Community Assessment Final

Running head: COMMUNITY ASSESSMENT 1
Community Assessment:
African American Men with HIV/AIDS in Los Angeles County
Brenda Phong
HS 159, Section 3
Professor Buckner-Capone
March 20, 2013

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Community Assessment:
African American Men with HIV/AIDS in Los Angeles County
There are more new cases of HIV/AIDS that occur among African American adults than
Whites and Hispanics alone. (Healthypeople.gov) In 2010, African American men in particular
accounted for 70% of the new cases, even though they represent about 12-14% of the US
population. (CDC, 2013) With numbers rising and if left untreated or recognized the number of
men who have sex with men (MSM) with HIV/AIDS will continue to grow. (CDC, 2013)
Social Assessment
Who Makes Up the Community
Most of the males who have HIV/AIDS are adults ranging from ages 20-49. (Los
Angeles County Department of Public Health, 2009, p. 16) In California alone, Los Angeles has
the most cases of HIV/AIDS, with many unaware that they have the disease. (Los Angeles
County Department of Public Health, 2009, p. 16) The income and poverty level between 2000
and 2007 held a median household income of $52,628 overall, with an average of $31,905 for
African Americans. (Los Angeles County Department of Public Health, 2009, p. 6) African
Americans also had the highest number of people living below the poverty level compared to
Asian/Pacific Islanders and Whites, while only representing about 8.7% of the total population in
Los Angeles. (Los Angeles County Department of Public Health, 2009, p. 6)
Geographically
Geographically, those who were exposed to or living with HIV/AIDS greatly depended on which
part of town they lived in. There were different risk factors like homelessness, poverty, co-
morbid diseases and substance abuse that were prevalent in certain cities than others. (CDC,

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2013) The fact that Los Angeles is such a large city is also challenging when trying to provide
services for those who are affected because most live in poverty and are without health
insurance. (CDC, 2013)
Assets and Resiliencies
Some of the assets that African American men have in Los Angeles involve their family
and the strength that they receive from having such a large and strong community based support
group. For example, Los Angeles has a House and Ball prevention program where those who are
affected come together and attend meetings, get tested or offer social support to one another.
(Holloway, 2012, p. 8) This program is important because most African American’s who have
HIV/AIDS go through with a test, but don’t follow up for a prevention program. (Holloway,
2012, p. 1) The House and Ball prevention program helps highlight the spread and severity of
HIV/AIDS, and although LA saw an increase in those who were getting tested, there was only a
small amount in those who participated in a follow-up or prevention after. (Holloway, 2012, p. 8)
This shows that a lot of African Americans took the steps that they needed to get tested but they
still lack to knowledge and resources for prevention follow-up to help stop the rise of HIV/AIDS.
Community Challenges
The rise of new cases of HIV/AIDS in African American’s is influenced by the
community challenges that they face. Both poverty and lack of health insurance, or higher
incarceration rates affect how African Americans with HIVAIDS receive health care. (Los
Angeles County Department of Public Health, 2009, p. 3) Poverty in many African American
communities limit access to health care services, such as getting tested or medicines, and may
hinder sources needed for health insurance (CDC, 2011) The Care and Prevention in the United
States (CAPUS) Demonstration Project is a recent break through to help with this by

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encouraging people to get tested and engage in prevention services for those who have or have
not been diagnosed, with a special emphasis on ethnic minorities. (CDC, 2013)
Influential Social Experiences
Social experiences and programs have also influenced the health community to come
together and seek care for those who are living in poverty, or are afraid to come out because of
stigmas surrounding those who are positive for HIV/AIDS. For example, the African American
Gay Men’s Health Initiative in Los Angeles has developed a project called “Let’s Flip the
Script,” that brings together black gay men in the Los Angeles community to reduce the
incidence of HIV and STI’s, promote wellness and address factors such as discrimination and
stigmas that can influence risky behaviors. (APLA, 2013) The Black Aids Institute has also
influenced the African American community by developing a 5-step plan along with an
Affordable Care Act to reduce the number of those affected with HIV/AIDS. The program
influences prevention by making sure that everyone gets tested, they also help eliminate the
medical gap or services needed for treatment, and to strengthen research in finding a vaccine or
cure for HIV/AIDS. (Black Aids Institute, 2013)
General Health Of Community
The general health of the African American community is improving overall. There is a
decline in many health issues such as women giving birth to low or very low birth weight, the
death rate for diseases such as heart disease, cancer and stroke has also seen a decrease between
2000 and 2007. (Los Angeles County Department of Public Health, 2009, p. 7) And although
new HIV/AIDS still seems to be a challenge in LA, the case of AIDS went from the 7th
leading
cause of death to the 6th
leading cause in 2001. HIV/AIDS was also recognized as the 2nd
and 3rd
leading cause of death for most Black and Hispanic males. (LACDPH, 2009, p. 7)

