Eliminating Health Disparities: A Literature Review on the HIV/AIDS Epidemic

By Agbaje-Williams, Mayowa M. | The Western Journal of Black Studies, Summer 2007 | Go to article overview

Eliminating Health Disparities: A Literature Review on the HIV/AIDS Epidemic


Agbaje-Williams, Mayowa M., The Western Journal of Black Studies


Introduction

One of the overarching goals of the Healthy People (HP) 2000 was to eliminate gaps in health status and outcomes between minorities and the total population. HP is a 10-year consortium plan targeted towards disease prevention in the United States (U.S.). In 1995, a midcourse review evaluated towards the HP 2000 objectives found that Blacks had more objectives moving away from the targets. In 2005, a midcourse review evaluated towards the HP 2010 objectives indicated that health disparities remain virtually unchanged. This raises concerns that disparities are persisting, if not increasing, in the U.S. Furthermore, the 2007 National Health Disparities Report (NHDR) showed that blacks had the greatest percentage (68%) of core quality of care measures considered to be "not improving."

The National Center for Health Statistics (NCHS) via the Center for Diseases Control and Prevention (CDC) lists adult mortality rates by cause of death and race/ethnicity. Although Blacks have considerably higher mortality rates compared to Whites, it is glaring to note that human immunodeficiency virus (HIV) is listed as the 27th leading cause of death for Whites, while it is listed as the 16th leading cause of death for Blacks. Furthermore, the mortality rate for Whites due to HIV is listed as 2.5 while that for Blacks is listed as 21.4. As evidence of this, a study conducted to estimate the contributions of specific diseases to disparities in mortality found that HIV was one of the most important disease indications in terms of potential life-years lost when adjustments were made for age, sex, and level of education.

HIV infections in the U.S. rose rapidly in the mid-1980s and declined in 1992. The CDC credits this decline to HIV behavioral prevention programs including school-based programs, client-centered counseling and personalized risk-reduction strategies. Additionally, the advent of highly active anti-retroviral therapy (HAART) in the mid- 1990s has decreased AIDS cases and deaths dramatically in the U.S. and individuals are living longer with the illness. However, survival continues to be lowest among Blacks.

The primary objective of this review is to redirect the focus of HIV outreach programs targeting Blacks from commonly cited socioeconomic factors to less popular socio-cultural issues. To achieve this objective, this review will show that the lack of HIV knowledge is insignificant compared to the underlying socio-cultural context that permeates Black culture. Secondly, this review proposes that the lack of a racially diverse health-workforce contributes to health disparities.

Contributing Factors

Socioeconomic Factors--Education/ Knowledge of HIV

Research has shown that social determinants such as lower levels of education, lack of employment etc. contribute to health disparities. According to the CDC, these factors are associated with high rates of HIV risk behaviors in minorities and are barriers to accessing HIV testing, diagnosis and treatment. Consequently, efforts have focused resources on educating minorities about HIV.

Hancock et al. (1999) compared level of HIV/AIDS knowledge among freshmen and senior high school students. It was concluded that Black seniors consistently had the lower scores compared to White seniors. This is significant because adolescents are considered to be a high-risk group for contracting HIV. The weight that this finding places on HIV knowledge suggests an inverse association between knowledge and high risk behavior such as increased and unprotected sexual activity in adolescents. Conversely, Walker (1992) surveyed the knowledge, attitudes, and risk behaviors related to HIV/ AIDS among suburban New Jersey teenagers. It was concluded that a high level of HIV knowledge among high school students did not preclude participation in high-risk behaviors. Thus, HIV knowledge is not a significant cause for behavior modification. …

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