AIDS
AND
RACISM
IN
AMERICA
Janis
Hutchinson,
PhD
Houston,
Texas
Institutionalized
racism
affects
general
health
care
as
well
as
acquired
immunodeficiency
syndrome
(AIDS)
health
intervention
and
serv-
ices
in
minority
communities.
The
overrepre-
sentation
of
minorities
in
various
disease
categories,
including
AIDS,
is
partially
related
to
racism.
The
national
response
to
the
AIDS
epidemic
in
minority
communities
has
been
slow,
showing
an
insensitivity
to
ethnic
diver-
sity
in
prevention
efforts
and
AIDS
health
services.
(J
Nati
Med
Assoc.
1992;84:1
19-124.)
Key
words
*
acquired
immunodeficiency
syndrome
(AIDS)
*
human
immunodeficiency
virus
(HIV)
*
racism
*
minorities
Racism
has
always
affected
the health
of
those
being
discriminated
against.
This
fact
is
documented
through-
out
the
history
of
the
United
States
as
evidenced
during
the
Colonial
era
by
the
treatment
of
the
Native
Americans,
during
the
slavery
era
by
the
treatment
of
blacks,
and
during
the
Civil
War
era
by
the
treatment
of
black
soldiers
who
died
in
large
numbers
in
hospitals
because
of
neglect.'
While
gross
abuses
of
human
and
civil
rights
have
mostly
disappeared,
discrimination
remains
beneath
the
surface,
however
subtle
it
may
be.
Unfortunately,
discrimination
hits
minorities
where
they
live,
and
affects
how
and
when
they
die.2
It
is
well
known
that
there
are
racial
differences
in
the
epidemiology
of
acquired
immunodeficiency
syndrome
(AIDS).
This
is
not
surprising
given
the
importance
of
race
as
a
social
structure
and
its
potential
importance
in
shaping
relationships
and
behaviors
that
make
people
vulnerable
to
human
immunodeficiency
virus
(HIV)
infection.
There
can
be
racial
differences
in
vulnerabil-
ity
to
viral
infection,
in
the
frequency
of
different
behaviors
or
relationships
that
increase
the
risk
of
From
the
Department
of
Anthropology,
University
of
Houston,
Houston,
Texas.
Requests
for
reprints
should
be
addressed
to
Dr
Janis
Hutchinson,
Dept
of
Anthropology,
University
of
Houston,
Houston,
TX
77204-5882.
transmitting
the
virus,
or
in
the
disease
outcomes
related
to
infection.
Racial
structures
in
society
contrib-
ute
to
differences
in
responses
made
to
the
epidemic
by
people
of
different
races
and
can
affect
the
way
that
powerful
institutions
respond
to
an
epidemic
depending
on
the
race
of
the
people
most
affected
by
the
disease.3
This
article
examines
the
relationship
between
the
current
AIDS
epidemic
in
minority
communities
and
racial
discrimination
in
this
country.
MINORITY
HEALTH
The
overrepresentation
of
minorities
in
various
disease
categories,
including
AIDS,
is
partially
related
to
institutionalized
racism
in
this
country.
Minority
popula-
tions
in
the
United
States
suffer
poorer
health,
evidenced
by
more
illnesses
and
a
higher
incidence
of
disease,
and
they
die
in
larger
numbers
than
the
nation
as
a
whole.4'5
Minorities
experience
a
shorter
life
expectancy,
higher
rates
of
debilitating
and
chronic
diseases,
and
lower
protection
against
infectious
diseases.6
While
Americans
are
living
longer,
infant
mortality
figures
are
improving,
and
progress
has
been
made
against
heart
disease
and
cancer,
the
health
of
minority
Americans
has
not
kept
pace.2
For
example,
the
life
expectancy
of
black
Americans
is
69.6
years
compared
with 75.2
years
for
nonminorities.4
Diabetes
is
33%
more
common
among
blacks
than
whites
and,
among
women,
it
is
50%
more
common
among
blacks
than
whites,
especially
for
obese
women.
