Enlighten Plan Program

Literature Review
Laquelia Maye-Lewis
HLTH 634
Professor: Z Inniss-Richter

Literature Review
HIV/ AIDS continues to be an epidemic in the United States, affecting some
populations more than others. Although, HIV is a preventable disease it continues to cause havoc
among the United States due to a lack of knowledge and misconceptions. This literature review
will highlight how HIV/AIDS continues to be a major health disparity. According to the CDC,
1,218,400 citizens in the US age 13 years and over are infected with HIV, including 156,300
(12.8%) individuals who are unaware of their HIV status1. Although the number of people living
with HIV has increased, the number of new HIV infections has remained relatively stable. One
major issue in the fight against HIV/AIDS is that the percentages of infected African Americans
have increased but has decreased among White Americans1. Currently, there is an estimated
50,000 new HIV infections per year1. Men who have sex with men (MSM) are the group most
affected by HIV and African Americans is the race most affected by this dreadful disease
followed by Hispanics1.
African Americans and Hispanics make up 57% of more than 700,000 case of AIDS in the US.
African Americans comprise 38% of all AIDS cases even though they comprise 12% of the US
population2. Hispanics comprise 195 of all AIDS cases even though they only make up 13% of
the US population2. These numbers show that there is a gross disproportionate impact of the
epidemic upon the poor, the disenfranchised, and racial ethnic, and sexual minorities2.

1 Centers for Disease Control and Prevention. HIV in the US at a glance.

http://www.cdc.gov/hiv/statistics/basics/ataglance.html Last update: July 1, 2015.
Accessed: September 13, 2015.
2 Medline Plus. HIV/AIDS: an unequal burden. National Institute of Health.
2009;4():pgs14-16.
https://www.nlm.nih.gov/medlineplus/magazine/issues/summer09/articles/summer0
9pg14-15.html Published: Summer 2009. Accessed: September 13, 2015.

The HIV epidemic in the inner cities in the US has become comparable to that of third world
nations2. Adding to the problem of tackling the HIV epidemic is obesity, diabetes, and cultural
and economic hardships. Minorities are less likely to be in the care of a physician and on
HAART medication than others with HIV/AIDS. These disparities yield in poorer outcomes for
minorities especially blacks with HIV/AIDS2.
Gay, bisexual, and other men who have sex with men of all races and ethnicities
continues to be the population most affected by HIV1. In 2010, the estimated number of new HIV
infections among MSM was 29,800, a major 12% increase from the 26,700 new infections
among MSM in 20081. MSM only represent about 4% of the male population in the US, in 2010
but accounted for approximately 78% of new HIV infections among males and 63% of all new
infections1. HIV infection was highest among the MSM population ages 13-24. Adolescent black
MSM accounted for 45% of new HIV infections among black MSM overall1. Since the
beginning of the HIV/AIDS epidemic approximately 311,087 MSM with an AIDS diagnoses
have died, including an estimated 5,380 in 20121. It is believed that men who have sex with men
and women (msmw), put females at an increased risk for HIV, often without disclosing their
sexual orientation, preventing females from recognizing their partners HIV risk3.
Research has found that black MSM are no more likely to engage in HIV risk behaviors, than
non- black MSM. HIV risk behaviors do not account for the disproportionate number of HIV
infections in this group4. Research suggest that the structural factors that exist contribute to the
ongoing high HIV infection rates among black MSM. One issue is that black MSM, including
black men who have sex with men and women (MSMW) have double minority status because of
3 Parsons J, Halkitis P, Wolitski R, and Gomez C. Correlates of sexual risk behaviors
among HIV positive men who have sex with men. AIDS Education and Prevention.
2003;15(5):PGS383-400. Doi: 10.1521/aesp.15.6.383.24043.

