The Fourth Annual Stand Against Racism takes place today, April 29. The YWCA-sponsored event will see more than 250,000 individuals and organizations take a Stand Against Racism by raising awareness of racism and suggesting ways to eliminate it. AIDS Action Committee is participating in Stand Against Racism today as part of our mission to attack the root causes of HIV/AIDS.
The existence of racial and ethnic health care disparities has long been recognized. They were most notably documented in a comprehensive 2002 report from the Institute of Medicine that cites local, state, and federal researchers and commissions, titled Unequal Treatment: Confronting Health Care Disparities .
No one should be surprised that these disparities have been persistent in the transmission and treatment of HIV and AIDS. In our work, we see disparities in higher community HIV viral loads, later diagnosis of HIV and AIDS, and less effective treatment for HIV and AIDS as experienced by people of color versus their white counterparts.
A 2007 report from the Massachusetts Department of Public Health observed: “While medical services are well utilized across race/ethnicity among persons living with HIV/AIDS, lower utilization of preventive and testing services is evident, particularly among African American and other black individuals. Non-white individuals are also greatly under-represented in needle/syringe exchange programs. Stigma surrounding HAIV/AIDS and the behaviors that transmit HIV, lack of knowledge about HIV and HIV risk, the relative lack of culturally and linguistically appropriate services, the under-representation of members of communities of color in HIV/AIDS services, and the compounding effects of the mistrust of the medical and public health system, multiple health issues, economic stressors and societal racism and discrimination are factors in these patterns of low utilization of HIV/AIDS services.”
But what the figures fail to reveal is why the disparities exists.
Is it racism? And, if so, what can we do about it?
First we need to ask what racism looks like in health care settings.
It starts with the color of the caregiver. The 2007 DPH report sums it up nicely: “Despite the location of HIV/AIDS services in communities of color statewide (and great effort to staff these programs with members of their priority populations) these services continue to be delivered largely by white individuals located in large institutions that may be intimidating to certain members of these communities.”
And it continues with how people feel that they are being treated. One Consumer Advocacy Board volunteer reports: “When I go to my eye doctor, I am treated differently and worse than the white patients in the clinic. It’s like she doesn’t want to deal with me.”
Physicians were more likely to provide highly active antiretroviral therapy to HIV/AIDS patients when they were perceived as likely to be adherent to treatment. They then examined patient characteristics associated with physician predictions of adherence by randomly assigning physicians to review patient vignettes varying only in terms of the patient’s sex, disease severity, ethnicity, and risk group. Results revealed that, independent of other factors, the patient depicted in the African American vignette was more likely to be rated as nonadherent. Physicians have been found to have a less participatory decisionmaking style and to adopt a more “narrowly biomedical” communication pattern (characterized by low patient control of communication and psychosocial talk and high levels of physician biomedical information provision and closed-ended question asking) with non-White than with White patients patients’ characteristics have been found to be associated with provider communication effectiveness and physician interpersonal behaviors such as nonverbal attention, empathy, courtesy, and information giving.
So what can YOU do about this?
Notice your own assumptions about different groups and how they behave
Notice your relationships with people from other racial and ethnic backgrounds
Notice who decides what or how medical or other care gets provided and to whom
Learn about how the perception of race affects medical care providers’ assumptions and actions. Start by checking out the links in this article.
And, finally, please let us know what you think. How does racism in HIV/AIDS treatment affect you? And what do you think can be done about it?