This paper shall pursue the issue of AIDS in African Americans as the subject of discussion. The discussion shall primarily be one of exploratory nature and shall attempt to consider the issue in two frames of reference. The first frame of reference shall be that of the biology behind the issue. The biological aspects of the health problem shall be covered and special attention shall be given to the role of the environment and socio-cultural systems with regard to their implications on the subject of discussion.
The paper shall then attempt to proceed to the second frame of reference: Medical Anthropology. In this area, the discussion shall consider AIDS in African Americans in light of the cultural and social aspects of the issue, before moving on to a briefing on necessary causes, and the directly and indirectly contributing factors pertaining to the issue. Further on in the paper, a discussion shall also be presented in light of the cultural ecological systems model and areas such as community ecology, infrastructure, social structure and community practices shall also be addressed in the paper.
Introduction
“African Americans are more likely than other racial/ethnic groups to report ever having been tested for HIV. In 2000, more than half (58%) of African Americans reported ever having been tested for HIV, compared to 43% of the population overall” (Ruiz, Kates, & Pontius, 2003).
Of all races and ethnicities in the United States, the African American community is the one that has been hit the hardest by the AIDS epidemic. Medical and social scientist have long pointed to certain practices within the community which put people of African American descent at greater risk of contracting AIDS than members of other communities, among these socio-cultural factors is, a culture of casual sexual encounters, considering promiscuous women and self-identified homosexual men as the only vectors of AIDS, an aversion to AIDS testing and the use of condoms and the cultural practice of black men who consider themselves heterosexual, having secret sexual relationships outside their heterosexual relationship with other men in a practice that is commonly referred to as being “on the.down low”. In addition drug use and the incarceration of millions of African Americans on drug charges, low rates of higher education among African American and the high rate of poverty, are all contributory factors in the asymmetrical spread of AIDS in the African American communities of the United States. According to the Centers for Disease Control:
- Blacks accounted for 51% of the 42, 655 (including children) new HIV/AIDS diagnoses in 34 states with long-term, confidential name-based HIV reporting (Ruiz, Kates, & Pontius, 2003).
- Blacks accounted for 48% of the 551,932 persons* (including children) living with HIV/AIDS in 34 states with long-term, confidential name-based HIV reporting (Ruiz, Kates, & Pontius, 2003).
- AIDS in African American women was observed to have been transmitted primarily through engagement in heterosexual activities and through the use of Intravenous drugs.
For black men living with HIV/AIDS, the most common methods of HIV transmission were (in order):
- sexual contact with other men
- injection drug use
- high-risk heterosexual contact
HIV in an infected person is carried in the lymphocytes; a type of white blood cell, HIV spreads from one person to another through the transfer of lymphocyte rich fluids such as blood, semen/pre-ejaculatory fluid, vaginal and cervical fluids, urine and feces, breast milk, saliva and tears. Among these, the highest concentration of lymphocytes is in blood and semen making intravenous drug users (IDUs) who share hypodermic syringes and males infected with HIV, the greatest vectors of the disease (Batmanghalidj, 1991).
“African American women and white women are most likely to have been infected through heterosexual contact (67% of African American women and 59% of white women). Thirty percent of African American women and 38% of white women are estimated to have been infected through injection drug use” (Ruiz, Kates, & Pontius, 2003).
In the African American community as in Sub-Saharan African societies multiple sex partners and casual sex is not necessary looked upon in an unfavorable manner (The Black AIDS Institute, 2006). Child-bearing outside the wedlock carries little stigma. Among men having multiple female partners may be seen as a sign of masculinity. In women, having multiple partners may be seen as an economic necessity. It is common for women to have one main partner, referred to as the ‘Cake Daddy’ or the ‘Main Man’. This is usually a comparatively wealthy older man who is valued for the economic stability he brings. In addition a young woman may have ‘Second Man’ closer to her own age. ‘Third Players’ are young poor men with whom a woman has casual sex. According to a University of Alabama study, these often secret social arrangements are greatly conductive to the spread of Sexually Transmitted Illnesses.
