CABWHP publishes issue guides with thorough analyses of health policy issues addressing mental, emotional and physical health. Our Issue Guides are distributed via mail to Policy Advisory Group members and to over 2,000 colleagues and organizational collaborators.
A Time for Change: HIV/AIDS Prevention Strategies
If Black America was a sovereign nation it would rank 88th in infant mortality and 105th in life expectancy. Black America would also rank 16th worldwide in the number of people living with HIV.1 African American women only make up 12 percent of the United States' population but account for 66 percent of new HIV infections.2 The face of HIV/AIDS in America is becoming browner, younger, and more female.3 Advocates and policymakers are challenging the U.S. government to heighten its efforts to fight the war on AIDS. The FDA's recent approval of the new female condom is a step in the right direction. We must also fund HIV-prevention efforts designed specifically for African-Americans. Overall, we must change how the government and health organizations approach HIV-prevention efforts.
According to Congressional Black Caucus Chairperson Barbara Lee, "Black communities and leaders are now mobilized on AIDS but the federal government has not committed the necessary funding and focus to fight AIDS in America, let alone in Black America."4 Far greater support is needed for community responses to the epidemic in Black America. The CDC needs to double its HIV prevention budget to at least $1.3 billion.5 Congresswomen Lee and Waters, along with Senator Clinton and Congressman Waxman, have introduced H.Con.Res.413 calling for the development of a national AIDS strategy.
The original female condom was first introduced to the public and made available for domestic use 15 years ago. However, it still has not gained widespread popularity among sexually active women. Even though it is currently the only tool for HIV prevention that a woman can initiate and control, its relative price when compared to male condoms and the training and practice required to become accustomed to its use have posed significant barriers6. A new joint report discussed at this year's International AIDS Conference also places some blame on policymakers for the failure of this condom to gain ground in becoming an effective and efficient strategy for HIV prevention.7
Female Health Company (FHC), the London-based manufacturer of the "FC Female Condom" (the only version of the female condom approved by the FDA for use in the United States), is attempting to overcome these obstacles with the introduction of the "FC2 Female Condom." The FC2 hopes to succeed by reducing the cost of the female condom to the consumer. In mid-December 2008, an FDA advisory panel voted 15-0 in favor of recommending approval of this new, less costly version of female condom. By using a simpler manufacturing method similar to that of the male condom and shifting from a polyurethane base to a synthetic rubber called nitrile, the company has been able to significantly cut costs of production.8
We need "novel, innovative, and participatory approaches"9 to address the gaps in HIV/AIDS prevention for Black women. The CDC reports that the major risk factor for HIV infection among African American women is high-risk heterosexual contact, which accounts for 80% of all diagnoses among this group.10 The following factors contribute to this high percentage: (1) lower perception of risk; (2) drug and alcohol use; (3) different interpretations of safer sex; and (4) not recognizing a partner's risk factors.11
Earlier this year, a group of health researchers, community-based organization leaders, and representatives from both the healthcare and non-healthcare sectors engaged in a dialogue about new approaches which may begin to address the prevention needs of African- American women. Many concrete recommendations came out of their discourse including:
- integrating HIV-prevention activities and education into all women's service organizations;
- offering HIV tests when women receive their annual Pap tests;
- offering educational classes to teach parents how to talk to their children about sex; and
- tailoring new types of messages about HIV for African American women in order to divest them completely from the "stigma associated with the source of infection."12
Black women at high risk for HIV lie at the center of the intersection between racism, discrimination, poverty, and sexual abuse.13 These factors can also lead to depression. The development of depression is affected by chronic stress and the "subsequent immuno-regulatory effects associated with living as a member of a marginalized racial and gender group."14 Social forces such as racism and sexism impose continuous psychological stress and increase the likelihood of developing physical and mental illnesses.15
Since both sexual violence and poor mental/emotional health are risk factors for HIV infection among Black women, the stigma and imposed silence around these issues keeps women from addressing them and can lead to high-risk sexual behaviors. When Black women have the social, economic and political power to negotiate the relationships in our lives, our risk of becoming HIV positive will decrease dramatically. In this season of change, we must stand up for the rights of all Black women and be strategic in our work to improve the health of Black women and girls. We must hold policymakers accountable for expanding resources and implementing new strategies that will save our lives.
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1 Report: Fighting the Global AIDS Pandemic Abroad Must be Extended in the United States, CBCF News, Fall 2008 by Rep. Barbara Lee.
2 Rose et al, An HIV/AIDS Crisis Among African American Women: A Summary for Prevention and Care in the 21st Century, Journal of Women's Health, Volume 17, Number 3, 2008.
3 HIV Prevention and Reproductive Justice: A Framework for Saving Women's Lives, National Women's Health Network- Women's Health Activist May/June 2008 Cover Story by Dazon Dixon Diallo
4 Report: Fighting the Global AIDS Pandemic Abroad Must be Extended in the United States, CBCF News, Fall 2008 by Rep. Barbara Lee
6 Thapar, Sumita. Female condoms put HIV prevention in women's hands. Aug. 7, 2008. http://www.monstersandcritics.com/news/health/news/article_1421997.php
7 Female Condoms: a scandal of willful neglect. Oxfam International, Press Release. http://www.oxfam.org/en/pressroom/pressrelease/2008-08-06/female-condom
8 FDA Advisory Panel Backs New Female Condom, Reuters, Dec. 11, 2008. Edited by Carol Bishopric and Bernard Orr. http://www.reuters.com/article/healthNews/idUSTRE4BA78P20081211?feedType=RSS&feedName=healthNews
9 Rose et al., Abstract. An HIV/AIDS Crisis Among African American Women: A Summary for Prevention and Care in the 21st Century, Journal of Women's Health, Volume 17, Number 3, 2008
10 Rose et al., Introduction. An HIV/AIDS Crisis Among African American Women: A Summary for Prevention and Care in the 21st Century, Journal of Women's Health, Volume 17, Number 3, 2008
11 Center for Disease Control and Prevention, HIV/AIDS Among Women, CDC HIV/AIDS Fact Sheet. Available at http://www.cdc.gov/hiv/topics/women/resources/factsheets/women.htm
12 Rose et al. Strategies and Approaches from the Field: An HIV/AIDS Crisis Among African American Women: A Summary for Prevention and Care in the 21st Century, Journal of Women's Health, Volume 17, Number 3, 2008.
13 Rose et al. An HIV/AIDS Crisis Among African American Women: A Summary for Prevention and Care in the 21st Century, Journal of Women's Health, Volume 17, Number 3, 2008.
14 Annelle Primm, M.D., M.P.H., Director of American Psychiatric Association's Office of Minority and National Affairs.
15 Depression Treatment in Black Women Must Consider Social Factors, Psychiatric News, American Psychiatric Association, December 2, 2005.