rates would decrease.
Identification of moderating and mediating variables that influence sexual behaviors and HIV transmission is critical to risk reduction if HIV interventions are to be successful in African American communities. One such variable is culture, which includes customs, lifestyle, activities, values, and beliefs, all of which are pertinent to individual sex roles.
The next generation of interventions targeting African Americans need to go beyond basic sex education and condom use and availability, acknowledging limitations of earlier interventions. Condom use must also be examined within a broader sociocultural context.
Alternatively, population-level indicators of HIV risks such as partner availability and concurrency may also influence condom use [ 1819 ].
Finally, societal-level interventions, such as reducing HIV stigma, may influence HIV testing and possible condom use. Thus, HIV interventions must address the historical and institutional factors that can affect individual, as well as interpersonal decision-making, integrating the sociocultural context with critical core elements of community relationships and infrastructure.
Without acknowledging the context and the strengths and challenges of African Americans within their communities, behavioral models of HIV risk reduction will only be plagued with limitations that do not provide the skills or problem solving strategies to maintain long-term behavioral change.
This next generation of interventions must lend attention to core cultural and community elements, which will facilitate individual HIV risk reduction, but also support successful translation and implementation at the couple and community level.
Addressing Culture After thoroughly reviewing evidenced-based interventions, Williams et al. While most successful interventions address four of these core elements, two are commonly neglected. Applying appropriate theoretical models and focusing attention to cultural and historical factors tend to be commonly ignored or only minimally addressed.
Finding Appropriate Theoretical Models The first generation of HIV prevention research focused on mainly one prevention strategy, safer sex with condom use. They minimally addressed and included African American history and culture [ 21 ], or how these factors could impact individual experiences and sexual decision-making.
Consequently, research promoted an individualistic approach to risk taking practices. Another limitation was that it assumed homogeneity across groups, which erroneously supported the notion that HIV risk factors were universally the same [ 21 ]. A second generation of research focused on examining differences in race and ethnicity [ 23 ].
Attempts by researchers to address and incorporate historical patterns of behavioral change and cultural beliefs and values that contradicted prevention messages often resulted in myopic interpretations and oversimplification of the complexities and depth of differences between ethnic groups and their risk for disease transmission.
Also, the inclusion of media resources, such as using videos and music lyrics that included African American models or was written by African American artists, was supposed to demonstrate attention to culture [ 16 ]. While ethnic matching may be important [ 24 ], the issue of being culturally competent to what is being communicated along with the manner in which the message is conveyed may be as important, if not more important than simply having someone who looks like the intervention participant.
The inclusion and application of culture as a specific social construct in HIV intervention approaches is an innovative concept, which stemmed from the belief that by understanding cultural characteristics of a given group, public health programs would be more capable of meeting the health needs of its members [ 25 ].
The SHM addresses these survival patterns and promotes concepts of interconnectedness, body awareness, and sexual ownership to acknowledge historical and contemporary contradictions and reframe these critical strategies. Lacking cultural elements limits the paradigms that could be developed for African Americans.
Another possible barrier is that reviewers of grants and journal manuscripts may be socialized to expect specific concepts promoted in traditional models. Concerns about introducing more relevant conceptual frameworks, familiar in ethnic studies or black psychology, may prevent investigators from trying new or different models.
Two primary strategies have been identified to incorporate culture in HIV prevention interventions [ 16 ].
The belief is that there is a decreased chance of miscommunication when information is provided by individuals who look and sound like the participants [ 16222529 — 31 ]. Ethnic minorities must be allowed to define their own language and develop their own dialogue if they are to become empowered in regards to their health [ 32 ].
Risk reduction messages must be presented in a manner that speaks to the target population. Further, to ensure the success of the intervention, those who are providing the intervention must be familiar with and ideally be a member of the target population and of the surrounding community.
Curriculum content involves the incorporation of cultural concepts within the intervention.From to , new estimated annual HIV infections remained stable among African American gay and bisexual men, at about 10, per year. Among all gay and bisexual men who received an HIV diagnosis in the United States, African Americans accounted for the highest number (10,; 38%), followed.
After years of sharp increases, diagnoses among young African American gay and bisexual men (aged ) stayed about the same. Heterosexuals and people who inject drugs also continue to be affected by HIV. Between and , HIV diagnoses fell by 8% among African Americans/black people overall, except for among African American/black men who have sex with men aged (see ‘men who have sex with men’ section above).
among African Americans with diagnosed HIV, less than half (49 percent in ) have achieved viral suppression (that is, the virus is under control at a level that helps them stay healthy and reduces the risk of .
HIV/AIDS and African Americans In the United States one of the leading causes of death for African American women is HIV/AIDS. This paper is on the African American women living in the United States with HIV / AIDS, how the health care policy affects them and the different stakeholders that are being affected by the health care policy.
Act Against AIDS Leadership Initiative (AAALI)—Harnessing the Strength of African-American Organizations to Fight HIV and AIDS From CDC's Division of HIV/AIDS Prevention Empower Young Men —videos on HIV prevention with young men of color who have sex with men.