Dislike of Condom Use in Men and Women
The use of latex condoms during sexual intercourse significantly reduces the risk of acquiring AIDS. The topic of Heterosexual African America men having secret homosexual tryst has been the subject of many lurid tabloid journalism style stories in the mass media. The criminalization of the use, manufacture and sale of recreational drugs has resulted in the incarceration of millions of young black men, this has produced several ill effects in African American society which are the reason for, or exacerbate the ill-effects of other causes of AIDS.
One of the direct sources of AIDS infection through incarceration is through voluntary and involuntary anal intercourse among incarcerated prisoners (CDC.gov, 2006). Since the men in prison are mostly cut off from the society of women, they are more likely to engage in homosexual relationships than the rest of the society. Homosexuality in jails is not only a way for sexual relief; it is also a tool for perpetuating the existing social order among prisoners and to establish the social pecking order.
Etiology of disease
“Healthcare in the US is principally funded through private insurance payments. This either means that those who cannot afford insurance have to be insured by the government through state Medicare or Medicaid schemes (see our HIV treatment in America page for more details) or that they remain uninsured altogether and have to pay for every individual treatment or consultation they receive. In 2007, nearly a fifth of African Americans did not have health insurance, compared to just over 10% of whites” (Ruiz, Kates, & Pontius, 2003).
It is of the utmost importance to realize at this point that the African American community accounts for only around thirteen percent of the American population (Boer, 2009). Yet, it is the one social community in which the recorded cases of death show nearly half of the deaths to be attributable to AIDS. The risk of the contraction of AIDS in African American man and women is far higher than that currently recorded for any other community in the region. It is therefore justified to surmise that there are more variables at play here than those that seem apparent.
When AIDS was first identified in the African American community, it began acquiring rapid recognition in light of its expanded prevalence in the African American community on account of gay activity and the involvement in intravenous drugs by a large number of the African American community. This realization came forth in the 1980s and began to acquire momentum with a steady pace. By the early 1930s, the incidence and recording of cases of AIDS in African American men and women had increased and the number of cases continued to increase in rapid succession.
The cause of this increasing rate of incidence of AIDS in African American men and women is one that owes its existence and increase to the initial decades of the African American community in the region. Education amongst the African American community was rare to find and it was significantly difficult for them to acquire the same degree of recognition in the health system as that of the community in majority in the region. Another issue that came into play was the fact that the increasing incidence of AIDS was attributed to the white gay community and very little or no attention was given to the incidence of AIDS in the men of the African American community. However, this discrimination in attention did not serve to change the fact that the incidence of AIDS cases in gay African American men was far more than that recorded for the case of gay white men.
Another cause of the increased incidence of AIDS in African American community has been found to be the extensive and excessive use of Intravenous Drugs, The use of intravenous drugs leads to the sharing of injections between drug users, which is in essence the ideal scenario for the spreading of AIDS to take place. The rate of development in the African American community has experienced deceleration as a result of the use of drugs and this usage of drugs has in turn led to an increased prevalence of AIDS across the drug users. Collateral damage comes across in the form of the actions and measures to which drug users resort to fund the continued consumption of drugs and the futile attempts to acquire healthcare in order to remedy the continuous consequences of continuous drug usage.
Cultural Ecological Subsystems Model
In light of the cultural ecological systems model, it shall be assumed that the current standing of African Americans with regard to the prevalence of AIDS is one that owes its origins to the role of four ecological subsystems. These four subsystems are not only interdependent but also interactive with each other in nature and a discussion on the medical anthropology of AIDS in African Americans cannot be considered to be complete without an elaboration through the frame of reference on the cultural ecological subsystems model.