their race and sexuality4. Minority stress may be a likely factor for black MSM that also
contributes to ongoing increases in HIV infections. According to Meyer et. al., the theory of
minority stress holds that stigma, prejudice, and discrimination based partially within frames of
racism and heterosexism, makes a hostile and stressful environment that contributes to
psychological problems and it increases sexual risk among ethnic minorities who are also sexual
minorities4.
The Hispanic population has some serious challenges in the HIV/AIDS epidemic. Hispanics with
HIV often receive a delayed diagnoses and are more present with AIDS, and concomitant
opportunistic infections5. Characteristics that define the HIV epidemic in Hispanics need further
research in order to identify new opportunities to increase linkage to health care, increase
efficacy in health care provision, and reduce social disparities that are linked to the Hispanic
population5. It is estimated that out of 100,000 people with new HIV infection 40 were Hispanic
verses 16 for White men and 12 for Hispanic women verses 2.6 for White women. Also, 1 in 36
Hispanic men and 1 in 106 Hispanic women will be diagnosed with HIV at some point in their
lifetime, as compared with 1 in 106 White men and 1 in 526 White women5.
Another group negatively affected by HIV are women. Clinical issues affecting women with
HIV/ AIDS differ slightly form those affecting men6. The disparities of HIV among women also
4 Dyer T, Regan R, Wilton L, et. al., Differences in substance use, psychological
characteristics and HIV related sexual risk behavior between black men who have
sex with men only (BMSMO) and black men who have sex with men and women
(BMSMW) in US cities. 2013;90(6) pgs:1181-1182. Doi: 10.1007/s11524-013098-111
5 Henao-Martinez and Castillo-Mancilla J. The Hispanic HIV epidemic. Curr Infect Dis
Rep. 2012;15(1) pgs: 46-51. Doi: 10.1007/s11908-012-0306-0.
6 Stone V. HIV/AIDS in women and racial/ ethnic minorities in the US. Current
Infectious Disease Reports. 2012:14(1):PGS53-60. Doi: 10.1007/s11908-01-022604

reflect racial/ ethnic difference in treatment and outcome, since approximately 80% of women
with HIV/ AIDS are black or Hispanic3. Women with HIV faces serious threats because of
perinatal transmission. The proportion of women with HIV has risen from 8% of all new
infections in 1985 to 27% in 2000, and now the rate have leveled off to 25% of new infections
being among women in 20093. In 2009, the AIDS rate among black women and Latinas were 23
and 5 times the rate among white women3.
Another challenge in the fight against the HIV/AIDS epidemic is obesity. Populations most
affected by HIV are also more likely to have a high prevalence of obesity7. HIV providers,
traditionally focused on preventing HIV-related wasting, weight-loss, and lipodystrophy. Thanks
to the development of highly active antiretroviral therapy, HIV specific morbidity and mortality
have depleted while conditions such as cardiovascular disease has become a health threat for
individuals with HIV4. Providers are going to have to shift some of their focus to preventing
obesity and related conditions such as diabetes, and heart disease. The occurrence of obesity in
HIV positive individuals range from 17% to 32%4.
A threat to the fight against minorities in the HIV/AIDS epidemic is that minorities are
underrepresented limits the understanding of how applicable outcomes are to the general
population and reduces the potential benefits of clinical research to all groups in society8. The
reason that minorities are underrepresented are varied and difficult; some of them are common to
all minority groups (ex. Little information and access to clinical trials, providers bias on
7 Taylor B, Liang Y, Sergio L, et al. High risk of obesity and weight gain for HIVinfected uninsured minorities. J Acquir Immune Defic Syndrome. 2014:65(1):pgs 33e40. Doi: 10.1097/QAI.00000000000000010.
8 Castillo-Mancilla J, Cohns S, Krishrans, et. al. Minorities remain underrepresented
in HIV/ AIDS research despite access to clinical trials. HIV clinical trials.
2014:15(1):PGS14-26 Doi: http://dx.doi.org/10/1310/hct1501-14

adequacy of trial enrollment, conflicting family and financial priorities, lack of education, lack of
health insurance, and family and community negative opinions about research5. In a study
conducted by Castillo-Mancilla et. al. it was found that minorities were underrepresented at all
levels of the research participation continuum: knowledge of trials, plans to participate, being
approached by research team, effort to enroll, and successful enrollment5.
Another challenge hindering the progress in the epidemic against HIV/ AIDS is the gender and
ethnicity differences in HIV related stigma9. In a study conducted by Loufty et. al., 1026 HIV
positive individuals living in Ontario, Canada it was found that HIV related stigma may worsen
certain preexisting social inequalities based on race and gender6. The study also found that HIV
positive women were viewed as dirty, diseased, and underserving and may be blamed and
shamed for HIV infection due to assumptions of them being promiscuous6. Gender norms that
stereotypes women as caregivers can increase stigma directed toward HIV positive women who
may be viewed as diseased and therefore a loser in personal and social roles6. The division of
gender, race, and class oppression are important pieces to understanding contexts of womens
HIV risk and experiences of stigma6.
Prior studies have indicated that HIV related stigma is correlated with mental, psychological, and
emotional health outcomes6. Stigma surrounding HIV may compromise treatment, care, and
support. Individuals who reveal their HIV status to their family and friends have faced isolation
and neglect6. Fear of disclosing statuses when purchasing and taking antiretroviral medications
may negatively impact medication adherence6.

