National Black HIV/AIDS Awareness Day

February 7th was National Black HIV/AIDS Awareness Day. In order to raise awareness about the disproportionate burden HIV/AIDS has on the Black community, we are dedicating this post to discussing some possible causes for the disparity.  

The Health Disparities

Black Americans are disproportionately affected by HIV/AIDS. In 2010, Black individuals made up 44% of all new HIV infections. This is despite the fact that the U.S. population is only 12% Black. In addition to HIV, one half of all newly diagnosed AIDS cases were to Black individuals. Note that AIDS is the most advanced form of HIV. Among those Black Americans diagnosed with HIV, Black Americans are less likely to be treated for HIV and are more likely to die as a result.

HIV/AIDS is spread within social circles, therefore creating clusters of incidence in some communities. Since HIV is primarily spread by sex or sharing needles with someone who is infected with HIV, it is essential that those already infected with HIV are aware of their condition. When an individuals knows they are infected with HIV he/she can be prescribed antiretrovirals. Antiretrovirals suppresses the HIV infection and reduce the spread of the disease.  In 2010, one-in-six Blacks living with HIV did not know of their diagnosis. Like all races/ethnicities, Black individuals tend to have sex with partners who are also Black.  After an HIV diagnosis, one-in-three Blacks get medical care and viral suppression. So to recap – Black Americans have both higher rates of HIV and are less likely to be treated.

Possible Contributing Factors

1.     Poverty. A quarter of African American families live in poverty. Low-income individuals might drop out of school at early ages, have difficulty seeking employment, and engage in risky behaviors such as drug use. Without steady employment, health insurance is challenging to obtain, especially in states that opted out of expanding Medicaid under the Affordable Care Act. Since HIV education is typically done in high school, dropping out of school at an early age may also prevent an individual from receiving HIV prevention education. Poverty can also force individuals to use sex as a way to earn money, thus increasing the chance of HIV spreading throughout sexual partners. A fatalistic view of life is also correlated with poverty. In a 2006 study that surveyed LA gang members, one-in-four felt it didn’t matter if they got HIV because they would die young anyway. Poor individuals tend to live in poor neighborhoods that lack adequate transportation and/or medical facilities.

2.     Imprisonment. Many people entering prison already have HIV. The prevalence of AIDS in prisons is estimated to be three times higher than the general population.  African Americans are incarcerated at the rate six times that of White Americans and in 2001, one in six Black men had been incarcerated at one time of their life. High prison rates increase risky behaviors associated with HIV. Jail time and poverty are closely related since jail time reduces the ability for those sentenced to get work experience and creates a blemish on their criminal record for future employment opportunities. However, there is good news – incarceration rates for Blacks dropped sharply between 2000 and 2009.

3.     Stigma. The fear of discussing risky sexual behaviors, drug use, or sexual orientation may keep Black Americans from being tested for HIV and seeking treatment. Some experts suggest that this stigma is tied, in part, to the religious belief that homosexuality is a sin in church congregations with a majority Black members. Since HIV/AIDS first was seen as a disease for white, gay men, it is still associated with homosexuality. Fueling the stigma against HIV/AIDS is the misinformation related to transmission of the disease.

What can we do?

Raise awareness around HIV/AIDS. In the last several years, the federal government attempted to do this by dedicated a day to HIV/AIDS in the Black Community, dedicating additional funds, and creating new educational materials. However, this information needs to trickle down into the areas of this county that are ripe with poverty. A possible way to do this is to use community health workers to work with Black Americans where they live. For more information about what we can do to alleviate the burden of HIV/AIDS on the black community, check out this website.

Black History Month Part 1 - American Heart Month

February is Black History Month - a time to recognize the incredible contributions that Black Americans have made.  If you are like me, you wish we didn't need a specific month to do this, but instead recognized Black History all year round.  However, as that is not yet the case, Emily and I want to use the remaining 3 posts this month, to tackle health disparities through the lens of Black History Month.

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

February is also American Heart Month which works well with our theme as Black Americans are 2 to 3 times as likely to die from cardiovascular disease than White Americans.  Part of this is due to disparities in risk factors for heart disease and part is due to disparities in access to appropriate care after heart disease or those risk factors are present.

Risk Factors for Heart Disease

According to the National Heart, Lung and Blood Institute, risk factors for Heart Disease include:

1.) High blood pressure - African Americans are much more likely to have high blood pressure than any other race.  High blood pressure can be caused or exacerbated by high sodium diets, smoking, lack of exercise and stress.  All of which are common in communities of color.

Race of Ethnic Group	Men (%)	Women (%)
African Americans	43.0	45.7
Mexican Americans	27.8	28.9
Whites	33.9	31.3
All	34.1	32.7

2.) High blood cholesterol - African Americans are also more likely than White Americans to have high cholesterol.  According to the CDC, “People with high total cholesterol have approximately twice the risk of heart disease as people with optimal levels.”