A
higher
rate
of
pancreatic
cancer
is
found
among
Chinese
American
women
than
nonminorities
while
for
Native
American
adults
under
the
age
of
35
years,
heart
disease
mortality
is
almost
twice
as
high
as
for
all
other
Americans.5
A
1990
study
by
the
Centers
for
Disease
Control
revealed
the
striking
gap
between
black
and
white
populations
in
terms
of
excess
mortality.
It
was
reported
that
the
all-cause
mortality
rate
for
blacks
exceeds
that
for
whites
by
149%
for
35-
to
44-year-olds
and
by
97%
for
45-
to
54-years-olds.7
The
minority
death
rate
is
higher
than
that
of
the
white
population
in
almost
every
category
of
mortality
listed.
For
example,
infant
deaths,
neonatal
deaths,
and
postnatal
deaths
are
twice
as
high
among
JOURNAL
OF
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NATIONAL
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VOL.
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NO.
2
119
AIDS
&
RACISM
TABLE
1.
PERCENT
AIDS
CASES
BY
EXPOSURE
CATEGORY
AND
RACE/ETHNICITY,
REPORTED
THROUGH
SEPTEMBER
1990,
UNITED
STATES*
Exposure
Category
Black
Hispanic
White
Asian
Native
American
Male
homosexual/bisexual
36
41
76
74
54
contact
IV
drug
use
(female
&
39
40
8
4
17
heterosexual
male)
Male
homosexual/bisexual
7
6
7
2
13
contact
&
IV
drug
use
Hemophilia/coagulation
disorder
0 0
1
2
4
Heterosexual
contact
11
6
2
4
5
Blood
transfusion,
blood
1
2
3
8
1
components,
or
tissue
Undetermined
1
2
3
8
1
*Adapted
from
the
Centers
for
Disease
Control.9
blacks
compared
with
whites.
Also,
a
greater
proportion
of
minorities
die
of
heart
disease,
cerebrovascular
disease,
and
cancer
compared
with
the
white
population.8
Possible
explanations
for
mortality
differentials
include
unequal
access
to
health-care
services
and
differences
in
social
attitudes
and
physical
environment.7
In
general,
blacks
have
less
access
to
health
care
regardless
of
economic
circumstances.8
Between
25
and
35
million
people,
about
15%
of
the
US
population,
do
not
have
access
to
the health
care
they
need.
These
people
are
often
below
the
official
poverty
level
of
$10
650/year
for
a
family
of
four.
They
may
be
full-time
employees
at
minimum-wage
jobs
and
often
are
employed
by
small
businesses
that
cannot
afford
a
health
plan.
Of
course,
many
are
not
employed
at
all.
In
1976,
65%
of
those
classified
as
poor
were
eligible
for
Medicaid,
while
in
1986
this
figure
was
about
50%.2
While
new
methods
of
paying
for
health
care,
such
as
health
maintenance
organizations,
prospective
payment
systems,
and
private
insurance
plans,
are
supposed
to
deliver
services
for
the
least
cost,
to
remain
profitable
they
must
have
a
significant
number
of
healthy
enrollees.
The
poor
are
usually
sicker
before
they
seek
health
care
and
require
more
services
for
longer
periods.
Therefore,
they
are
usually
excluded
from
these
programs
because
they
are
high-risk
patients.
Often,
the
health-care
needs
of
poor
minorities
are
served
by
emergency
rooms
where
the
treatment
is
expensive,
slow,
impersonal,
and
even
hostile;
in
addition,
treat-
ment
is
usually
delivered
by
relatively
inexperienced
personnel.2
Poor
minorities
end
up
going
from
one
physician
to
another
without
receiving
long-term
health
care
from
one
or
a
few
physicians.
To
maintain
the
health
of
minorities,
minority
health
providers
are
needed.
While
it
has
been
said
that
there
is
a
glut
of
physicians
in
this
country,
what
is
true
for
the
white
majority
is
not
so
for
blacks.
While
blacks
comprised
12%
of
the
population,
only
6.6%
of
those
entering
medical
school,
2.6%
of
the
practicing
physi-
cians,
and
1.7%
of
medical
school
faculty
are
black.6
In
1983,
only
3%
of
the
total
physicians
in
this
country
were
African
Americans.4
In
the
United
States,
white
medical
schools
have
a
history
of
segregation,
and
the
acceptance
of
blacks
in
these
institutions
has
been
slow.
