HIV Impact in African American Women - An Interview with A Health Education Specialist

 In recognition of Women's Month & last weekend's National Women & Girls HIV/AIDS awareness day I interviewed a good friend and Health Education Specialist about the impact that HIV/AIDS is having on women and particularly in African American Women.

1.  Share with our readers a little bit about your professional background as it relates to women's health & why you're so passionate about women's health issues?

Sure. My name is Nakisha Floyd, M.A., CHES, RHEd. Professionally, I currently serve as an Education Consultant with the State of North Carolina. I am a Certified Health Education Specialist (CHES) and Registered Health Educator with a Bachelor of Science in Community Health Education from North Carolina Central University (Durham, NC) and a Master of Art in Health Education and Promotion from East Carolina University (Greenville, NC). I’ve been practicing in the field of health education for over 14 years and most of my work has been centered on sexuality education and reproductive health among adolescents.

My passion for adolescent and women’s health issues developed while working as a Health Education Program Coordinator in a semi-rural county located in Eastern North Carolina. I remember talking with so many teenage girls about issues regarding their sexual health and so many of them were clueless about their bodies and/or the decisions being made that would affect them for a lifetime. Often times, I would ask this one question “Why did you decide to have sex with your partner [that person]?” No matter who it was, or how many times I asked the question, most of them would start off their response by saying “I don’t know…” What was extremely disturbing to me was that majority of these young women were African-American. I knew then that I needed to go above and beyond the “9 to 5” to educate them because if not addressed, these same attitudes and behaviors would follow them into their adulthood. It’s not just about gaining the knowledge; it’s about applying it. I know that I would have to provide these young people with the knowledge and SKILLS to change those attitudes and behaviors that could impact their quality of life or end it prematurely.  

2.  According to statistics, HIV is the leading cause of death for Black women aged 25 -34 years.   The rate of AIDS diagnoses for Black women is 23 times the rate for Caucasian women and 4 times the rate for Latina women.  These stats show that Black women are disproportionately affected among women in other ethnic groups in the United States.  Can you give us some thoughts and facts on why this is the case?

Although recent statistics record African-Americans representing only 14% of the U.S. population, our community faces a number of challenges that contribute to the higher rates of HIV infection.

The Centers for Disease Control and Prevention (CDC) cite some of the following reasons for the HIV infection disparity in Black America, particularly among African-American women.

1)   The greater number of people living with HIV (prevalence) in African American communities and the fact that African Americans tend to have sex with partners of the same race/ethnicity means that they face a greater risk of HIV infection with each new sexual encounter.

Most women are infected with HIV through heterosexual sex. Some women become infected because they may be unaware of a male partner’s risk factors for HIV infection or have a lack of HIV knowledge and lower perception of risk. Relationship dynamics also play a role. For example, some women may not insist on condom use because they fear that their partner will physically abuse or leave them.

African American communities continue to experience higher rates of other sexually transmitted infections (STIs) compared with other racial/ethnic communities in the US. Rates of gonorrhea and syphilis are higher among women of color than among white women. The presence of certain STIs can significantly increase the chance of contracting HIV. Additionally, a person who has both HIV and certain STIs has a greater chance of infecting others with HIV.

Both unprotected vaginal and anal sex pose a risk for HIV transmission. Unprotected anal sex presents an even greater risk for HIV transmission for women than unprotected vaginal sex.

2)   The socioeconomic issues associated with poverty, including limited access to high-quality health care, housing, and HIV prevention education, directly and indirectly increase the risk for HIV infection and affect the health of people living with and at risk for HIV infection.

Women who have experienced sexual abuse may be more likely than women with no abuse history to use drugs as a coping mechanism, have difficulty refusing unwanted sex, exchange sex for drugs, or engage in high-risk sexual activities.

Through my years of community work, I’ve experienced a number of instances where issues of sexual abuse have occurred; yet have gone unaddressed. By not talking about it and acting as if sexual abuse does not occur within the black community, we are giving power to perpetrators and making a silent statement that sexually victimizing people is acceptable. It is not OK! Believe it or not, talking about sexual abuse and giving young people quality sexuality education so they have the language to discuss all issues of sexual health, including abuse indirectly strengthens the fight against HIV infection.

Injection drug and other substance use increase HIV risk through sharing injection equipment contaminated with HIV or engaging in high-risk behaviors, such as unprotected sex, when under the influence of drugs or alcohol.

3)   Lack of awareness of HIV status can affect HIV rates in communities. Approximately 1 in 5 adults and adolescents in the US living with HIV are unaware of their HIV status. This translates to approximately 116,750 persons in the African American community. Late diagnosis of HIV infection is common, which creates missed opportunities to obtain early medical care and prevent transmission to others. The sooner an individual is diagnosed and linked to appropriate care, the better the outcome.

