Why Tackling Racism Against Black Women in Health Care is Key to Ending the HIV Epidemic in the United States

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Forty years after the start of the HIV / AIDS epidemic, black women continue to bear the heaviest HIV burden among women.

Although black women make up only 13% of the female population, they accounted for more than half of HIV diagnoses among all women in the United States in 2018, according to data from the United States Centers for Disease Control and Prevention. . White women, who make up 62% of the female population, accounted for 21% of HIV diagnoses.

Black women are also less likely than white women to receive antiretroviral therapy, which is very effective in preventing HIV infection and are more likely to die from HIV-related causes.

The theme for this year’s World AIDS Day included ending inequalities in HIV and AIDS care. But addressing inequalities will require examining their root causes. In the United States, the most important reasons for these disparities are structural and systemic racism.

I am the co-founder and director of a research center at Columbia University, the Social Intervention Group. Over the past 30 years, more than a thousand black women [living with or at risk for HIV] participated in the centre’s studies on the causes and dynamics of HIV, drug addiction and gender-based violence. These include intervention studies to put new strategies into practice and assess their impacts.

We have identified three approaches that can help improve the health of this population of women at risk, as well as their access to health care.

Address contexts and life experiences

Many women who participated in our studies told us that their caregivers rarely pay attention to their life context.

The life context includes racism, discrimination, poverty, a history of homelessness, incarceration, domestic violence, stigma and trauma. Black women often lack integrated health services to deal with these concurrent problems, and simultaneously their needs are often overlooked by their health care providers, meaning they do not get the treatment they need.

The data confirm the personal experiences of these women. Black women are almost three times more likely to live in poverty and die from pregnancy-related causes than white women. They are also more likely to work in low-paying jobs that do not offer health benefits.

Black Americans overall remain more likely to have no health insurance than their white counterparts. They often lose their insurance coverage faster.

To help overcome these inequalities, the Social Intervention Group has developed an intervention called “Empowering African American Women to Health,” or E-WORTH. This study was designed by and for black women to reduce HIV transmission and improve access to care, and it assessed whether its methods improve participants’ health outcomes in practice.

E-WORTH is a new cultural adaptation of an HIV intervention for black women called Project WORTH, which was selected as a best practice by the CDC.

Culturally Appropriate HIV Care

A total of 352 women participated in our E-WORTH intervention study, which began in November 2015 and ended in August 2019. The intervention included a one-to-one orientation and HIV testing session of one month. hour, and four weekly 90-minute group sessions.

These sessions included awareness of HIV and other risks of sexually transmitted infections, appropriate condom use, sexual negotiation skills, setting risk reduction goals, increasing social support and linkages to sex. services, intimate partner violence screening, safety planning and referral to violence prevention services.

Participants had the opportunity to discuss their experiences with barriers to health care and other services, and how racism has affected their access to services.

These unique intervention components have had a positive effect. We found at the 12-month follow-up that compared to women in a one-session HIV testing intervention, women in the five-session E-WORTH intervention were 54% less likely to test positive for HIV. any sexually transmitted infection. They also reported 38% fewer acts of vaginal or anal sex without a condom.

The results suggest that implementing an HIV / sexually transmitted infections intervention that is culturally appropriate and designed for black women holds promise for reducing the disproportionate burden of these infections in this population.

Culturally sensitive health care shows promise in improving the health outcomes of black women. Gregory Smith / Corbis History via Getty Images

Research shows that black women often do not receive adequate care because caregivers often do not believe their pain is real. Several E-WORTH participants said that in their overall experience with the healthcare system, “no one ever believes me”.

In contrast, due to the trust and respect shown by the facilitators and study staff, women participating in E-WORTH reported feeling heard and believed.

These same women also told us that sometimes clinical staff blamed them for contracting HIV and failed to discuss or offer treatment and care options, preventing them from accessing or staying in care.

To address the context of life, E-WORTH is closely linked to the Afrocentric themes of trauma and resilience. These draw on the historical and lived experiences of black Americans, from slavery in Jim Crow to the mass incarceration of blacks. The multimedia footage of the sessions is intentionally permeated with conversations about historical oppression, race, and culture, as well as systemic issues such as the oversight of black communities and disproportionate sentencing laws.

The facilitators of the intervention sessions led discussions about how intersecting identities of race and ethnicity are at the heart of the HIV epidemic among black women. The scripts used by the facilitators featured Afro-centric language, based on comments from previous focus groups of black women, including the names of the characters. Afrocentric graphics were used, such as purple for royalty.

A need for black doctors and training in structural racism

Researchers have found that the health outcomes of black patients improve when treated by black doctors. Additionally, black women are more likely to trust doctors who live in their community.

However, a recent study found that only 5.4% of American doctors are black, and only 2.8% of them are women.

Another recent study suggests that creating medical education programs at historically black colleges and universities could increase the number of black doctors. This supports other studies confirming the importance of these schools in expanding the ranks of black doctors in the United States.

However, increasing the number of black suppliers is only part of the solution. Less than half of medical schools in the United States provide some kind of education or training on addressing structural racism and racial disparities in medical care.

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In recent years, medical schools as well as allied health schools have become more committed to training the next generation of health professionals to fight racism.

While research has shown that structural racism is a powerful driver of health disparities, there is a large gap in the literature on the impact of such trainings on the practices of medical personnel and the health outcomes of their staff. patients. This highlights the need to pay more attention to this type of research.

The foundations of racism in the medical system

In late 2020, the American Medical Association declared structural racism a threat to public health and underscored the urgent need to prepare U.S. healthcare workers to address it.

“Without systemic and structural change, health inequalities will continue to exist,” wrote Willarda V. Edwards, WADA Board Member. “Declaring racism as an urgent threat to public health is a step in the right direction to advance equity in medicine and public health. “

The Social Intervention Group continues to develop and evaluate solutions to address the HIV crisis among black women. Our research results suggest that when these women are actively involved in all stages of their health services and research, they can improve their health and their lives. But it will require health professionals to address the structural racism inherent in the health system as well.

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