Consequently,
poten-
tial
black
health-care
providers
have
been
segregated
in
overcrowded
black
teaching
institutions.6
The
affirma-
tive
action
programs
that
began
in
the
1960s
in
medical
schools
and
continued
into
the
early
1970s
increased
the
proportion
of
minorities
entering
these
schools.
However,
since
1974,
when
affirmative
action
pro-
grams
declined,
there
has
been
a
continual
drop
in
the
number
of
minority
students
entering
medical
school.
In
addition,
financial
aid
has
declined
while
medical
school
tuition
has
increased.
Because
minorities
are
generally
less
able
to
fund
their
education,
they
are
more
affected
than
other
groups.2
PREVALENCE
OF
AIDS
More
than
152
000
cases
of
AIDS
have
been
reported
in
the
United
States,9
and
it
is
estimated
that
between
1
and
1.5
million
Americans
are
infected
with
the
HIV
virus.10
Most
of
the
AIDS
cases
are
among
white
homosexual
men
(Table
1).
However,
among
hetero-
sexual
men,
70%
of
the
AIDS
victims
are
black
and
Hispanic;
70%
of
the
cases
among
females
and
75%
of
the
cases
in
children
also
are
in
these
two
ethnic
groups."I
It
is
believed
that
1%
to
1.4%
of
the
black
population
is
infected
with
the
AIDS
virus
compared
with
.3%
to
.5%
of
whites.12
It
also
was
estimated
that
by
1991,
67
500
blacks
will
have
had
AIDS
with
45
000
deaths
occurring.
13
Although
blacks
and
Hispanics
120
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AIDS
&
RACISM
comprise
only
12%
and
6%
of
the
US
population,
respectively,
US
AIDS
patients
are
disproportionately
black
(26%)
and
Hispanic
(13%).14
Such
racial
disparities
probably
underestimate
the
true
devastation
of
AIDS
in
minority
populations.
For
example,
intravenous
(IV)
drug
users
often
die
of
non-AIDS
HIV-related
diseases
prior
to
contracting
specific
opportunistic
infections
that
qualify
as
clinical
AIDS.
Table
2
provides
data
on
narcotic-related
deaths
by
cause
of
death
in
New
York
City.
Non-AIDS
infections
such
as
bacterial
pneumonia,
endocarditis,
and
tuberculosis
may
be
a
byproduct
of
HIV-induced
immunosuppression.3
In
this
city,
the
number
of
deaths
among
IV
drug
users
from
such
HIV-related
diseases
may
be
as
much
as
twice
as
large
as
the
number
of
deaths
among
IV
drug
users
with
diagnosed
AIDS.
The
difference
in
these
deaths
by
race
is
significant
at
the
.001
level.'5
Therefore,
people
who
do
not
satisfy
the
CDC
definition
of
AIDS,
but
who
are
infected
with
HIV
are
another
dimension
of
the
HIV
epidemic.'6
While
the
majority
of
AIDS
cases
in
all
ethnic
groups
are
related
to
infection
through
homosexual
contact,
IV
drug
use
and
heterosexual
contact
are
much
more
commonly
reported
as
transmission
routes
for
Hispan-
ics
and
blacks.'4
Among
the
US
AIDS
cases
associated
with
IV
drug
use
in
heterosexuals,
54%
occurred
among
blacks
and
26%
among
Hispanics.
Large
proportions
of
men,
women,
and
children
with
IV
drug-associated
AIDS
are
found
among
Hispanics
and
blacks."I
Studies
indicate
that
AIDS
will
spread
at
a
much
faster
rate
among
blacks
and
Hispanics
than
among
whites.'7
For
example,
it
was
reported
that
among
IV
drug
users,
Hispanics
and
African
Americans
are
more
likely
to
be
infected
than
whites.3
In
one
study,
it
was
shown
that
42%
of
black
and
Hispanic
IV
drug
users
were
infected
with
the
HIV
virus
compared
with
14%
among
whites.
The
reason
for
this
difference
is
unclear.
However,
economic
and
cultural
factors
certainly
play
a
role.
For
instance,
IV
drug
users
contract
AIDS
by
sharing
needles.