4)   Stigma, fear, discrimination, homophobia, and negative perceptions about HIV testing can also place too many African Americans at higher risk. Many at risk for infection fear stigma more than infection and may choose instead to hide their high-risk behavior rather than seek counseling and testing.

Source: The Centers for Disease Control and Prevention - www.cdc.gov

3.  Seven out of the top 10 states with the highest rates among women are in the South and the rate of women in DC infected with HIV/AIDS is 12 times the national average.  Why are a greater portion of women infected below the Mason/Dixon line?

There are a number of social factors contributing to the reasons why HIV infection is concentrated in the Southern region of the United States. The greater portion of women infected with HIV are below the Mason/Dixon line due to many of the socioeconomic issues discussed in Question #2.

Factors linked to poverty, which include limited access to high-quality health care, housing, and HIV prevention education may be the driving force behind the increased risk of HIV infection among black women in the South. This issue is extremely complicated as many of these factors are interrelated.  The African-American population is concentrated in the South, as well as rates of extreme poverty. Another issue is that the region below the Mason/Dixon line is also referred to as the “Bible Belt”. Many view sex as a moral issue instead of an issue of normal human growth and development. Talking about sex and receiving quality sexuality and reproductive health education is very sensitive, political and often times taboo. Many have this idea that discussing sex makes young people “promiscuous”. This is a major myth! It has been proven that the more factual and medically accurate information that young people receive, the more likely they will be to prolong sexual involvement. Lack of knowledge is not just a young persons problem. If an individual never received the education as an adult, 9 times out of 10 s/he does not have that knowledge as an adult. KNOWLEDGE is POWER…the earlier that an individual is exposed to age-appropriate sexuality education, the better.  It serves as empowerment in a number of ways.

4. What can women do to protect themselves?  What are your thoughts about testing in dating relationships vs. marriages?

Women can protect themselves from HIV infection in the following ways.

1)   Choose abstinence. If you are not in a monogamous relationship, not having sex is the easiest way to prevent HIV infection.  Both individuals in the relationship must practice monogamy, which is defined as the practice or state of having a sexual relationship with only one person, in order to be effective. This may not be a realistic option for many, especially with the high rate of African-American women who are not or may not marry in her lifetime. That’s where the other tips are helpful in protecting your sexual health and your life.

2)   Get tested regularly and know your status. An individual should get tested every 3 to 6 months after every act of unprotected sex (oral, anal or vaginal). You have to ask your healthcare provider for an HIV test. It is not done automatically, even during routine blood work.  

3)   Limit your sexual partners and know your partner’s status too! A person can become infected after being exposed only one time. You don’t know what people do when they are not with you; therefore, it is empowering to practice regular HIV testing in any relationship. Again, it’s about monogamy, not one’s marital status.

4) ALWAYS use a latex or polyurethane condom. HIV is transmitted through the exchange of 1) blood, 2) semen, 3) vaginal fluids and 4) breast milk. Latex and polyurethane (for those who may have a latex allergy) condoms, if used properly, act as a barrier to the exchange of bodily fluids during sexual activity. Lambskin condoms are porous and do not act as an effective barrier. 

5.  How does the healthcare community view HIV/AIDs?  Twenty years ago it was painted as an absolute death sentence.  Now I see commercials on TV stating that after treatment HIV can be "undetectable"?  How is that?

Now that HIV infected people who are taking prescribed medications properly are living longer and have an improved quality of life, the healthcare system is starting to view it as more of a treatable chronic disease versus an absolute “death sentence”. Chronic disease is defined as a disease lasting 3 months or more (U.S. National Center for Health Statistics). The problem is that many HIV/AIDS medication assistance programs that aid low-income populations in receiving life-saving medications are losing their funding. This is another issue all together.

There are medications out that can reduce the viral load to the point that HIV can be undetectable in an infected person’s system. Many feel that this is working its way to a cure; however, at this point there is no cure for HIV. Taking medications treat the symptoms but do not cure this disease. This is the difference between a treatment versus a cure.   

6.  In your opinion, will we ever see a day where HIV/AIDs will be a thing of the past?  If so, what is our role in seeing this disease retreat from epidemic stage in our generation?

I pray that one day there will be a cure to a virus that has wreaked havoc among people on every continent of our world, but right now, the closest thing that we have to a cure is PREVENTION! Prevention starts with YOU! Do your part by educating yourself about the virus that causes AIDS, get tested regularly and know your status (you have to ask your healthcare provider for this test), limit your sexual partners, and use protection with EVERY act of sex (oral, anal, and/or vaginal)! Remember, HIV is totally preventable. It’s not who you are, but what you do that puts you at risk for HIV infection!

Thank you to Ms. Nakisha Floyd for taking the time for this very informative interview!  If you have any questions for her or would like her to speak at an organization that you are a part of, please leave a comment below!