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Epidemiological Assessment
The Health Problem & Priority Population
HIV/AIDS is considered an epidemic in the United States, and in Los Angeles County
alone African Americans who have sex with men (MSM) account for 80% of the new diagnoses
and currently have about 77% of the population living with HIV/AIDS. (Los Angeles County
Department of Public Health Aids Surveillance Report, 2011, p. 1) Among the priority
population, it is more apparent in African American men ranging from ages 20-49 years old but
the incidence ranges within the age group. Young men ages 20-29 had the highest estimated
incidence followed by men ages 30-39, and 40-49 years old. (Los Angeles County Department of
Public Health Aids Surveillance Report, 2011, p. 16)
The causes of HIV/AIDS can be linked to sexual contact, injection and non-injection
drugs, using contaminated needles/syringes (IDU), transmission from mother to child, and
receiving HIV-contaminated blood or blood products. . (Los Angeles County Department of
Public Health Aids Surveillance Report, 2011, p. 1) The cause that affects African American
men the most is sexual contact. Most of the men who are infected are continuing to have sex
with other men without knowing their HIV status. The men who are infected are also choosing
not to wear condoms, without realizing the consequences that follow their risky sex behaviors.
Importance and Magnitude of HIV/AIDS
There is a high need in addressing and recognizing that there is a HIV/AIDS problem in
the Los Angeles county, if left untreated the number of African American MSM will not get
tested and will continue to spread and account for a significant number of the new cases. One of
the main reasons as to why HIV/AIDS is most likely to spread is because of the large number of
people who are living with HIV/AIDS in African American communities, are having sex with

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the same sex partners. (CDC, 2013) If men do not know their HIV/AIDS status they will
continue to engage in sex with or without a condom and will continue to spread throughout the
African American community. The numbers of African American men in LA who get tested are
low, it’s mostly affects communities that are in poverty, making if difficult to get tested because
of lack of health care or health insurance. (CDC, 2013)
Extent of HIV/AIDS
In the Los Angeles County African Americans are the group that is mostly affected and
have higher rates of new incidences. African Americans represent about 9% of the Los Angeles
County but represent about 22% of the persons living with HIV/AIDS. (LACDPH, 2009, p. ii)
HIV/AIDS continues to affect the African American population in the Los Angeles County even
though they account for a small percentage of the population. African American MSM are also
disproportionality affected because they represent minority males. (LACDPH, 2009) They also
have higher occurrences of new cases due to social and economic factors that hinder then from
getting the care that they need in impoverished neighborhoods. And compared to other racial
groups, African American adult and adolescent males rate of HIV/AIDS are two times more than
White or Latino males. (LACDPH, 2009, p. ii)
Los Angeles County in Comparison with the United States
The HIV/AIDS epidemic among African American MSM accounts for a high portion in
both the Los Angeles County and the U.S. There are many similarities for both the Los Angeles
County and the US such as a decrease in both diagnosed cases and deaths from 1995-1998, with
a steady decrease in 2006. (LACDPH, 2009, p. 25) Since then from 2001-2003 the CDC has
reported a 2.2% increase in the annual HIV/AIDS report, with looking at the link of MSM
resistance to follow up or treatment. (LACDPH, 2009, p. 25) And as the number of AIDS cases