It
is
possible
that
sterile
needles
are
more
available
to
whites,
and
whites
may
be
more
able
to
afford
them.
This
pattern
is
indicated
because
18%
of
white
IV
drug
users
reported
using
new
needles
at
least
half
the
time
while
only
8%
of
blacks
or
Hispanics
reported
this.
In
this
same
study,
Hispanic
and
black
IV
drug
users
reported
substantially
fewer
years
of
education
and
were
more
likely
than
white
patients
to
receive
public
assistance.
Hispanics
and
blacks
may
be
less
aware
of
the
connection
between
infection
and
used
needlesl7
or
they
may
not
have
access
to
or
be
able
to
afford
new
needles.
TABLE
2.
PERCENT
OF
NARCOTIC-RELATED
DEATHS
BY
CAUSE
OF
DEATH
IN
NEW
YORK*
Cause
Black
Hispanic
White
Other
Pneumonia,
65
19
10
7
endocarditis,
tuberculosis
AIDS
45
34
13
8
Othert
56
21
18
5
Total
54
24
15
6
*Adapted
from
Friedman
et
al.34
tOther
causes
of
death
include
overdoses,
liver
disease,
cardiovascular
problems,
sepsis,
mycoses,
gastrointestinal
disease,
other
respiratory
problems,
neoplasms,
chronic
renal
failure,
intracerebral
hemor-
rhage,
other
central
nervous
system
problems,
inju-
ries,
other
genitourinary
problems,
and
meningitis.
White
male
homosexuals
with
AIDS
tend
to
have
a
higher
socioeconomic
status
than
the
general
popula-
tion.
They
are
also
more
likely
to
have
health
insurance.
In
contrast,
the
black
or
Hispanic
IV
drug
user
is
more
likely
to
be
unemployed
and
without
health
insurance.
For
instance,
among
cocaine
addicts
admitted
to
Wayne
County
hospitals,
mainly
blacks,
77%
were
unem-
ployed.
Intravenous
drug
users
with
AIDS
also
are
more
expensive
to
care
for
because
they
seek
care
late
in
the
disease
progression,
have
more
infections,
and
have
a
poorer
prognosis.'2
As
a
result,
minority
drug
users
do
not
receive
the
same
health
care
as
their
white
counterparts.
SPENDING
ON
AIDS-RELATED
BEHAVIOR
Although
we
know
how
AIDS
is
transmitted
and
what
behavior
changes
are
needed
to
decrease
its
transmission,
between
1982
and
1988,
the
US
govern-
ment
spent
only
$1.1 billion
on
preventive
education
and
almost
nothing
on
research
examining
what
causes
people
to
alter
their
behavior.'8
Winkenwerder
and
associates59
reported
expenditure
data
for
AIDS
col-
lected
from
federal
agencies
between
1982
and
1989.
A
total
of
$5.5
billion
was
spent
on
HIV-related
illness
by
the
federal
government
during
this
period.
Twenty
percent
of
federal
spending
for
AIDS
was
allocated
for
education
and
prevention
and
only
6%
of
that
money
was
for
cash
assistance.
Winkenwerder
and
colleagues
estimate
that
spending
for
AIDS
will
increase
to
$4.3
billion
in
1992.
However,
this
is
only
1.8%
of
the
$238
billion
in
total
federal
health
spending
projected
for
this
year.
While
spending
for
HIV
is
comparable
to
other
major
diseases,
it
pales
in
comparison
with
the
estimated
$200
billion
needed
to
aid
the
thrift
industry
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121
AIDS
&
RACISM
or
the
$128
billion
needed
to
clean
up
nuclear
arms
plants.
18,19
Acquired
immunodeficiency
syndrome
is
prevalent
in
minority
IV
drug-using
communities;
however,
funds
and
facilities
for
their
treatment
are
in
short
supply.20
For
example,
New
York
City
has
an
estimated
200
000
IV
drug
users
with
an
HIV-positive
seropre-
valence
rate
of
40%
to
70%,
but
the
city
has
facilities
to
treat
fewer
than
38
000
of
them.21
In
1989,
the
Alcohol,
Drug
Abuse,
and
Mental
Health
administration
spent
11%
of
their
cumulative
AIDS
appropriations
from
the
Public
Health
Service
($352
million)
on
AIDS-related
research,
HIV-related
information,
and
treatment
of
IV
drug
users
and
their
sexual
partners,
and
training
for
drug
abuse
counselors
and
health-care
workers
in
the
psychological
aspects
of
AIDS.