9 Loufty M, Logie C, Zhang Y, et. al. Gender and ethnicity differences in HIV related
stigma experienced by people living with HIV in Ontario, Canada. PLOS One. 2012.
Doi: 10.1371/journal.pone.0048168

To combat the epidemic of HIV better communication strategies within racial and
minority ethnic groups about HIV vaccines needs to be implemented10. HIV advocates should be
trained to disseminate information to others in their communities to raise awareness of
prevention strategies7. According to Hall et. al, the CDC recommends persons at risk for HIV
infection to get tested annually for HIV infection to access care early and to change their
behaviors to prevent the spread of disease11. It should be noted the HIV testing among high
school students is relatively low and only about 11% of males and 15% of females who have
ever had sexual intercourse have been tested for HIV10.
From the review of current literature, there is a great need for Enlighten Plan Program to help
disseminate the stigma, myths, and discrimination that plague minorities in the fight against the
HIV/AIDS epidemic. Much attention needs to be given to minorities in terms of education, to
combat this dreadful disease that has destroyed the lives of so many.

10 Kelly R, Hannana A, Kreps G, et al. The community liaison program: a health

education pilot program to increase awareness of HIV and acceptance of HIV
vaccine trials. Oxford Journals. 2011. Doi: 10.1093/her/cys013
11 Hall I, Walker F, Daxa S, and Belle E. Trends in HIV diagnoses and early detection
among US adolescents and young adults. AIDS Behav. April 12, 2011. Doi:
10.1007/s10461-011-9944-8

References:

Centers for Disease Control and Prevention. HIV in the US at a glance.

http://www.cdc.gov/hiv/statistics/basics/ataglance.html Last update: July 1, 2015. Accessed:
September 13, 2015.
Medline Plus. HIV/AIDS: an unequal burden. National Institute of Health. 2009;4():pgs14-16.
https://www.nlm.nih.gov/medlineplus/magazine/issues/summer09/articles/summer09pg1415.html Published: Summer 2009. Accessed: September 13, 2015.
Parsons J, Halkitis P, Wolitski R, and Gomez C. Correlates of sexual risk behaviors among HIV
positive men who have sex with men. AIDS Education and Prevention. 2003;15(5):PGS383-400.
Doi: 10.1521/aesp.15.6.383.24043.
Dyer T, Regan R, Wilton L, et. al., Differences in substance use, psychological characteristics
and HIV related sexual risk behavior between black men who have sex with men only
(BMSMO) and black men who have sex with men and women (BMSMW) in US cities.
2013;90(6) pgs:1181-1182. Doi: 10.1007/s11524-013098-11-1
Henao-Martinez and Castillo-Mancilla J. The Hispanic HIV epidemic. Curr Infect Dis Rep.
2012;15(1) pgs: 46-51. Doi: 10.1007/s11908-012-0306-0.
Stone V. HIV/AIDS in women and racial/ ethnic minorities in the US. Current Infectious Disease
Reports. 2012:14(1):PGS53-60. Doi: 10.1007/s11908-01-022604
Taylor B, Liang Y, Sergio L, et al. High risk of obesity and weight gain for HIV-infected
uninsured minorities. J Acquir Immune Defic Syndrome. 2014:65(1):pgs 33-e40. Doi:
10.1097/QAI.00000000000000010.
Castillo-Mancilla J, Cohns S, Krishrans, et. al. Minorities remain underrepresented in HIV/
AIDS research despite access to clinical trials. HIV clinical trials. 2014:15(1):PGS14-26 Doi:
http://dx.doi.org/10/1310/hct1501-14

Loufty M, Logie C, Zhang Y, et. al. Gender and ethnicity differences in HIV related stigma
experienced by people living with HIV in Ontario, Canada. PLOS One. 2012. Doi:
10.1371/journal.pone.0048168
Kelly R, Hannana A, Kreps G, et al. The community liaison program: a health education pilot
program to increase awareness of HIV and acceptance of HIV vaccine trials. Oxford Journals.
2011. Doi: 10.1093/her/cys013
Hall I, Walker F, Daxa S, and Belle E. Trends in HIV diagnoses and early detection among US
adolescents and young adults. AIDS Behav. April 12, 2011. Doi: 10.1007/s10461-011-9944-8