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continued to decline between 2002 and 2006, the number of AIDS cases in both the US and the
LAC started to stabilize as well. (LACDPH, 2009, p. 25)
Although the number of HIV/AIDS started to stabilize in Los Angeles and the U.S., the
number of MSM continued to have a higher number of those that were affected and living with
AIDS. The Los Angeles County accounted for about 89% while nationally MSM accounted for
about 77% of the population. (LACDPH, 2009, p. 26) Race and ethnicity also had some
similarities in 1997 where the predominant group that was most affected were Latinos, but have
since then moved to African Americans since 1996. ((LACDPH, 2009, p. 27) This shows that the
impact of African Americans are larger and when accounting for sex, African American men are
also disproportionately affected by the epidemic, and are contributing the most to the new cases
of HIV/AIDS. (LACDPH, 2009, p. 27)
The mode of exposure of the Los Angeles County compared to the US varies greatly in
that Los Angeles has a large percentage of exposure through MSM. (LACDPH, 2009, p. 28)
From 1986-2006, the number of MSM as a primary mode of exposure went down from 65% to
46% nationally, and with the Los Angeles County seeing a decline as well from 86% to 70%.
(LACDPH, 2000, p. 28) In 2006, Los Angeles County MSM accounted for 77% of the
HIV/AIDS cases, while the US and nationally MSM accounted for about 48% of cases in the
same year. (LACDPH, 2000, p. 28) While most of the Los Angeles County and the US are
experiencing decline of MSM cases, Los Angeles continues to have higher cases and numbers of
AIDS with MSM. (LACDPH, 2009, p. 28)
Trends, Relationships and Community Interest in Change

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The overall trend for HIV/AID has killed more than 31,448 people since the epidemic has began,
and about 44,450 people are living with HIV/AIDS with an emphasis of on males. (HIV Aids
Lifecycle) HIV/AIDS is affecting about 88% of males and about 70% specifically for those who
are older than 40 years old. (HIV Aids Lifecycle). And although African Americans make up
about 9% of Los Angeles they account for about 22% of those living with AIDS, and are
growing in numbers among African Americans who have sex with men.
The number of MSM in Los Angeles is growing and the problem is getting worse every
year. According to the CDC, in 2009 MSM accounted for of 61% of new infections and 79% of
infections among newly infected men. (CDC, 2012) Among African American MSM there were
about 10,800 new infections in 2009, with a 48% increase among young MSM. (CDC, 2012)
Some of the disparities that exist are linked to stigmas, poverty and overall lack of
support that hinders a lot of African American men who have sex with men from looking and
utilizing resources to get tested or treat HIV/AIDS. (Neff, 2006, p 1) Poverty remains one of the
main reasons why African American are greatly affected. African American MSM are more
likely to live below the poverty level compared to HIV-negative MSM, proving that difficulties
that African American men have with resources for treatment. (LACDPH, 2009, p. 55)
Not only are African American’s noticing the disparities that they have to face, but so are
political figures such as President Obama. President Obama and resources such as the AIDS
Project of LA and the Healthy People 2020, have come together to make a change. According to
the AIDs Project of LA, President Obama has come up with he nations first ever National AIDS
strategy. It includes a comprehensive and coordinated plan with measurable goals and objects to
acknowledge and fight the epidemic, not only within Los Angeles but nationally as well. Healthy
People 2020 has included it in is leading health indicators and has included a baseline of 16,749

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cases to look at as a target and to keep track of 15,074 new cases with a reported record so far of
10% improvement among HIV/AIDS. (Healthy People, 2012)
Key Factors that Influence the HIV/AIDS
Some key factors that influence this health experience overall are, unprotected sex and
substance abuse. Both are leading causes as to why most African American men transmit
HIV/AIDS. Research has shown that among African American men that are HIV positive, about
30-40% have unprotected sex. (Neff, 2006, p. 110) With such a high percentage of the
population of men having unprotected sex it is identified as the main contributor of the spread of
HIV among the population. (Neff, 2006, p.110) The CDC also reports that about over 50% of all
African American men living with HIV/AIDS gets or passes the disease through male-to-male
sexual contact. (2009) Keeping in mind that African American men make up about 9% of the
Los Angeles County, for about half of the small population to contract HIV through unprotected
sex, proves that there are preventions that need to focus on safe sex and with the issue of
multiple sex partners among the African American community.
Other factors that contribute to a high rise in HIV/AIDS is substance abuse. (CDC,
Overview of LA County, 2013) It has been found that substance abuse interferes with HIV/AIDS
because if people are using drugs most cognitive actions and judgments are hindered. For
example, according to the CDC, substance abuse is known to interfere with both adherence to
medications and treatments. (2013) The use of meth also interferes and contributes to cases of
HIV/AIDS passing from one male to another because when under the influence people are more
likely to engage in risky factors such has having casual sex. (CDC, 2013) Unsafe sex while under
the influence of alcohol or other drugs also enhances one’s chance of contracting HIV/AIDS
from their sex partner.