This
is
a small
expenditure
for
drug
abuse
within
the
Health
and
Human
Services
Department.
Consider-
ing
the
clear
link
between
IV
drug
use
and
HIV
transmission,
it
is
notable
that
a
small
amount
has
been
allocated
to
drug
abuse
treatment
and
prevention.'9
AIDS
EDUCATION
Acquired
immunodeficiency
syndrome
education
en-
deavors
were
initially
aimed
at
white
homosexual
males.
Consequently,
these
messages
were
not
sensitive
to
the
culture
of
ethnic
minorities
and
did
not
reach
the
black
and
Hispanic
communities.22
For
instance,
a
potent
barrier
to
AIDS
education
among
minority
women
is
the
middle-class
bias
in
how
prevention
messages
are
structured.
Mays
and
Cochran23
claim
that
the
message
of
monogamy
in
the
context
of
unstable
relationships
and
significant
numbers
of
unmarried
minority
females
(Latino
47%
and
black
65%)
is
not
a
realistic
goal
and
is
an
insensitive
message
to
this
population.24
Cultural
differences
of
minority
groups
often
are
considered
barriers
to
AIDS
education.24
For
example,
among
Latinos,
beliefs
and
values
make
discussion
of
some
sexual
matters
taboo.
Alleged
traditional
roles
like
marianisma
(the
obedient
and
submissive
Latino
martyr)
preclude
Latino
women
from
suggesting
that
their
male
partners
use
condoms.25
Moreover,
the
use
of
condoms
is
considered
unmacho
by
some
Hispanic
and
black
men.22
However,
ways
can
be
devised
to
present
AIDS
intervention
messages
that
are
culturally
appro-
priate.
Unfortunately,
such
considerations
occurred
late
in
the
AIDS
pandemic.
Recognition
of
the
diversity
within
ethnic
minority
groups
is
needed
to
develop
successful
educational
programs.
For
instance,
nuances
within
the
language
(eg,
Spanish)
must
be
understood
and
used
properly
in
educational
campaigns.
The
standard
message
for
whites
cannot
simply
be
translated
into
Spanish
without
consideration
of
cultural
appropriateness
for
this
group.
For
blacks,
standard
English
as
well
as
"Black
American
English"
must
be
used
in
printed
and
video
material.22'26
In
the
past,
AIDS
education
messages
were
not
sensitive
to
ethnic
diversity
although
a
disproportionate
number
of
AIDS
victims
are
Hispanic
and
black.
There
was
a
push
to
educate
white
male
homosexuals
but
not
minority
heterosexual
drug
users.
The
disdain
for
drug
users
and
for
the
racial
group
visibly
using
illicit
drugs
resulted
in
misinformation
or
no
information
or
education
for
this
group.
As
a
result,
the
paucity
of
HIV-related
education
among
minority
drug
users
early
in
the
AIDS
epidemic
continues
to
have
devastating
consequences.
SOCIAL
ASPECTS
OF
AIDS
Cancela24
argues
that
to
understand
the
types
of
minority
AIDS
intervention
programs
needed,
the
specific
sociopolitical
circumstances
of
minority
com-
munities
in
the
United
States
must
be
understood.
For
instance,
Latinos
and
blacks
are
overrepresented
among
the
unemployed
or
underemployed,
the
uneducated
or
miseducated,
the
incarcerated,
and
the
medically
un-
derserved.24
When
the
percentage
of
black
prisoners
is
compared
to
the
percentage
of
blacks
in
the
general
population,
blacks
are
disproportionately
represented
in
the
prison
population.
In
prison,
IV
drug
use
and
homosexual
acts
also
make
blacks
potentially over-
represented
in
regard
to
HIV
infection.27
There
also
is
a
long
history
in
the
United
States
of
minorities
being
devalued
and
of
having
their
illnesses
labeled
deviant.
