Solutions for Minorities
In an endeavor to address the strong correlations between percentage of AIDS cases and percentage of population that is black or Hispanic, HIV prevention information should be targeted to these minority groups; to do so, the two large-scale clinics should offer mental health counseling for minorities, establish training programs that enable individuals to volunteer in the clinics, and relate presentation and content of HIV/ AIDS information to cultural groups. A 2003 study in Los Angeles by Myers, applicable to the black population in Erie County due to its encompassment of a variety of African-American male groups, 50.3% heterosexual, 34% MSM, and 15.7% MSM/W, revealed high psychological distress, HIV negative status, older age, low socioeconomic status, and being an MSM/W represented the best predictors of sexual risk. For the total sample, which included both HIV positive and negative men, being an MSM/W was associated with a 48.6% increase in risky sexual behavior, while each incremental 10 point increase on a symptom checklist designed to measure psychological distress was associated with a 2.1% increase in risky behavior. Additionally, each one year increase in age was associated with a 1.5% increase in risky sexual behavior. On the reverse side, higher education, social support, and employment correlated with reduced risky sexual behavior. Although HIV positive men reported engaging in fewer sexual acts than HIV negative men, evincing the notion of a “wakeup call” in HIV positive men that “encouraged them to become more sexually responsible”, HIV prevention information needs to be targeted to African-American men as a whole in order to prevent the necessity of a wakeup call before curbing risky sexual acts. This study also reveals a higher prevalence of psychiatric disorders, elevated levels of psychological distress, and lower social support in HIV positive men. The increases risk for African-Americans in L.A. parallels the increased risk for the black population in Erie County. Due to psychological distress as a predictor of sexual risk, HIV clinics in Erie County need to “address the broader mental health needs of the participants” through mental health counseling and weekly support groups for people living with AIDS. Additionally, because of the increased risk for African-American bisexuals, who may “underestimate their relative risk”, clinics should hold group meetings specifically for bisexuals, in which they offer HIV prevention and education in a casual atmosphere facilitated by therapists (Myers 2003).
In addition to addressing the increased risk among African-Americans, the elevated risk among Hispanics in Erie County must also be addressed. A 2003 study by Ramirez-Valles and Brown in Chicago involving 62 telephone interviews with HIV/AIDS organizations and 6 in-depth interviews with Latino gay men revealed increase in self-esteem, empowerment, and safer sex behaviors as consequences of volunteer work in HIV clinics. The Chicago study is applicable to Erie County because it represents an urban area with minority populations, much like the inner-city regions of Buffalo possess the greatest black and Hispanic populations, as perceived in the 23% black population and 36% Hispanic population of 14201 and the 65% black population of 14203. This study found few Latino participants in HIV/AIDS community based organizations; however, those who did volunteer at such organizations attained positive behavioral results. The majority of organizations, 33, used volunteers for clerical and administrative work and events and special activities; 27 organizations employed volunteers for peer counseling, hospital visits, making and distributing condom packets, and creating education materials. The in-depth interviews with Latino gay men conducted by the study found that community involvement produced “self-esteem, sense of empowerment, professional skills, social connection, learning about HIV/AIDS, and safer sex behaviors.” In order to replicate the positive results of volunteer work in Erie County, AIDS clinics can recruit Hispanics through advertisement within the zipcodes that possess a large Hispanic population, including 14201, 14202, 14203, 14204, and 14213. Recruiting Hispanics to participate in the AIDS clinics benefits both the clients and the volunteers; through a pre-volunteer training program and interacting with AIDS victims, volunteers gain education on HIV and AIDS and possibly may “maintain HIV preventive behaviors”, while the clients gain access to social support. Community involvement may resemble some type of employment, which Myers associated with a 24% decrease in risky sexual behavior. Activism on behalf of Hispanics may prove to be “an effective prevention strategy” and may reduce the increased risk for Hispanics (Ramirez-Valles and Brown, 2003).
Specifically within HIV education to the black and Hispanic population in Erie County, both the presentation and the content of information must be culturally integrated. A 2003 study by Wilson and Miller identified numerous approaches that related HIV information to various subcultures and proved to be “critical to improving overall intervention efficacy.” Techniques for “making the intervention look culturally appropriate” utilized were facilitators and video actors of the same race as the “target population”, scripts containing cultural terminology, address of the HIV themes relevant to a specific minority group, and focus groups that assessed “specific cultural issues that were relevant to HIV prevention efforts.” Small group delivery format of HIV intervention information that emphasized gender and ethnic pride to low-income heterosexual African-American women increased condom use, sexual self control, sexual communication, and sexual assertiveness (DiClemente and Wingwood, 1995). Small group settings for African-American males that included black facilitation and video actors and was pilot tested for information accuracy and relevancy to male black youth promoted less risky sex and less risky sexual intentions (Jemmott, 1992). Communication skills education session for African-American women that tailored to cultural themes promoted elevated percentage of condom use, discussing condom use, and refusing unprotected sex (Kalichman, 1996). African-American women with low socioeconomic status who viewed videotapes in which the content of prevention message and setting were altered to reflect themes of cultural pride, community concern, and family responsibility, all of which are relevant to the African American community, represented increased likelihood to request condoms and engage in HIV testing than women who viewed a standard health message video comprised of white actors (Kalichman, 1993). As revealed through the Wilson and Miller study, presentation of HIV information containing cultural integration proves to be an effective strategy in the promotion of safer sexual behavior (Wilson and Miller, 2003). In order to incorporate these positive effects of culturally relevant information in Erie County, the two AIDS clinics can establish weekly HIV education and discussion sessions, one group devoted specifically to blacks and one to Hispanics. Minority groups can provide a useful environment to discuss cultural issues and concerns about HIV/AIDS. Additionally, the location of the two clinics in zipcodes 14201 and 14209 is conducive to the prevalence of minorities in these areas; the population of 14201 is 36.37% Hispanic and 23.42% black and the population of 14209 is 49.68% black. Many zipcodes with the largest percentage Hispanic and black populations, including 14202, 14203, 14204, and 14208, are all located close to the clinic locations.
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