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Educational Assessment
Predisposing Factors
Some predisposing factors that affect African American men are the beliefs and
knowledge that they have about themselves and HIV/AIDS that hinder then from seeking
treatment of classifying the disease. Some of their reactions include fear of how their lives will
be changed once they are diagnosed, feelings of embarrassment, depression, devastation and how
others will react to them. (Gaskins et al, 2012, p. 445) Before most of the men knew about
HIV/AIDS, they had this preconceived thought that it was a fatal disease that only affected
homosexuals. (Gaskins et al, 2012, p. 450)
Many also feared that once they came out and told their family members, friends or
partners that they would look at them differently and either ignore of leave them for good. The
constant fear of not knowing what was going to happen hindered most of the men from seeking
care or getting tested. Emotions such as being embarrassed, depressed, or devastated lingered in
the back of their minds because most of the men lived in tight communities where if they told the
wrong person about their condition and was passed on throughout the community they wouldn’t
be able to walk around or show their faces comfortably. (Gaskins et al, p. 444) Most of the men
could also not find people to relate to or find peers who also are living with AIDS/HIV; this also
contributed to the feeling of being alone or isolated. (Gaskins et al, 2012, p. 445) Going through
a disease alone scared them and they felt that they needed to tell the right people to build trust so
that their lives would not be affected by it socially or mentally.
Mixed feelings such as being numb or in shock at the initial beginning stages also
hindered most of the men from coming out, talking to family, friends or loved ones and from
seeking care. They did not know how to react to it, and many wondered why.

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Reinforcing Factors
The attitudes and values that most MSM receive from their immediate family is
supportive overall, but have found that they still recognize the stigmas of HIV/AIDS and don’t
get tested because they are afraid of what others will think about them. (Neff, 2006) Others
beliefs and knowledge about HIV/AIDS stand as a barrier to prevention and treatment efforts.
(Gaskins et al, 2012, p. 450)
Research has found that when most men come out to their family and let then know about
their HIV/AIDS status they choose wisely who to talk to. (Gaskins et al, 2012, p. 447) Their
needs to be a level of trust between the two because most men do not want their family members
attitudes of beliefs affected their process of care or judge them because of it. (Gaskins et al,
2012, p. 447) People such as siblings, mom and dad were the ones that were reached out to the
most because of trust factors. (Gaskins et al, 2012, p. 446) They knew that they would and
should be the first ones to go to because they will most likely have an accepting attitude about
the situation overall.
Moreover, family members that were close to the men proved to be supportive in that
they often called to check up on them and make sure that they have taken the right measures to
take care of themselves. Things such as regular medication intake or even providing emotional
support throughout the process helped because they didn’t treat them differently and took them
for whom they were. But on the other hand, among those who were unsupportive when their
HIV/AIDS status was revealed were distant family members such as aunts, uncles or cousins,
friends and sex partners who were not close to the person. (Gaskins et al, 2012, p. 449) Many of
these people judged them heavily and either no longer socialized or interacted with them or left
because of fear of contracting the disease themselves. (Gaskins et al, 2012, p. 449)