Cancela24
states
that
"stigmatized
minorities
are
hence
further
socially
ostracized
and
marginalized
by
AIDS
when
it
is
viewed
as
yet
another
reason
to
dissociate
from
those
people."24
A
prime
example
is
the
experience
of
the
Haitian
community.
Because
they
were
at
one
time
considered
a
risk
group,
Haitians
lost
their
jobs
simply
because
they
were
Haitian.28
They
experienced
racial
discrimination
be-
cause
of
the
racism
within
American
society
and
because
of
their
minority
status
within
the
larger
black
population.29
Drug
abuse
is
endemic
in
poor,
inner-city
residents.
In
general,
people
have
a
negative
attitude
toward
IV
drug
users.
Intravenous
drug
users
are
almost
univer-
sally
despised
by
the
medical,
legal,
and
social
establishment.20
Honey
stated
that
"they
are
often
seen
as
the
least
tolerated
group
of
people
due
to
both
their
122
JOURNAL
OF
THE
NATIONAL
MEDICAL
ASSOCIATION,
VOL.
84,
NO.
2
AIDS
&
RACISM
risk
behavior
and
their
ethnicity
if
they
are
members
of
an
ethnic
minority
group.
For
this
reason,
little
professional
support
and
few
community
resources
exist
for
this
population."20
Also,
infected
IV
drug
users,
of
which
minorities
comprise
a
large
proportion,
are
viewed
as
having
caused
their
own
victimization
of
the
disease.
Both
IV
drug
use
and
sudden
infant
death
syndrome
were
considered
minority
health
problems
until
these
factors
emerged
among
white
gay
males
and
white
youth.
It
was
only
when
heterosexual
transmission
among
whites
became
a
threat
that
IV
drug
use
and
AIDS
were
closely
examined.
This
contributes
to
and
strengthens
the
view
that
minorities
are
traditionally
discriminated
against
in
the
United
States.24
Pares-Avila30
suggested
that
other
socioeconomic
considerations
relating
to
AIDS
may
catalyze
the
development
of
immune
deficiency
among
those
exposed
to
the
HIV
virus.
For
instance,
the
constant
struggle
against
racism,
poverty,
and
similar
stresses
may
weaken
the
immune
system
and
increase
vulnera-
bility
to
the
disease
upon
exposure
to
the
HIV
virus.
He
argues
that
certain
behaviors
that
can
compromise
the
immune
system
may
be
in
response
to stresses
in
the
workplace,
the
social
environment,
or
a
way
of
dealing
with
conflict.24'31
In
response
to
stresses,
individuals
may
drink
excessively,
use
drugs,
smoke,
and
engage
in
risky
sexual
behavior.24
Living
with
limited
options
and
uncertainty
may
provide
an
impetus
for
ego-exalting
substance
use.24'32
Problems
such
as
citizenship
status,
poverty,
or
lack
of
health
resources
may
create
a
fatalistic
attitude
of
"if
one
thing
doesn't
get
me
another
will."24
From
this
perspective,
there
is
no
need
to
worry
about
one's
health.
Such
social
variables
may
be
precursors
for
HIV
infection.
It
has
been
argued
that
inequalities
in
employment,
education,
and
other
institutions
deprive
minorities
of
the
knowledge
and
resources
needed
to
protect
them-
selves
from
AIDS.33
This
is
supported
by
the
fact
that
whites
have
lower
drug-related
HIV
infection
frequen-
cies
than
Hispanics
and
blacks33
and
that
whites
use
shooting
galleries
a
smaller
percentage
of
time
than
Latinos.3
Friedman
et
a134
reported
that
in
a
1986
methadone
treatment
sample,
whites
were
more
likely
to
know
that
bleach,
hydrogen
peroxide,
alcohol,
or
boiling
water
can
kill
the
AIDS
virus.
These
findings
suggest
that
white
IV
drug
users
may
have
more
contact
with
formal
channels
of
information
dissemination
than
minority
IV
drug
users.
It
is
important
to
note
that
aspects
of
society
lead
to
the
disproportionate
use
of
drugs
among
minorities.3
Malnutrition,
inadequate
health,
inadequate
education,
and
poverty
form
the
backdrop
for
the
AIDS
epidemic
in
Africa
and
are
reproduced
in
pockets
of
poverty
in
US
urban
centers.35
Gay
black
men
fall
into
multiple
risk
factor
catego-
ries.