Race or Ethnic Group	Men (%)	Women (%)
Non-Hispanic Blacks	34.4	27.7
Mexican Americans	41.9	31.6
Non-Hispanic Whites	30.5	32.0
All	32.5	31.0

3.) Diabetes - According to the National Diabetes Information Clearinghouse, “Compared with non-Hispanic white adults, the risk of diagnosed diabetes was 18 percent higher among Asian Americans, 66 percent higher among Hispanics/Latinos, and 77 percent higher among non-Hispanic blacks”

Diagnosed and Undiagnosed Diabetes among People Ages 20 Years or Older, United States, 2010

Group	Number or percentage who have diabetes
Non-Hispanic whites	15.7 million, or 10.2 percent, of all non-Hispanic whites ages 20 years or older
Non-Hispanic blacks	4.9 million, or 18.7 percent, of all non-Hispanic blacks ages 20 years or older

4.) Smoking - Not only is smoking more prevalent in Black communities than in White, but also there is evidence that African Americans and Hispanics are less likely to be offered cessation services than white patients.

Group	Percent Who Smoke
American Indian/Alaska Native	34.1%
Black	21.3%
White	19.6%
Hispanic	14.9%
Asian/Pacific Islander	9%

Access to Care and The Determinants of Health

Black Americans also tend to have reduced access to appropriate care - whether that is actual medical care (primary and specialist) or access to social and economic opportunities (income, appropriate physical environment, etc).  The Affordable Care Act will reduce some of the disparities in health insurance rates, but it won’t necessarily address issues of access to primary care doctors or high quality specialists.  If those physicians aren’t accepting patients or are not located in communities of color, health insurance won’t help.

Poverty also contributes to a lack of access to care.  35% of Black Americans and 33% of Hispanic Americans live in poverty (compared to 13% of White Americans).  Even with insurance, most people must pay something for prescription medications which often results in low-income sufferers of heart disease to ration their medication to save money.  Living in a low income neighborhood also can reduce the likelihood that an individual will live an active lifestyle - this could be because of high crime, poorly maintained or non-existent sidewalks or lack of public transportation options.  Where an individual lives can also affect his/her ability to buy fresh produce rather than highly processed foods which contributes to heart disease.  Finally, living in poverty increases an individual’s stress level (the presence of racism does as well), which can exacerbate high blood pressure.

State of the Union Recap

President Obama delivered the State of the Union address on January 28th. 

The State of the Union address is the President’s annual opportunity to address Congress and define upcoming legislative priorities. Below is a word cloud depicting the most frequently mentioned words. As you can see, America, Americans, help, work, new, and people were words President Obama repeated the most. President Obama also focused on issues of inequality, joblessness, and poverty - all which are closely related to health.

Source: http://www.politico.com/story/2014/01/state-of-the-union-2014-word-cloud-america-102767.html

The Issues: Raising Minimum Wage and Creating Jobs

President Obama stated that he would increase the minimum wage for federal contractors to $10.10 an hour and urged Congress to increase the federal minimum wage from $7.25 per hour for all employees. Increasing the federal minimum wage and creating jobs would affect as many as 16.7 million workers and the 6.7% of Americans that are unemployed. Increasing the federal minimum wage (some states already have a higher minimum wage) is hotly debated among economists, policy makers, and the business community. On one side, a higher minimum wage will put more money in the pockets of low-income workers, thus raising the quality of life, and pouring money back into the economy. On the other side, businesses would have to pay workers more and could therefore lead them to hire fewer employees. President Obama also pushed for job creation. This is nothing new and something most of Congress can agree on. The debatable part is how to create jobs.

Raising the minimum wage and providing more jobs for the unemployed could have an impact on health. About 21.8% of children under the age of 18 live in poverty and 14.5% of householders are food insecure. Although it seems counterintuitive, researchers found that low wages predict an increase in the prevalence of obesity. The mechanisms behind the correlation between obesity and wages is not clear. The increasing consumption of cheap food (for example fast-food and highly processed foods) have been cited as a possible explanation. On a related note, with a higher income, a family could live in a safer home, decrease chronic stress, pay for health care, and leave more time for family. Creating jobs would also give people the opportunity to obtain health insurance through an employer. Check out our previous post about long-term unemployment and health.

The Issues: Equal Pay for Equal Work and Time Off for Sick Kids

President Obama emphasized the need for women to receive equal pay for equal work.  In 2011, women working full time were paid roughly 77 cents for every dollar paid to their males counterparts and there are variations by race. For every dollar earned by a white man, a white woman earns 77 cents, a black woman earns 69 cents, and a Latina woman earns 57 cents.  

In addition, women are about two-thirds of low-income workers. President Obama also pushed for policies that allow women to have a baby and take care of a sick child without fear of job loss. Workplace policies that could allow parents to care for a sick child without consequences could decrease the spreading of germs, allow the child to heal more quickly, and provide an opportunity to seek care from a doctor.

Does the State of the Union matter?

The issues that President Obama chose to include in the State of the Union are significant. Although some topics like unemployment are not new, President Obama did formally articulate an interest in raising the federal minimum wage and the increasing inequality in America. Policies and programs are not necessarily modified and formed because they are mentioned in the State of the Union. However, they do give a clear direction from the executive branch.