Academic journal article Health and Social Work

HIV-Prevention Capacity Building in Gay, Racial, and Ethnic Minority Communities in Small Cities and Towns. (Practice Forum)

Academic journal article Health and Social Work

HIV-Prevention Capacity Building in Gay, Racial, and Ethnic Minority Communities in Small Cities and Towns. (Practice Forum)

Article excerpt

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HIV disease continues to be a major public health problem. As of June 1999, 711,344 people in the United States had been diagnosed with AIDS, and an estimated 1 million people were infected with HIV (Centers for Disease Control and Prevention [CDC], 1999).

HIV infection is most often transmitted through behaviors that are associated with social stigma--sex between men and injection drug use. Of all those diagnosed with AIDS, nearly one-half (48 percent) are men who have sex with men (MSM); 25 percent are women and men who are injection drug users (IDU) (CDC, 1999). Racial and ethnic minority members are disproportionately represented in these groups and may be further stigmatized by their minority community members (De La Rosa, Khalsa, & Rouse, 1990; Diaz, Buehler, Castro, & Ward, 1993; Luckey, 1995; Morales & Fulliove, 1992; Quimby, 1993; Ramirez, Suarez, De La Rosa, Castro, & Zimmerman, 1994).

Furthermore, HIV carries its own stigma (Alonzo & Reynolds, 1995). Just being perceived as engaging in high-risk behaviors that lead to infection or supporting those who may can be enough to trigger sanctions (Green, 1995). Taking a public position in support of gay rights, syringe exchange, or increased services for HIV-infected people may "taint" someone. Discrimination based on stigma is compounded in small cities and rural areas because maintaining privacy is more difficult than in larger cities (Burnette, 1999; McGinn, 1996).

In addition to the problems faced by individual members of high-risk groups, tensions also exist at the community level. The African American community's experiences with the Tuskeegee study and the sexual-orientation minority community's (lesbian, gay male, bisexual, and transgender) experiences with forced interventions such as castration, confinement in institutions, and aversion therapy re-enforce distrust in these communities and result in reluctance to cooperate with government and medical institutions (Benedek, 1978; Katz, 1994).

Stigma and marginality not only explain many of the barriers facing HIV-prevention programs, but also help explain the inability of some providers to reach members of racial, ethnic, and sexual minority groups. The Council on Scientific Affairs of the American Medical Association reported that many providers lack the necessary knowledge, attitudes, and skills to reach members of the gay and lesbian community (American Medical Association, 1996).

One way to establish ties and win the trust of stigmatized populations is to bring these populations together in the planning, development, and implementation of public health programs (Stoto, Abel, & Dievler, 1996). Supporting this understanding, the CDC in 1993 announced that state territorial health departments must establish HIV-prevention committees made up of citizens who mirror the AIDS epidemic population. These committees were instructed to develop prevention plans for jurisdictions to use in their requests for funds. Funds could be denied or reduced if a committee's plan was not adequately reflected in the application or if the committee refused to concur with the application.

When notified of these new requirements, the Pennsylvania Health Department asked faculty at the University of Pittsburgh's Graduate School of Public Health for technical assistance in designing an HIV-prevention intervention. This article describes the community leadership development model that emerged from this collaboration and presents guidelines for developing leadership among stigmatized groups.

INDENTIFYING INDIGENOUS LEADERS

If HIV-infected people and members of high-risk communities were to participate at the local level, infrastructures for capacity building were needed in the at-risk communities. Capacity building required the identification and recruitment of competent and committed local people who were members of the groups at risk or who had strong and trusting relationships with these groups. …

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