A Look at Health Disparities

I recently met with a professor of nursing at UAB, and what she said shocked me. She said that since she is African-American, and I am Caucasian, then the chances of her contracting HIV/AIDS is astronomically higher than the chance of it affecting me. (To be clear, her area of research involves health disparities and other factors that affect people with HIV/AIDS.) Even though I knew about health disparities, I didn't realize it was so prevalent with this disease. HIV is a virus that can affect anyone. If given the opportunity, it would not discriminate against its victims. Even still, there are obvious disparities that cannot be ignored.

One study I read cites that between 2001 and 2004, the rate of HIV/AIDS diagnoses among African American women was 20.9 times higher than that for Caucasian women. They are also at a significantly higher risk for STI's, including high-risk strains of HPV. While cervical cancer incidence and mortality has fallen in the US in recent years, there is still a disparity among African American women (Andrasik, Rose, Pereira, & Antoni, 2008).

A study done in Thailand determined that of several variables including nadir CD4 count, income, hormonal contraceptive use, antiretroviral use, condom use, parity, and number of lifetime sexual partners, a low CD4 count and income were the only two variables significantly associated with cytological abnormalities in the sample the studied (Mangclaviraj, et al. 2008).

While these studies can't be directly generalized to the population of patients at the 1917 Clinic, they can still provide insight into the severity of these health disparities. Living with HIV/AIDS is enough for any woman to face. The color of her skin should not be another thing she has to worry about in relation to her prognosis.

So what can we do? Obviously, this is a societal problem that will be difficult (though possible) to change. For the individual, perhaps recognizing the risks is the first step. After that, it is up to the health care providers and their patients to be proactive in addressing the risks African American women face. By no means should we assume that African American women will automatically have a poorer outcome. However, we can't deny that these women are being done a disservice based on the statistics. It is that knowledge, combined with quality care given on a patient-by-patient basis, that will enable the provider and the patient to reach the best treatment plan possible.

References:

Andrasik, M., Rose, R., Pereira, D., & Antoni, M. (2008). Barriers to cervical cancer screening among low-income HIV-positive African American Women. Journal of Health Care for the Poor and Underserved, 19(3), 912-925.

Mangclaviraj, S., Kerr, S., Chaithongwongwatthana, S., Ananworanich, J., Hirschel, B., Emery, S., Cooper, D., Chotopparatpattara, P., Ruxrungtham, K. (2008). Nadir CD4 count and monthly income predict cervical squamous cell abnormalities in HIV-positive women in a resource-limited setting. International Journal of STD and AIDS, 19, 529-532. doi: 10.1258/ijsa.2007.007222.