The micro system perspective is one that perceives the scenario with regard to the role and relevance of the individual while the meso system perspective considers to the role and relevance of the family. The exo-system perspective considers the community with regard to the subject of discussion while the macro system perspective considers the subject social community in a bigger picture.
The first aspect of the cultural theoretical model, the micro system, shows that there was a considerable degree of intervention from the strength of cultural beliefs in the evolution of norms followed and observed within the African American community. The strength of the beliefs was one that was strengthened by the recognition of the fact that there was a heritage to protect through the protection of these beliefs. As a result, the micro system and its constituents became stringent encouragers of traditional and customary norms that led to the sustenance of the AIDS trends in the primarily African Americans.
The second system is the meson-system which highlights the role, relevance and implications of the interaction between external systems on the interactions that the micro system has with other systems in the external environment. In this regard, it would be reasonable to concede that the initial decades of the African American community in the region were ones that were plagued with controversial debates and an extensive degree of negligence in recognition (Shapiro, 1999). This excluded the African American community from numerous areas and opportunities, and subjected them to an environment where they had no other option but to make the best of the resources to which they had access. This fact, combined with the one discussed earlier, brought forth a scenario in which beliefs from African heritage survived for a prolonged period of time in the African American community.
The third context in this model is that of the exo-system. This frame of reference seeks to identify the role of external systems on the micro systems under discussion. In the case of the prevalence of AIDS in African Americans, it is evident that African Americans faced an extensive degree of exclusion from the mainstream of the society in the beginning and external micro systems therefore influenced the development of the African Americans by ostracizing them and expelling them from opportunities through which they could take advantage of the developments that occurred in the meso-system.
The fourth and last context under the cultural ecological model of subsystems is one that addresses the macro system. The perspective under the macro systems is one that perceives the three previously discussed subsystems and the implications of the religious and social perceptions of the society collectively. In this regard, it can be surmised that the environment created as a result was one in which the African American community was subjected to extensive isolation that only increased the segregation and discrimination. While this segregation and discrimination does not exist today and is strongly denounced in the American society, it was one that existed very strongly in earlier decades and it is for the same reason that the biological trend that sustained the prevalence of AIDS found ground to develop in the same manner across African Americans as they did in Africans.
Conclusions
The discussion serves to show that there is a strong need to realize the prolonged implications of the discrimination between the African American community and the white people. This statement can be found authentic in light of the fact that a majority of the contributing factors according to the model discussed were ones that had their roots in earlier decades in which the African American community was denied access to privileges and resources that could have contributed to the development of an increased degree of awareness across the community. As a result of this negligence, the long term implications were ones that did not allow the macro system to identify the implications in time to prevent them.
It is evident from the discussion that the current prevalence of AIDS in the African American community is one that has strong and undeniable ties to the combined effect of the physical and cultural environment to which the African American community was subjected. The implications of this environment were ones that had effects on the African American community as a whole.
If a generalization as to be derived from the discussion presented above, then it is clear that the discussion stands for the significance an increased degree of attention to be given to the incidence of health based cases in minorities. No matter how small the community may be, unless initial symptoms and recordings are given significant, there remains a chance that the health problem can acquire the position of an epidemic and can put far more lives at risk than may be apparent.
Reference
Batmanghalidj, F. (1991). AIDS: The Dead End of Virus Etiology. Science in Medicine Simplified , 2, 47-55.
Boer, B. d. (2009). HIV and African Americans. Web.
CDC.gov. (2006). HIV Transmission Among Male Inmates in a State Prison System – Georgia. CDC MMWR Weekly , 55 (15).
Ruiz, S., Kates, J., & Pontius, C. O. (2003). African Americans and HIV/AIDS. Kaiser Family Foundation , 1-2.
Shapiro, e. (1999). Variations in the Care of HIV-Infected Adults in the United States. JAMA , 281 (24).
The Black AIDS Institute. (2006). AIDS in blackface: 25 years of an Epidemic. The Black AIDS Institute.