STD Quarterly-Expanding HIV prevention programs in African-American communities

1 in 160 African-American women infected

While African-Americans represent only an estimated 12% of the total U.S. population, they comprise almost 37% of all AIDS cases reported in this country.1 Take a closer look at the epidemic's impact on African-American women, and you'll know that your job as a reproductive health care provider becomes that much more significant in educating these women about HIV prevention.

Almost two-thirds (62%) of all women reported with AIDS in 1998 were African-American.1 It is now estimated that one in 160 African-American women is HIV-infected, notes Janet Cleveland, MS, special assistant to the director for HIV prevention at the Atlanta-based Centers for Disease Control and Prevention (CDC), Division of HIV/ AIDS Prevention, Intervention Research and Support.

Although AIDS-related deaths among women are now decreasing, largely as a result of recent advances in HIV treatment, HIV/AIDS remains among the leading causes of death for U.S. women ages 25 to 44. Among African-American women in this same age group, AIDS results in more deaths than from any other cause.2

Why the gap?

Race and ethnicity in the United States are not risk factors for HIV infection, but they correlate with other more fundamental issues such as poverty, access to quality health care, health care seeking behavior, illicit drug use, and living in communities with high prevalence of sexually transmitted diseases (STDs), says the CDC.3

Acknowledging the disparity in HIV and STD rates by race or ethnicity is one of the first steps in empowering affected communities to organize and focus on the problem.

While AIDS has taken its toll on African-Americans, the Hispanic population has been affected as well, Cleveland notes. African-American and Hispanic women together represent less than one-fourth of all U.S. women, yet they account for more than three-fourths (77%) of AIDS cases reported to date among women in the United States.2 (See story, p. 141 in this month's Contraceptive Technology Update, for an overview of reproductive health needs for Hispanic women.)

In response to HIV's rapid spread among African-Americans, the CDC has worked in partnership with national, local, and regional minority organizations to build its prevention efforts, increasing funding levels from nearly $11 million in 1988 to more than $120 million in 1999.

African-American leaders and the Congress ional Black Caucus were instrumental in obtaining an additional $156 million for prevention programs in 1998, with $39 million administered by the CDC this fall. The money represents a 50% increase over 1998 funding earmarked for HIV prevention programs in African-American communities.4

Targeting women at risk

Reaching at-risk women with group education and prevention case management in 12 transitional and homeless shelters in Chicago is the focus of one CDC-funded program: Shelter Women's AIDS Project. A service of the South Side Help Center, a Chicago not-for-profit organization, the project is now in its third year of CDC funding. It offers a series of eight educational group sessions over a four-month period to help women in the shelters learn about HIV and how to protect themselves from it.

The program also provides a weekly support group to further disseminate the prevention message, says Elayne Owens, prevention case manager and prevention specialist. A variety of educational approaches are used, including games and role-playing, as well as videos and informational speakers. "I bring in speakers who are HIV-positive to put a face on the disease, so they see the reality," notes Owens. "I also have females who are either a family member or friend who is impacted with the virus to speak so they realize that this virus is really here."

The eight educational sessions are about two hours in length and cover such information as methods of HIV transmission and correct male/female condom use. The courses are set on a four-month cycle as women move out of the shelters and new ones enter the program.

Women served by the program are provided referrals for mental health services, substance abuse treatment, medical care, and other social and health services. By addressing women's immediate needs, such as planning for long-term housing, program staffers help remove barriers to allow women to receive the prevention message.

In addition to education and counseling, the program offers HIV testing. The program leaders direct women to convenient neighborhood testing sites operated by the local board of health or provide transportation to satellite testing sites operated by South Side Help Center. Owens stays in touch with the women for a year and serves as a stable resource for those who find themselves in transition.

"I tell them, 'We're just struggling here together, so let me know where you are and what you're doing,'" says Owens. "It gives them the opportunity if they are having some problems, they have somebody they can call. That is very important."

Teen WISE (Women Informed Seeking Empowerment), a CDC-funded program in Detroit, focuses its efforts at African-American young women between ages 12 and 19. Also in its third year of CDC funding, the program is operated by Neighborhood Service Organization of Detroit, a private nonprofit organization.

Workshops, support groups, and street outreach are the main vehicles for reaching the teens, says Janice Cross, Teen WISE coordinator and program coordinator for community health services at Neighborhood Service Organization. The workshops can be presented as a one-time session for a church or group, a set of three to four workshops, or a series of nine workshops for a school. Support groups can follow, set up on a weekly, biweekly, or monthly basis. Street outreach moves education out into bus stops, parks, and other community gathering areas, where condoms and safer sex kits are distributed.

One popular approach to reaching teens is the "Pamper Party," which group educators coordinate with local cosmetology colleges. A small group of adolescent women gather for a one-hour HIV-prevention message, then may choose to have their hair or nails done by cosmetology students.

For Valentine's Day, program staffers coordinate a "Love Yourself First" party, with a decorated cake and grab bags filled with inexpensive hand lotions and other personal grooming products. A workshop is presented on HIV prevention, followed by group discussion.

A communitywide activity includes Teen WISE's outreach picnics, held during the summer at Belle Isle, a public park and a popular teen gathering. Teen WISE collaborates with other programs to sponsor a picnic with entertainment from local musical and dance groups, combined with education from peer outreach educators, counseling, and testing services.

Peer educators play a large role in Teen WISE's success, says Cross. Training and a trial presentation allow program coordinators to select qualified teens, who then go on the program payroll. Training sessions are held several times a year to keep educator slots filled.

"Our peer educators are to be role models because kids will listen to other kids," says Cross. "Even our outreach workers, who are in their 30s, are thought to be too old. Kids listen to other kids, which is the whole point of where this program is going."

References

1. Centers for Disease Control and Prevention. HIV/AIDS Among African Americans. Atlanta; August 1999.

2. Centers for Disease Control and Prevention. HIV/AIDS Among US Women: Minority and Young Women at Continuing Risk. Atlanta; August 1999.

3. Centers for Disease Control and Prevention. HIV Continues to Exact Toll on African Americans. Atlanta; Aug. 30, 1999.

4. Kim LL. Funds for preventing HIV in minorities raised. Atlanta Journal Constitution; Oct. 6, 1999: C1.