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Enabling Factors
Factors that create a barrier to MSM in Los Angeles include lack of income or health
insurance. Overall, Los Angeles County in California has the highest rate of people who are
uninsured, limiting those from going in to receive care, getting tested, or getting the medications
needed to help with the health issue. (LACDPH, 2009, p. 2) High rates of unemployment and
household income are factors into deciding who gets health insurance because most should be
provided by jobs, but if most people live in poverty and hold low paying jobs it’s more likely
that they don’t have health insurance or coverage.
Lack of health insurance or health services is also linked to a high percentage of African
Americans who have low socioeconomic status (SES). According to the Los Angeles County
Department of Public Health, low SES is one of the factors that increase the risk for HIV/AIDS
infection. (2009, p. 2) If there is a high number of African Americans who are living below the
poverty line they will disproportionately be affected because they will not have the resources to
know about certain health issues, how to get tested, or how to overcome the health issue. Health
care access will be limited and as a result health outcomes for most people will be poor.
(LACDPH, 2009, p. 3)
To overcome these barriers most African Americans with HIV/AIDS receive their
health insurance from Medicaid, but might have to find alternative motives for health insurance
because of the recent budget cuts in 2007. Many African American men living or newly
diagnosed with HIV/AIDS struggle to find resources or governmental help to overcome financial
barriers in order to fight the ever-growing rate of HIV/AIDS.

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Health insurance along with low SES has contributed to lack of awareness of HIV status
in my African American men. (CDC, 2013) (HIV Among African Americans) As many as
100,000 people in the African American community were unaware of their status, and if were
tested was too far along the stages due to lack of early medical care and prevention measures.
(CDC, 2013) The poverty rate is too high among African Americans in the Los Angeles County
and proves to be the only issue that to receiving high-quality health care practices, housing and
HIV/AIDS prevention education. All of these factors combined are enabling factors that hinder
African Americans from treating HIV/AIDS properly and preventing the transmission among
groups such as MSM.
Next Steps
Moreover, African Americans and men in particular are disproportionately represented
when it comes to HIV/AIDS because although they make up about a small percentage of the
population in the Los Angeles County, they have the highest number of new HIV occurrences.
MSM in particular have the highest rates of new transmission because of lack of HIV/AIDS
prevention education, high-quality health care access, and insurance. Both social and institutional
barriers need to be recognized in the African American community if the Los Angeles County
wants to see a decline in new occurrences of HIV/AIDS among MSM and the African American
community overall.

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References
Aids Lifecycle-Rite to End Aids, 2010, HIV/AIDS Facts and Figures, Retrieved from:
http://www.aidslifecycle.org/about/hivstats.html
Aids Project Los Angeles, 2013, HIV Education, Retrieved from: www.apla.org
Black Aids Institute, 2013, “Light At The End Of The Tunnel,” Retrieved from:
www.blackaids.org
Center for Disease Control and Prevention, 2011, CDC Fact Sheet, Estimates of New Infections,
Retrieved from: http://www.cdc.gov/nchhstp/newsroom/docs/HIV-Infections-2006-
2009.pdf
Center for Disease Control and Prevention, 2013, “HIV Among African Americans,” Retrieved
from: http://www.cdc.gov/hiv/topics/aa/index.htm
Center for Disease Control and Prevention, 2013, “The Heightened National Response to the
HIV/AIDS Crisis Among African Americans,” Retrieved from: www.cdc.gov/hiv/topics/
aa/cdc.htm
Healthypeople.gov, 2012, HIV, Retrieved from://www.healthypeople.gov/2020
/topicsobjectives2020/overview.aspx?topicId=22
Holloway et al., 2012, “HIV Prevention Service Ultiization in the Los Angeles House and Ball
Communities: Past Experiences and Recommendations for the Future. NIH Public
Access. Doi: 10.1521/acap.2012.24.5.431
Gaskins et al., 2012, “Making Decisions: The Process of HIV Disclosure for Rural African
American Men,” American Journal of Men’s Health, Retrieved from: http://jmh.
sagepub.com.libaccess.sjlibrary.org/content/6/6/442.full.pdf+html

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Los Angeles County Department of Public Health, 2009, 2011 Annual HIV Surveillance Report,
http://publichealth.lacounty.gov/wwwfiles/ph/hae/hiv/2011_Annual%20HIV%20Surveill
ance%20Report.pdf
Los Angeles County Department of Public Health, 2009, “An Epidemiologic Profile of HIV and
AIDS in Los Angeles County, HIV Epidemiology Program, Retrieved from: http://
publichealth.lacounty.gov/wwwfiles/ph/hae/hiv/2009-epi.pdf
Neff K, 2006, “The HIV/AIDS Pandemic in African American MSM: Targets for Intervention.
Journal of Health Disparities Research and Practice. Retrieved from: http://
digitalscholarship.unlv.edu/jhdrp/vol1/iss1/7/

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