HIV/AIDS Disparities: The Mounting Epidemic Plaguing US Blacks by ProQuest


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HIV/AIDS Disparities: The Mounting Epidemic
Plaguing US Blacks
Christine U. Oramasionwu, PharmD, MSc, BCPS; Carolyn M. Brown, PhD; Laurajo Ryan, PharmD, MSc,
BCPS, CDE; Kenneth A. Lawson, PhD; Jonathan M. Hunter, MA; Christopher R. Frei, PharmD, MSc, BCPS

                                                                                   munity.1 It is now estimated that 3% of all residents in
  Funding/Support: Funding for this project was provided in                        the District of Colombia are living with HIV/AIDS; the
  part by the National Institutes of Health loan repayment pro-                    highest burden of disease is found among black males,
  gram and a graduate fellowship from The University of Texas                      at a rate of 6.5%.2 Alarmingly, these rates are compa-
  at Austin, both granted to Dr Oramasionwu. This project was                      rable to the HIV/AIDS epidemic plaguing the resource-
  also supported by faculty start-up funds from The University                     limited countries of sub-Saharan Africa.3 Blacks dispro-
  of Texas at Austin, awarded to Dr Frei.                                          portionately experience the brunt of disease, including
  The human immunodeficiency virus (HIV)/AIDS epidemic pres-                       the majority of new HIV diagnoses, disease complica-
  ents a formidable challenge for the black community. Blacks,                     tions, and AIDS-related deaths.1 As recently as Febru-
  although a small proportion of the US population, are over-                      ary 2009, Dr Anthony Fauci, director of the National
  represented, not only in the number of people living with HIV,                   Institute of Allergy and Infectious Diseases, called upon
  but also in the categories of new diagnoses and AIDS-related                     the nation to “unite to address this public health crisis in
  deaths. Fortunately, national initiatives are in place to slow and               the black community…[and to] promote tolerance and
  ultimately reverse these racial inequities. While these disparities              compassion for people infected with HIV and ensure
  may be widely recognized, their causes are not clearly under-                    HIV testing, counseling and treatment for all.”4 The
  stood. A variety of underlying issues exist for blacks in the United             widespread impact of this disease throughout the black
  States that may also contribute to these growing disparities.                    community poses challenges not only for health care
  These include transmission risk factors, socioeconomic factors,                  providers and infected individuals, but also for members
  underrecognition, delayed presentation, and other comor-                         of American society as a whole.
  bid conditions. We present a review of the literature regarding                      The Institute of Medicine defines health disparities
  the potential causes of racial disparities and how they may                      as the “racial or ethnic differences in the quality of
  contribute to health outcomes for blacks with HIV/AIDS in the                    health care that are not due to access-related factors or
  United States. We also identify possible gaps in knowledge and                   clinical needs, preferences, and appropriateness of inter-
  offer future directions for research of HIV/AIDS racial disparities.             ventions.”5 For blacks, these racial inequities expand
                                                                                   beyond the realm of HIV/AIDS to also include higher
  Keywords: African Americans n HIV/AIDS n racial disparities                      rates of colorectal cancer, increased risk of diabetes,
  J Natl Med Assoc. 2009;101:1196-1204
                                                                                   poor nutritional status, and a variety of other chronic
                                                                                   health conditions.6-9 A national response is necessary to
Author Affiliations: The University of Texas at Austin, College of Pharmacy (Drs
                                                                                   find new and plausible solutions that will effectively
Oramasionwu, Brown, Ryan, Lawson, and Frei), Austin, Texas; and The Univer-        lessen these disparities.
sity of Texas Health Science Center at San Antonio, Department of Medicine
(Drs Oramasionwu, Ryan, and Frei; and Mr Hunter), San Antonio, Texas.              National Initiatives for HIV/AIDS
Corresponding Author: Christine U. Oramasionwu, PharmD, MSc, BCPS, The             Ethnic Disparities Research
University of Texas Health Science Center at San Antonio, Pharmacothera-
py Education & Research Center, MSC-6220, 7703 Floyd Curl Dr, San Anto-
                                                                                       National initiatives have been instituted to reduce
nio, TX 78229-3900 (                                     these disparities among ethnic minorities who are at
                                                                                   increased risk for experiencing elevated morbidity and
INTRODUCTION                                                                       mortality rates. Specifically, the National Institutes of
                                                                                   Health (NIH) established the National Center on Minority
HIV/AIDS Health Disparities                                                        Health and Health Disparities (NCMHD) with a mission
Among Blacks in the United States                                                  to “promote minority health … to reduce and ultimately
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