They
did
not
share
in
the
wealth
of
information
that
influenced
change
in
the
gay
white
community.
Gay
black
men
do
not
benefit
from
support
systems
that
are
already
established
for,
and
often
by,
white
gay
males.
Because
minorities
were
not
included
at
the
outset
of
the
assessment
of
groups
at
risk
for
AIDS,
they
have
not
been
among
the
initial
recipients
of
the
enormous
information
and
education
available.
For
instance,
among
those
receiving
excellent
hospital,
hospice,
grief,
and
bereavement
services,
minorities
with
AIDS
have
been
few
and
for
the
most
part
invisible.35
When
a
Hispanic
or
black
has
AIDS,
culturally
sensitive
medical
treatment
or
support
networks
are
difficult
to
find.
For
instance,
English
is
usually
used
to
inform
Spanish-speaking
patients
that
they
have
AIDS.
Without
understanding
their
own
affliction,
these
individuals
do
not
pursue
proper
medical
treatment,
let
alone
deal
with
the
anger
and
depression
associated
with
having
a
terminal
illness.
Minorities
often
die
in
confusion
without
understanding
their
affliction.35
The
following
is
an
example
of
this
powerlessness.
Bud,
a
27-year-old
black
man
with
a
5-year
drug
habit,
was
losing
weight
for
months
and
suffering
unex-
plained
fevers
and
rashes.
His
poverty,
coupled
with
a
feeling
that
white
doctors
treated
him
with
condescen-
sion,
made
him
postpone
seeking
help.
He
finally
went
to
the
emergency
room
of
the
county
hospital
when
an
AIDS-related
lesion
had
closed
his
rectum
and
made
it
impossible
for
him
to
defecate.
Although
the
doctor
attending
Bud
immediately
diagnosed
him
as
having
AIDS,
he
gave
Bud
no
explanation.
Bud
sought
help
from
an
AIDS
support
agency
and
was
accepted
into
one
of
the
organization's
shelter
programs.
However,
the
stress
of
being
the
only
nongay
man
in
the
organization's
care
tended
to
make
Bud
hostile.
To
protect
the
other
people
in
the
shelter
home,
the
organization
forced
Bud
to
leave.
Bud
moved
into
a
rundown
hotel
in
the
Tenderloin
District
of
San
Francisco.
He
died
alone
in
his
room
3
weeks
later.35
CONCLUSIONS
Institutionalized
racism
impacts
general
health-care
and
AIDS
health-care
delivery
in
minority
communi-
ties.
The
slow
national
response
to
the
AIDS
epidemic
in
minority
communities
illuminates
this
racism.
The
lateness
in
developing
culturally
sensitive
AIDS
mes-
sages
also
shows
the
lack
of
national
interest
and
concern
for
the
health
of
minorities.
Such
racism
also
has
been
shown
by
the
paucity
of
minorities
in
clinical
JOURNAL
OF
THE
NATIONAL
MEDICAL
ASSOCIATION,
VOL.
84,
NO.
2
123
AIDS
&
RACISM
trials
of
AIDS
drug
treatment
and
inclusion
of
minorities
in
research
sampling
designs.
While
these
situations
have
recently
changed,
it
is
noteworthy
that
such
change
comes
late
in
the
AIDS
pandemic.
To
circumvent
a
second
epidemic
among
minorities,
broad-based
community
prevention
programs
are
needed
that
are
sensitive
to
the
culture
of
minority
groups.35
If
AIDS
is
identified
as
a
disease
of
minorities,
and
if
the
media
further
identifies
AIDS
among
minorities
as
mainly
due
to
drug
use,
such
coverage
could
heighten
already
existing
racism.
The
hesitancy
in
coming
to
grips
with
issues
such
as
homosexuality
and
drug
use
among
minorities
and
the
slowness
of
national
mobilization
around
reducing
HIV
transmission
may
make
it
difficult
for
Hispanics
and
blacks
to
respond
effectively
if
such
a
racist
response
occurs.3
To
curtail
the
spread
of
AIDS
in
minority
communities,
there
must
be
increased
national
concern
and
involvement.
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