The Phenomenon of the Growing
Epidemic of HIV/AIDS Among
African American Females
February 22, 2007
Physician Assistant Masters Project
Advisor: Prof. David Fahringer, MSPH, PA-C
• HIV/AIDS epidemic
– Affects all people regardless of age, religion, sexual
orientation, socioeconomic status, race/ethnicity
– Originally believed to be a virus of “gay white men”
– African Americans, particularly African American females,
are the fastest ethnic population for HIV diagnoses
– Why are African American women, in particular,
contracting and being diagnosed at higher rates than any
other ethnic group?
• How can Physician Assistants (PAs) take an active role in the
• HIV (Human Immunodeficiency Virus)
– Targets cells of the immune system, mainly CD4+ T-cells
• Without these cells, patients are unable to fight off infections
• Patients who are sick are mostly ill due to other illnesses and not the HIV virus
– Frequent monitoring of CD4+ T cells is required
• Once the T-cell count is consistently below the 200 cells/μl level (along with S/Sx)
the patient is said to have AIDS
• AIDS (Acquired Immune Deficiency Syndrome)
– The most severe manifestation of HIV
– Further weakening of the immune system causing more illnesses
• Symptoms of AIDS is primarily the result of not having an healthy immune system
– With antiretroviral therapy, survival time is 5+ years
– Without therapy, survival time is <1 year
• NO CURE!!
Race/ethnicity of persons (including children) living
• At the end of 2003, ~1,039,000-
1,185,000 were living with HIV/AIDS in
with HIV/AIDS, 2004 the U. S. (~24-27% were unaware and
undiagnosed with the virus) (CDC,
• 40.3 million people live with HIV/AIDS
worldwide (Harrington & Spach, 2006)
• Of the ~300,000,000 people in the
United States, African Americans only
make up ~12% (U. S. Census Bureau)
• African Americans make up about half
of HIV diagnoses in the U. S.
• ~69% of the HIV diagnoses among
African Americans are women
Source: CDC, 2006
Reasons for the Epidemic Among the African
American Female Population (Review of Literature)
• Incarceration of African American Men
– Black men are twice as likely to be imprisoned over Hispanics; five times more likely than white men
– MSM and IV drug use
– HIV + men return to society, engage in sexual acts, transmit the virus (Goosby, 2004)
• African American Culture
– Taboo to be a gay black male; therefore, homosexual men lead heterosexual lifestyles but continue to
have sexual encounters with other males (“Down-Low”)
– Promiscuity is accepted and encouraged among the black males
• Black males are more likely to engage in risky sexual behaviors (i.e. multiple sex partners, have their first sexual
encounter at an early age), which increases the chances of contracting and/or transmitting HIV at phenomenal
rates (Clarke-Tasker et al., 2005)
• Lack of perception of risk (i.e. due to being in a monogamous relationship)
– HIV transmission is becoming more popular amongst heterosexual acts (Simmons et al., 2005)
• Substance Abuse
Reasons for the Epidemic Among the African American
Female Population (Review of Literature)
• Adolescent and adult women who were diagnosed with
HIV from 1999 to 2004 were investigated in seven areas of
the U. S.
– At the end of the study, HIV diagnoses over the 5 year span remained
consistently higher for Hispanic woman but especially higher among
African American women; the rates for Hispanic women and black
women were 5 and 21 times, respectively, the rate for white women.
– Minority women with HIV in the southern area of the U. S. had
higher rates than any other area, possibly due to women having
heterosexual contact with men on the “down-low” (McDavid et. al.,
What can PAs do if…?
THE PATIENT IS NOT HIV
• Encourage the use of contraceptives (i.e. male condom, female condom)
– Do not only inform the patient but demonstrate its application in order for proper
– African American women were unaware of the female condom and its added protection
during sexual intercourse; therefore they relied on the male condom as their means of
protection (Brown & Wimberly, 2005)
• Encourage patients to become interested in knowing their HIV status by being
tested at least once and more frequently if involved in risky behaviors
– “Only ~27% of African American patients were tested for HIV because of their own
curiosity…talking with your patients is a must to decrease detection of unknown HIV
infections and to reduce AIDS” (Simmons et al., 2005)
• Do not be judgmental of patients because of their lifestyle
– It is our job to put the patient’s medical needs first
What can PAs do if…?
THE PATIENT IS HIV POSITIVE
• Try to establish an open-communication relationship between you and your
– Allows the patient to adhere to suggestions, treatment, and prevention measures to
– Having a “patient-centered” patient-provider relationship is associated with HIV +
patients agreeing to receive antiretroviral therapy and more importantly, adhering to it
(Beach et al., 2006)
• Continue educating the patient about the virus
• Encourage the patient to remain aware of their status (i.e. remind them that
they are able to still transmit the virus)
• Relay to the patient the importance of continuing good health habits (diet,
exercise, continuing their meds) to strengthen their immune system
• Again, do not be judgmental
• “It is not an exaggeration to say that HIV/AIDS is an epidemic
in the African American community.” (Goosby, 2004)
– African American females remain to be the hardest-hit racial/ethnic
• By incorporating the ABC’s into practice, PAs can take an
active role in not only decreasing the HIV/AIDS epidemic in
the black community but in all populations
– Abstinence: the 100% way to not become infected with the virus
– Be faithful: no matter if it is in a homosexual or heterosexual
– Condom: encourage the use, male or female or both
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