ANAC HIV and Minorities: The Need for Culturally-Sensitive Education and Care

Sande Gracia Jones, ARNP, ACRN, CS, C, MSN, M.Ed, PhD (c), Secretary, Association of Nurses in AIDS Care

This issue of Numedx looks at the problem of HIV and minorities. HIV/AIDS has disproportionately affected minorities in the United States. The figures are disturbing and underscore the need for improved access to health education and care for these groups. However, the development and implementation of programs need to be based on an understanding of the issues involved in minority health care.

South Florida AIDS care nurses have described several issues related to HIV/AIDS and minorities.¹ HIV is still considered a stigma, particularly in the African American, Haitian, and Hispanic populations. Because patients wait until they are very ill before they seek treatment, people in South Florida are still dying from AIDS-related infections. In addition, HIV/AIDS is a problem among illegal aliens because of their concerns regarding deportation, fear of oppression from both the United States government and their native country, and the limited resources available to them.

The need for an increase in HIV-prevention education for minority communities has been discussed. But education by itself is not the answer. Education must be implemented within the context of the minority culture and community. Understanding the culture is crucial to the implementation of effective educational problems, particularly those that focus on sensitive material such as sexual education and HIV/AIDS.

For example, nurse researchers from the University of Miami found differences between Cuban and Haitian immigrant mothers, and potential for family conflict within immigrant groups whose language and cultural beliefs differ from those of the culture they have entered.² Further studies of immigrant Haitian families discovered considerable differences between parents and adolescents with regard to the sources and types of information learned about reproduction and contraception, when such information is learned, and expectations regarding premarital sexual intercourse. Both parents and adolescents lacked accurate biomedical information about contraception, placed responsibility for contraceptive use primarily on the female, considered reproduction to be a natural versus a medical event, and believed parents had the major responsibility for educating children about reproduction and contraception.³

Because the family is considered the proper arena for sexual education, attempts to deliver sexual education programs outside of the home might not be well received within this community. In addition, there is still resentment within the Haitian community for the focus on Haitians and HIV that occurred in the early 1980s. Another problem is fear of oppression by the government and immigration services. A more effective way to openly discuss HIV in this community might be through the use of the Haitian radio stations, which are a significant and respected source of information within the community. Addressing HIV/AIDS as a community issue might take the focus off of the stigma related to individual behaviors, and help the community to address HIV/AIDS in a united community effort.⁴

Innovative methods for delivering HIV education that have been used by Haitian nurses included writing and staging a play, which had both a moral message and a story about HIV infection. The play was produced at a local church. The Haitian audience not only enjoyed the play, but understood the message within the context in which it was delivered. Another effective intervention was the distribution of calendars that combined a monthly religious message with a scene from Haitian life and safer sex messages.⁵ Effective HIV education programs must be created in partnership and collaboration with key information-givers and respected places where people from the minority community gather, either to worship or play. In the African American community, as in the Haitian and Hispanic communities, the church plays a central role in the community. Church-based programs on HIV education, enacted in collaboration and partnership with church leaders, have been effective interventions for minority communities.⁵

The issue of effective care for minority immigrants is also crucial. Throughout the United States, illegal aliens are afraid to seek care because they fear deportation. In addition, even if they do seek care through community and public clinics, they are not eligible for benefits that would help them with food and housing. The position of the Association of Nurses in AIDS Care on HIV and immigration is that national and global health necessitates that all people receive health education for the prevention of HIV infection and treatment of HIV disease, regardless of immigration status.⁶ Nurses have a professional, moral, and ethical obligation to care for the sick, and this obligation does not recognize international and interstate boundaries. All residents of the United States (citizens, permanent residents, nondocumented immigrants, and visitors) should have access to health care, including primary, secondary, tertiary, and emergency care as well as the appropriate support and benefits necessary to regain and maintain health. These entitlement benefits, such as food stamps, financial assistance, and housing assistance, improve the individual's living conditions. This enhances quality of life and overall health, and may help promote a functioning immune system. In addition, all health care should be provided in a culturally and linguistically appropriate manner.

In summary, a key factor in effective HIV prevention education and care is the implementation of culture-specific interventions that address people's needs and concerns within the context of the community. These interventions should be planned and implemented in collaboration and partnership with churches and other community-based organizations that are respected by the minority community. In addition, the need for access to care for all minorities, whether legal or illegal residents, must be addressed, to improve overall HIV healthcare in the United States. Healthcare providers must understand the special needs and concerns of minority groups in order to address the issues of HIV/AIDS within these communities.

Sande Gracia Jones, PhD (c), ARNP, ACRN, C, CS, is an assistant professor at Barry University School of Nursing, Miami, Florida. She has worked as the Clinical Nurse Specialist/Nurse Practitioner for HIV/AIDS and TB at Mount Sinai Medical Center, Miami Beach, Florida. She is currently serving as the National Secretary for the Association of Nurses in AIDS Care (ANAC). Visit ANAC's website at anacnet.org or e-mail them at .

1. Jones S G. Caring for HIV/AIDS in South Florida. Vital Signs. 1999, Vol. 9, No. 22, Pages 67.

2. De Santis L, Ugarriza, DN. Potential for intergenerational conflict in Cuban and Haitian immigrant families. Archives of Psychiatric Nursing. 1995, Vol. 9, No. 6, Pages 354364.

3. De Santis L, Thomas JT. Sinnett K. Intergenerational concepts of adolescent sexuality: Implications for community-based reproductive health care with Haitian immigrants. Public Health Nursing. 1999, Vol. 16, No. 2, Pages 102113.

4. De Santis L. Intergenerational conflict: Perspectives on sexuality from Haitian parents and adolescents. Paper presented at the Center for Nursing Research Seminar, Barry University School of Nursing, Miami, Florida, February 2000.

5. Grossman D, Colin J, Travieso Palow D, Helmes B, Madayag T. Becoming culturally Sensitive. Panel presentation at the 10th Annual Conference of the Association of Nurses in AIDS Care, Miami Beach, Florida, November 1997.

6. Association of Nurses in AIDS Care. Position Statement: Immigration and HIV Disease. 1997.