African American Women: The Face of HIV/AIDS in Washington, DC

HIV/AIDS is a major cause of morbidity and mortality among African-American women in the United States, and a study by Whitmore (2005) reported that HIV increasingly affects African-American women. Despite prevention efforts and advances in HIV treatment, African-American women are more likely to become infected with HIV or to die of AIDS than women of other races/ethnicities. African-American women are also more likely to have risk factors associated with HIV infection, which include poverty and at-risk partners such as men who have sex with men and women (MSMW) or injection drug users (Whitmore, 2005). Additionally, increasing proportions of new AIDS diagnoses among African-American women may reflect disparities in testing behaviors, whether and how African-American women seek healthcare, differential effects of HIV anti-retroviral therapy, and lack of early access to medical care and drug therapies (Leigh, 1993). In 2007, estimated HIV and AIDS case rates for African-American adolescent and adult females in the United States was 60.6 per 100,000, as compared to a rate of 3.3 per 100,000 for white adolescent and adult females, thus highlighting the burden of HIV experienced by African-American women (AVERT, 2009). In general, women living with HIV or AIDS (WLWHA) may face a myriad of problems including, but not limited to, lack of childcare, misinformation regarding treatment options, lack of access to transportation, substance abuse and related recovery efforts, and a lack of stable and safe housing. Research suggests that specific barriers to the utilization of social and medical services for women in Washington, DC include a lack of insurance, current injection drug usage, and difficulty remembering appointments (DC Appleseed, 2005). In the lives of many HIV positive women, HIV is a disease that competes for resources that are already scarce, and in Washington, DC, unmet needs for basic necessities remains high among HIV infected persons with dependents and may disproportionately affect women (DC Appleseed, 2005). For example, when a woman must prioritize her spending, she may opt to take care of her basic needs, such as food, clothing, childcare, and housing, instead of paying for HIV/AIDS treatment and services. Additionally she may also postpone care due to lack of transportation to get back and forth to her appointments. These and other factors have been associated with a lack of access to care and usage of emergency departments for outpatient care. In addition to concerns related to access to resources, individuals who live with HIV/AIDS are at risk of internalizing the stigma associated with the disease, which may have adverse emotional effects if they do not have access to positive social networks and support (Buseh, 2006). Therefore, it is important to link HIV positive women to mental health services. Though the academic literature (Adimora, 2005; Edwards, 2006) elucidates some of the factors, such as familial stress and stigma related to being HIV positive, as ways to explain African-American women's lack of service utilization, additional research is needed to determine the combined social and mental health services that women of color need. There is a dearth of public health research focused on the social service needs of African-American women living with HIV, as evidenced by a literature review of the subject. A lone article published in 2011 by DiStefano and Cayetano focused on the delivery of services for women with HIV/AIDs from the perspective of stigma and providers. The current research addresses the following research questions: (a) What barriers to social services do HIV positive African-American women experience in Washington, DC, (b) What mental health issues place African-American women in DC at increased risk for HIV, and (c) Do women with HIV face discrimination and issues rooted in stigma? Methods Ethnographic research methods were used to address the study's research questions and can include informal interviews, direct observation, and collective discussions with participants, all of which were performed during the research (Daly, 2007). …