Lessons Learned from More Than Two Decades of Hiv/aids Prevention Efforts: Implications for People Who Are Deaf or Hard of Hearing
Winningham, April, Gore-Felton, Cheryl, Galletly, Carol, Seal, David, Thornton, Melanie, American Annals of the Deaf
IN CONTRAST with the nearly 30 years of HIV/AIDS research with the hearing community, data on HIV infection among persons who are deaf and hard of hearing is primarily anecdotal. Although the few available estimates suggest that deaf and hard of hearing persons are disproportionately affected by HIV infection, no surveillance systems are in place to identify either frequency or mode of HIV infection within this population. Moreover, to date, all empirically validated HIV prevention interventions have relied on communication strategies developed for persons who hear. Therefore, understanding and developing effective prevention methods is crucial for persons who are deaf or hard of hearing. The authors explore (a) factors among this population that may contribute to HIV-related behaviors, (b) four key concepts consistently included in successful interventions, and (c) practical ways in which to use this information to tailor effective intervention strategies for this population.
In the United States there are nearly 1 million individuals living with HIV/AIDS (Centers for Disease Control and Prevention [CDC]1 2006). It is estimated that an additional 40,000 individuals are newly infected each year (CDC, 2002a). While efforts are underway to develop an HIV vaccine, there does not appear to be one on the horizon. Thus, prevention efforts that target HIV-related risk behaviors remain the most effective method of lowering incidence rates, particularly among vulnerable populations.
About 10% of the total U.S. population, approximately 31 million individuals, is deaf or hard of hearing (Boon, in press). Estimates are that 8,000 to 40,000 of these people are infected with HIV (Health Resources and Services Administration [HRSA], n.d.]. A more precise estimate is not available, as the CDC does not specifically track the incidence or prevalence of HFV infection among persons who are deaf or hard of hearing. Thus, epidemiological information on HIV infection among this population is primarily anecdotal (Campbell, 1999).
Factors That Contribute to HIV Risk Behaviors Among Persons Who Are Deaf or Hard of Hearing
A number of factors may contribute to the HIV-related vulnerability of persons who are deaf or hard of hearing. These factors include cultural barriers to education efforts, a lack of HIV prevention programs, and communication difficulties (Peinkofer, 1994). Communication difficulties, for example, stem from the variety of communication strategies used by persons who are deaf or hard of hearing. Such strategies include the use of American Sign Language (ASL), Signed English, and speechreading. Because these, and other communication strategies, are very different from each other, persons using one may have difficulty understanding persons using another.
Additional factors contributing to HIV risk among persons who are deaf or hard of hearing include substance abuse. Rates of substance abuse among this population are nearly 40% higher than rates seen among persons who are hearing (Peinkofer, 1994). This is very concerning because substance abuse and sexual risk behaviors are the principal routes of HIV transmission (CDC, 2002b), and they tend to cooccur such that substance abuse is strongly correlated with high-risk sexual behavior (Ostrow et al., 1990). It is argued that alcohol and other drugs have direct causal effects on sexual behavior and condom use by impairing individuals' judgment about possible risks and making them less sensitive to the concerns of partners (Strunin & Hingson, 1992).
A review of the literature on HIV risk among persons who are deaf or hard of hearing provides anecdotal evidence of increased drug and alcohol dependency in comparison to the hearing population (HRSA, n.d.; Heuttel & Rothstein, 2001). Other literature suggests that persons who are deaf or hard of hearing score lower than hearing populations on tests of HIV knowledge (Campbell, 1999; Luckner & Gonzales, 1993). …